5个评分系统在评估围手术期主动脉夹层预后中的价值  

The value of five scoring systems in evaluating the prognosis of perioperative aortic dissection

作　　者：李辰 吕兴平 沈叶舟 刘晓彬 周炜[1] 樊国亮 朱峰[1] Li Chen;Lyu Xingping;Shen Yezhou;Liu Xiaobin;Zhou Wei;Fan Guoliang;Zhu Feng(Department of Critical Care Medicine,Shanghai East Hospital,Tongji University School of Medicine,Shanghai 200120,China)

机构地区：[1]同济大学附属东方医院重症医学科,上海200120

出　　处：《中华胸心血管外科杂志》2025年第2期91-97,共7页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：上海市卫生健康系统重点扶持学科计划(2023ZDFC0104)。

摘　　要：目的:评估围手术期主动脉夹层严重程度的最佳评分系统。方法:所有数据均来自美国重症监护医学信息数据库Ⅳ(medical information mart for intensive care-Ⅳ,MIMIC-Ⅳ)。通过接收者操作特征(ROC)曲线评估急性生理学及慢性健康状况评分系统(acute physiology and chronic health evaluation,APCHE)中的APSⅢ部分,牛津急性疾病严重程度评分(Oxford acute severity of illness score,OASIS),序贯器官衰竭评估(sequential organ failure assessment,SOFA),简化急性生理评分Ⅱ(simplified acute physiology scoreⅡ,SAPSⅡ),Charlson合并症指数(Charlson comorbidity index,CCI)评分系统的预测价值。使用曲线下面积(AUC)确定最佳预测评分,根据Youden指数计算评分的理想截断值,根据截断值分为高分组和低分组。Kaplan-Meier曲线显示主动脉夹层患者生存率的影响。结果:ROC曲线分析显示,APSⅢ(AUC:0.803,95%CI:0.721~0.885)在评估住院病死率方面优于SAPSⅡ(AUC:0.767,95%CI:0.654~0.880)、OASIS(AUC:0.760,95%CI:0.635~0.885)、SOFA(AUC:0.753,95%CI:0.649~0.857)和Charlson合并症指数(CCI)(AUC:0.670,95%CI:0.524~0.817)。根据ROC曲线和Youden指数计算,APSⅢ评分的理想截断值为57.5。Kaplan-Meier生存分析显示,APSⅢ高分组患者的28天生存时间较短,术后并发症发病率更高。相关性分析显示APSⅢ高分组患者的住院时间较长。结论:APSⅢ评分系统在预测主动脉夹层患者的28天病死率和预后方面更有价值。Objective To determine the best scoring system for assessing the severity of perioperative aortic dissection.Methods All data were obtained from the Medical Information Mart for Intensive Care-Ⅳ(MIMIC-Ⅳ)database in the United States.The predictive value of the Acute Physiology ScoreⅢ(APSⅢ),Oxford Acute Severity of Illness Score(OASIS),Sequential Organ Failure Assessment(SOFA),Simplified Acute Physiology ScoreⅡ(SAPSⅡ),and Charlson Comorbidity Index(CCI)scoring systems were evaluated using the receiver operating characteristic(ROC)curve.The area under the curve(AUC)was used to determine the best predictive score,and the ideal cutoff value of the score was calculated based on the Youden index.Patients were divided into high and low groups according to the cutoff value.The Kaplan-Meier curve was used to show the impact on the survival rate of patients with aortic dissection.Results ROC curve analysis showed that APSⅢ(AUC:0.803,95%CI:0.721-0.885)was superior to SAPSⅡ(AUC:0.767,95%CI:0.654-0.880),OASIS(AUC:0.760,95%CI:0.635-0.885),SOFA(AUC:0.753,95%CI:0.649-0.857),and CCI(AUC:0.670,95%CI:0.524-0.817)in assessing in-hospital mortality.Based on the ROC curve and the Youden index calculation,the ideal cutoff value of the APSⅢscore was 57.5.Kaplan-Meier survival analysis showed that patients in the high group of APSⅢhad a shorter 28-day survival time.Patients in the high group of APSⅢhad a higher incidence of postoperative complications,and correlation analysis showed that patients in the high group of APSⅢhad a longer hospital stay.Conclusion The APSⅢscoring system is more valuable in predicting the 28-day mortality and prognosis of patients with aortic dissection.

关 键 词：急性生理学评分系统Ⅲ 牛津急性疾病严重程度评分 序贯器官衰竭评估 简化急性生理评分Ⅱ 查尔森合并症指数 主动脉夹层 

分 类 号：R47[医药卫生—护理学]