不同评分系统对消化道和腹壁肿瘤患者ICU病死率评估的比较  

Comparison of different critical illness scores for intensive care unit mortality in patients with gastrointestinal and abdominal tumors

作　　者：宋雪峰[1] 董彪 张强[3] Song Xuefeng;Dong Biao;Zhang Qiang(Department of Gastrointestinal Oncology,Shanxi Province Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital,Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University,Taiyuan 030013,Shanxi,China;Department of Hepatobiliary Surgery,Fourth Hospital of Hebei Medical University(Hebei Province Cancer Hospital),Shijiazhuang 050000,Hebei,China;Department of Critical Care Medicine,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]山西省肿瘤医院,中国医学科学院肿瘤医院山西医院,山西医科大学附属肿瘤医院消化内科,山西太原030013 [2]河北医科大学第四医院(河北省肿瘤医院)肝胆胰外科,河北石家庄050000 [3]北京大学第三医院危重医学科,北京100191

出　　处：《中国中西医结合急救杂志》2024年第2期208-212,共5页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：北京市自然科学基金(M22036)。

摘　　要：目的评价序贯器官衰竭评分(SOFA)、简化急性生理评分Ⅱ(SAPS-Ⅱ)、牛津急性疾病严重程度评分(OASIS)、Logistic器官功能障碍评分(LODS)、急性生理学评分Ⅲ(APS-Ⅲ)和终末期肝病模型(MELD)评分对重症监护病房(ICU)消化道和腹壁肿瘤患者死亡风险的预测效能。方法比较符合入选标准的美国重症监护医学信息数据库Ⅲ(MIMIC-Ⅲ)数据库中消化道和腹壁肿瘤患者存活组和死亡组患者的特征,绘制受试者工作特征曲线(ROC曲线),并通过计算ROC曲线下面积(AUC)评估上述评分系统对消化道和腹壁肿瘤患者ICU病死率的预测效能。绘制Kaplan-Meier生存曲线分析SAPS-Ⅱ≤49分和SAPS-Ⅱ>49分患者,以及APS-Ⅲ≤68分和APS-Ⅲ>68分患者存活率的差异。结果共纳入1400例患者,其中ICU存活1233例,死亡167例。ROC曲线分析显示:SAPS-Ⅱ、APS-Ⅲ、OASIS、SOFA、LODS、MELD评分系统对消化道和腹壁肿瘤患者ICU预后均有预测价值,AUC分别为0.835、0.831、0.816、0.797、0.788、0.729,其中SAPS-Ⅱ评分的AUC最大。Kaplan-Meier生存曲线分析显示:SAPS-Ⅱ≤49分患者的ICU存活率明显高于SAPS-Ⅱ>49分者(Log-Rank检验:χ^(2)=122.87,P=0.001);APS-Ⅲ≤68分患者的ICU存活率明显高于APS-Ⅲ>68分者(Log-Rank检验:χ^(2)=146.37,P=0.001)。对于消化道和腹壁肿瘤合并脓毒症患者,SAPS-Ⅱ评分对患者ICU病死率的预测价值优于其他评分系统。结论SPAS-Ⅱ对消化道和腹壁肿瘤患者ICU病死率的预测效能较高。Objective To evaluate the predictive efficacy of sequential organ failure assessment(SOFA),simplified acute physiological scoreⅡ(SAPS-Ⅱ),Oxford acute severity of illness score(OASIS),Logistic organ dysfunction score(LODS),acute physiology scoreⅢ(APS-Ⅲ),and model for end-stage liver disease(MELD)score in predicting the intensive care unit(ICU)mortality among patients with gastrointestinal and abdominal tumors.Methods Patients that met the inclusion criteria with gastrointestinal and abdominal tumors were included from the American Intensive Care Medical Information DatabaseⅢ(MIMIC-Ⅲ),and characteristics of patients between survival and death groups were compared.The receiver operator characteristic curve(ROC curve)of 6 critical illness scores were plotted,area under the curve(AUC)was used to assess performance in predicting ICU mortality.Kaplan-Meier survival curve was drawn to analyze the difference in the cumulative survival rate between patients with SAPS-Ⅱ≤49 and those with SAPS-Ⅱ>49,and patients with APS-Ⅲ≤68 and APS-Ⅲ>68.Results A total of 1400 patients were enrolled for the final analysis,with 1233 being survivors and 167 deceased.The ROC curve analysis showed:SAPS-Ⅱ,APS-Ⅲ,OASIS,SOFA,LODS,and MELD scoring systems were all predictive values for ICU prognosis in patients with gastrointestinal and abdominal tumors with AUC values of 0.835,0.831,0.816,0.797,0.788,and 0.729,respectively,among which the AUC of SAPS-Ⅱscore was the largest.Kaplan-Meier survival analysis showed that ICU survival rate in patients with SAPS-Ⅱ≤49 score was significantly higher than that in patients with SAPS-Ⅱ>49 score(Log-Rank:χ^(2)=122.87,P=0.001);ICU survival rate in patients with APS-Ⅲ≤68 score was significantly higher than that in patients with APS-Ⅲ>68 score(Log-Rank:χ^(2)=146.37,P=0.001).Subgroup analysis showed that for patients complicating sepsis,the predicting efficancy of the SPAS-Ⅱscore was superior than other scoring systems.Conclusion SPAS-Ⅱhas better predication for ICU mo

关 键 词：消化道和腹壁肿瘤 评分系统 病死率 预后 

分 类 号：R735.5[医药卫生—肿瘤]