比较SOFA、APACHE-Ⅱ和OEWS三种预测评分系统在产科ICU中的应用效果  

Comparison of the application effect of SOFA,APACHE-Ⅱand OEWS in obstetric ICU admissions

作　　者：彭兰[1] 吴晓[1] 王城 PENG Lan;WU Xiao;WANG Cheng(Department of Obstetrics,Suzhou Municipal Hospital·Nanjing Medical University Affiliated Suzhou Hospital Suzhou Jiangsu 215000,China)

机构地区：[1]苏州市立医院·南京医科大学附属苏州医院产科,江苏苏州215000

出　　处：《中国急救复苏与灾害医学杂志》2024年第12期1626-1630,共5页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：苏州市2022年度第二十八批科技发展计划(医疗卫生科技创新)项目(编号:SKY2022056)。

摘　　要：目的比较序贯器官衰竭评分(SOFA)、急性生理学与慢性健康评分Ⅱ(APACHE-Ⅱ)和产科早期预警评分(OEWS)三种预测评分系统在入产科重症监护病房(ICU)孕产妇中对孕产妇严重结局(SMO)的预测能力。方法回顾性研究2015年1月—2018年12月期间入住南京医科大学附属苏州医院产科ICU的孕产妇共363例,采集孕产妇入住ICU 24 h内指标的最终用于计算SOFA、APACHE-Ⅱ和OEWS的评分,评估3种预测评分系统预测发生SMO的准确性、区分度(discrimination)和校准度(calibration)。结果研究期间共有363例孕产妇入住产科ICU,152例发生SMO,其中2例孕产妇死亡,ICU中孕产妇SMO发生率为41.87%,孕产妇病死率为0.55%。在全体入住ICU孕产妇中,SOFA评分预测SMO的区分度(AUC=0.87;95%CI:083~0.91)和准确性(当截断值为2.5时,LR>10)最优,其次是APACHE-Ⅱ评分(AUC=0.804;95%CI:0.757~0.85),OEWS评分最差(AUC=0.701;95%CI:0.646~0.757)。当根据入ICU原因分亚组比较时,三种评分系统表现与在全体人群一致,APACHE-Ⅱ和OEWS在直接产科原因组显著低估了SMO,尤其在产后出血组。结论SOFA可作为首选适用于所有产科危重症患者以预测SMO,APACHE-Ⅱ可作为次选,但不适用于直接产科原因入住ICU的孕产妇,OEWS并不适用于入产科ICU孕妇。关于进一步对产科危重症患者专用的预测预后评分系统的研究开发和验证任重而道远。Objective To compare the performance of SOFA,APACHE-Ⅱand OEWS in obstetric ICU admissions to predict the sever maternal outcome.Methods A retrospective study was performed on a total of 363 pregnant and postpartum women admitted to the obstetric ICU of The Affiliated Suzhou Hospital of Nanjing Medical University from January 2015 to December 2018.The scores of SOFA,APACHE-Ⅱand OEWS were calculated by the worst value within 24 hours of admission,and the discrimination and calibration of the three scoring systems for predicting the occurrence of SMO were evaluated.Results A total of 363 pregnant women were admitted to the obstetric ICU,SMO occurred in 152 cases,including 2 maternal death,the incidence of SMO in obstetric ICU was 41.87%,and the maternal mortality was 0.55%.Among all ICU admissions,SOFA had a excellent discrimination(AUC=0.87;95%CI:083-0.91)and was most accurate(cut off=2.5,LR>10)in prediction of SMO;the discrimination of APACHE-Ⅱwas good(AUC=0.804;95%CI:0.757-0.85)and the OEWS was acceptable(AUC=0.701;95%CI:0.646-0.757).When subgroup analysis based on the reason of admission,the performance of the scores were consistent with the overall,whereas APACHE-Ⅱand OEWS significantly underestimating SMO for direct causes,especially for postpartum hemorrhage.Conclusion SOFA may be the first choice for predicting SMO in obstetric ICU;APACHE-Ⅱmay be used secondly,but for direct cause admissions it is not applicable;OEWS is not apply to predict SMO in critically pregnant and puerperal women.A further study to develop and validate the prognosticate scoring system for obstetric critical patients is impendency.

关 键 词：孕产妇严重结局 产科ICU 预测评分系统 SOFA APACHE-Ⅱ OEWS 

分 类 号：R714.62[医药卫生—妇产科学]