ICU简化死亡风险评分对肺部感染相关脓毒症预后的判断价值  

Prognostic value of ICU simplified mortality score for patients with pulmonary infection-related sepsis

作　　者：汪国斌[1] 陈晓燕[1] 汪正光 邢芳芳 WANG Guo-bin;CHEN Xiao-yan;WANG Zheng-guang;XING Fang-fang(Department of Critical Care Medicine,Huangshan Shoukang Hospital,Huangshan,Anhui 245400,China)

机构地区：[1]黄山首康医院重症医学科,安徽黄山245000

出　　处：《临床肺科杂志》2023年第5期671-676,共6页Journal of Clinical Pulmonary Medicine

摘　　要：目的探讨ICU简化死亡风险评分(the Simplified Mortality Score for the Intensive Care Unit,SMS-ICU)对肺部感染相关脓毒症患者预后的预测价值,并与急性生理学与慢性健康状况Ⅱ评分进行比较。方法回顾2019年11月至2022年4月符合肺部感染相关脓毒症诊断标准的患者的临床资料,根据ICU转归将患者分为死亡组和存活组,分别计算两组患者的SMS-ICU评分和APACHEⅡ评分,分析两种评分对肺部感染相关脓毒症患者病情和预后的判断价值。结果共纳入112例患者,男80例(71.43%),女32例(28.57%)。存活组77例(68.75%),死亡组35例(31.25%)。肺部感染相关脓毒症病死率与SMS-ICU评分正相关,r=0.964(P=0.008),与APACHEⅡ评分正相关r=0.978(P=0.001)。APACHEⅡ评分预测死亡风险的ROC曲线下面积为0.623,诊断截点为23.5分,对应的Youden指数、灵敏度和特异度分别是0.226、0.629和0.597。SMS-ICU评分预测死亡风险的ROC曲线下面积为0.774,诊断截点为20.5分,对应的Youden指数、灵敏度和特异度分别是0.337、0.714和0.623。SMS-ICU评分的ROC曲线下面积大于APACHEⅡ评分,差异有统计学意义(Z=2.498,P=0.013)。结论SMS-ICU评分对肺部感染相关脓毒症患者的预后有较好的预测价值,优于APACHEⅡ评分。Objective To explore the predictive value of ICU simplified mortality score(SMS-ICU)in the outcome of patients with pulmonary infection-related sepsis,and to compare its performance with acute physiology and chronic health evaluationⅡ(APACHEⅡ).Methods The clinical data of patients meeting pulmonary infection-related sepsis diagnostic criteria from November 2019 to April 2022 were retrospectively analyzed.According to their prognosis in ICU,the patients were divided into the death group and the survival group.The SMS-ICU score and APACHE II score of the two groups were calculated respectively,and the performance of SMS-ICU was assessed through measurements of discrimination and compared with APACHE II.Results A total of 112 patients were included,including 80 males(71.43%)and 32 females(28.57%).There were 77 cases(68.75%)in the survival group and 35 cases(31.25%)in the death group.The fatality rate of pulmonary infection-associated sepsis was positively correlated with the SMS-ICU score(r=0.964)(P=0.008)and APACHEⅡscore(r=0.978)(P=0.001).The area under the ROC curve of APACHEⅡscore was 0.623,the diagnostic cut-off point was 23.5 points,and the corresponding Youden index,sensitivity,and specificity sum were 0.226,0.629,and 0.597,respectively.The area under the ROC curve of the SMS-ICU score was 0.774,the diagnostic cut-off point was 20.5,and the corresponding Youden index,sensitivity,and specificity sum were 0.337,0.714,and 0.623,respectively.The area under the ROC curve of the SMS-ICU score was larger than that of the APACHEⅡscore,and the difference was statistically significant(Z=2.498,P=0.013).Conclusion SMS-ICU score is better than the APACHEⅡscore in predicting the prognosis of patients with pulmonary infection-related sepsis.

关 键 词：ICU简化死亡风险评分 肺部感染 脓毒症 预后 价值 

分 类 号：R459.7[医药卫生—急诊医学]