入院后早期序贯器官衰竭评分变化对老年脓毒症短期预后的评估价值  

Evaluation value of early sequential organ failure score changes after admission for short-term prognosis of elderly sepsis

作　　者：常杰[1] 张新超[2] 温伟[2] CHANG Jie;ZHANG Xinchao;WEN Wei(Health and Medical Department,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing,100730,China;Department of Emergency,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences)

机构地区：[1]北京医院保健医疗部国家老年医学中心、中国医学科学院老年医学研究院,北京100730 [2]北京医院急诊科国家老年医学中心、中国医学科学院老年医学研究院

出　　处：《临床急诊杂志》2025年第1期19-23,共5页Journal of Clinical Emergency

基　　金：睿E(睿意)急诊医学研究专项基金(No:R2020004)。

摘　　要：目的:探讨入院后早期序贯器官衰竭评分(sequential organ failure assessment,SOFA)变化(ΔSOFA)对老年脓毒症短期预后的评估价值。方法:回顾性分析我院急诊重症监护病房(EICU)2016年1月—2019年12月收治的90例老年脓毒症患者的临床资料,根据28 d生存状况,分成生存组和死亡组,收集并分析一般资料和相关实验室指标。采用logistic回归分析筛选老年脓毒症患者28 d内死亡的危险因素;绘制受试者工作特征(ROC)曲线,探讨48 h-ΔSOFA对老年脓毒症28 d预后的评估价值。结果:90例老年脓毒症患者中,28 d内死亡47例,生存43例。单因素分析显示,死亡组入院即刻SOFA、48 h-ΔSOFA、血降钙素原和乳酸水平高于生存组,血清Ca2+水平低于生存组,差异均有统计学意义(均P<0.05)。多因素二元logistic回顾分析显示,48 h-ΔSOFA是老年脓毒症28 d死亡的独立危险因素(OR=2.383,95%CI:1.535~3.702,P<0.01);应用绘制ROC曲线分析显示,入院48 h-ΔSOFA预测老年脓毒症患者28 d预后的曲线下面积为0.900(95%CI:0.834~0.967,P<0.01)。结论:48 h-ΔSOFA在入院早期评估老年脓毒症病情严重程度及短期预后方面具有良好、可靠的预测价值。Objective:To explore the value of early changes in sequential organ failure assessment(SOFA)after admission(ΔSOFA)in evaluating the short-term prognosis of elderly sepsis.Methods:A retrospective analysis was conducted on the clinical data of 90elderly sepsis patients admitted to the emergency intensive care unit(EICU)of our hospital from January 2016to December 2019.Based on their 28day survival status,they were divided into a survival group and a death group.General information and relevant laboratory indicators were collected and analyzed.Using logistic regression analysis to screen risk factors for mortality within 28days in elderly sepsis patients;Draw receiver operating characteristic(ROC)curves to explore the evaluation value of 48h-ΔSOFA in the 28day prognosis of elderly sepsis.Results:Among 90elderly sepsis patients,47cases died within 28days and 43cases survived.Univariate analysis showed that the levels of SOFA,48h-ΔSOFA,procalcitonin and lactate in the death group were higher than those in the survival group upon admission,while the serum Ca2+level was low er than that in the survival group,and the differences were statistically significant(all P<0.05).Multivariate bi nary logistic review analysis showed that 48h-ΔSOFA was an independent risk factor for 28day mortality in elder ly sepsis(OR=2.383,95%CI:1.535-3.702,P<0.01).The application of ROC curve analysis showed that the area under the curve for predicting the 28day prognosis of elderly sepsis patients with 48h-ΔSOFA after ad mission was 0.900(95%CI:0.834-0.967,P<0.01).Conclusion:48h-ΔSOFA has good and reliable predictive value in evaluating the severity and short-term prognosis of elderly sepsis in the early stage of admission.

关 键 词：脓毒症 老年 预后 序贯器官衰竭评分 

分 类 号：R459.7[医药卫生—急诊医学]