[1]胡 畅,胡 波,李志峰,等.四种评分系统对脓毒症患者ICU死亡风险的预测价值比较[J].南方医科大学学报,2020,(04):513-518.[doi:10.12122/j.issn.1673-4254.2020.04.10]
 Comparison of four scoring systems for predicting ICU mortality in patients with sepsis[J].Journal of Southern Medical University,2020,(04):513-518.[doi:10.12122/j.issn.1673-4254.2020.04.10]
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四种评分系统对脓毒症患者ICU死亡风险的预测价值比较()
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《南方医科大学学报》[ISSN:1673-4254/CN:44-1627/R]

卷:
期数:
2020年04期
页码:
513-518
栏目:
出版日期:
2020-04-30

文章信息/Info

Title:
Comparison of four scoring systems for predicting ICU mortality in patients with sepsis
作者:
胡 畅胡 波李志峰杨 晓宋慧敏李建国
关键词:
脓毒症序贯器官衰竭评分简化急性生理评分牛津急性疾病严重程度评分Logistic器官功能障碍系统
Keywords:
sepsis Sequential Organ Failure Assessment Simplified Acute Physiology Score II Oxford Acute Severity of Illness Score Logistic Organ Dysfunction System
DOI:
10.12122/j.issn.1673-4254.2020.04.10
文献标志码:
A
摘要:
目的 评价序贯器官衰竭评分(SOFA)、简化急性生理评分(SAPS-Ⅱ)、牛津急性疾病严重程度评分(OASIS)、Logistic器官 功能障碍系统(LODS)评分系统预测ICU脓毒症患者死亡风险的价值。方法 通过MIMIC-Ⅲ数据库提取2001年至2012年共 计2470例脓毒症患者的临床资料,收集入ICU首日内SOFA评分、SAPS-Ⅱ评分、OASIS评分以及LODS评分。根据患者ICU 存活情况分为存活组和死亡组,分析比较两组间不同评分系统的差异性,计算4种评分系统ROC曲线下面积进行差异性分析, 对脓毒症患者ICU死亡情况进行二项Logistic回归分析,以综合比较4种评分系统对脓毒症患者ICU死亡的预测价值。结果 2470例脓毒症患者中ICU内存活1966例(79.6%),死亡504例(20.4%)。其中死亡组年龄、机械通气使用率、初始乳酸、肌酐、尿 素氮、SOFA、SAPS-Ⅱ、OASIS和LODS评分明显高于存活组(P<0.05),体质量及血小板明显低于存活组(P<0.05)。SOFA评 分、SAPS-Ⅱ评分、OASIS 评分以及 LODS 评分的 ROC 曲线下 AUC 值分别为 0.729(P<0.001),0.768(P<0.001),0.757(P< 0.001), 0.739(P<0.001)。其中SAPS-Ⅱ评AUC值明显高于SOFA评分和LODS评分(Z=3.679,P<0.001;Z=3.698,P<0.001), SAPS-Ⅱ与OASIS评分无明显差异(Z=1.102,P=0.271);OASIS评分明显高于LODS评分(Z=2.172,P=0.030),但与SOFA评分 无明显差异(Z=1.709,P=0.088)。按照是否合并脓毒性休克将患者分为两组,在单纯脓毒症组中,SAPS-Ⅱ评分预测患者死亡 的AUC值明显高于其他3种评分,为0.769(0.743-0.793),在合并脓毒性休克组中,SAPS-Ⅱ与OASIS评分预测患者死亡的 AUC值明显高于其他两种评分,分别为0.768(0.745-0.791)、0.762(0.738-0.785)。二项Logistic回归多因素分析后发现SOFA、 SAPS-Ⅱ、OASIS评分系统均与脓毒症患者死亡相关(OR:1.08,95% CI:1.03-1.14,P=0.001;OR:1.04,95% CI:1.02-1.05,P<0.001; OR:1.04,95% CI:1.01-1.06,P=0.001),但LODS评分与脓毒症患者发生ICU死亡无明显关系(OR:0.96,95%CI:0.89-1.04, P=0.350)。结论 SOFA、SAPS-Ⅱ和OASIS评分均能预测脓毒症患者ICU死亡风险,但SAPS-Ⅱ评分和OASIS评分预测价值 优于SOFA评分及LODS评分。
Abstract:
Objective To evaluate the value of Sequential Organ Failure Assessment (SOFA), Simplified Acute Physiology Score II (SAPS-II), Oxford Acute Severity of Illness Score (OASIS) and Logistic Organ Dysfunction System (LODS) scoring systems for predicting ICU mortality in patients with sepsis. Methods We collected the data of a total of 2470 cases of sepsis recorded in the MIMIC-III database from 2001 to 2012 and retrieved the scores of SOFA, SAPS-II, OASIS and LODS of the patients within the first day of ICU admission. We compared with the score between the survivors and the non-survivors and analyzed the differences in the area under the ROC curve (AUC) of the 4 scoring systems. Binomial logistic regression was performed to compare the predictive value of the 4 scoring systems for ICU mortality of the patients. Results In the 2470 patients with sepsis, 1966 (79.6% ) survived and 504 (20.4% ) died in the ICU. Compared with the survivors, the non-survivors had a significantly older mean age, higher proportion of patients receiving mechanical ventilation, and higher initial lactate level, creatinine, urea nitrogen, SOFA score, SAPS-II score, OASIS score and LODS score (P<0.05) but with significantly lower body weight and platelet counts (P<0.05). The AUCs of the SOFA score, SAPS-II score, OASIS score, and LODS score were 0.729 (P<0.001), 0.768 (P<0.001), 0.757 (P<0.001), and 0.739 (P<0.001), respectively. The AUC of SAPS-II score was significantly higher than those of SOFA score (Z=3.679, P<0.001) and LODS score (Z=3.698, P<0.001) but was comparable with that of OASIS score (Z=1.102, P=0.271); the AUC of OASIS score was significantly higher than that of LODS score (Z=2.172, P=0.030) and comparable with that of SOFA score (Z=1.709, P=0.088). For predicting ICU mortality in patients without septic shock, the AUC of SAPS-II score was 0.769 (0.743-0.793), the highest among the 4 scoring systems; in patients with septic shock, the AUCs SAPS-II score and OASIS score, 0.768 (0.745-0.791) and 0.762 (0.738-0.785), respectively, were significantly higher than those of the other two scoring systems. Binomial logistic regression showed the corrected SOFA, SAPS-II, and OASIS scores, but not LODS scores, were significantly correlated with ICU mortality in patients with sepsis, and their ORs were 1.08 (95% CI: 1.03-1.14, P=0.001), 1.04 (95% CI: 1.02-1.05, P<0.001), 1.04 (95% CI: 1.01-1.06, P=0.001), 0.96 (95% CI: 0.89-1.04, P=0.350), respectively. Conclusion The scores of SOFA, SAPS-II, OASIS, and LODS can predict ICU mortality in patients with sepsis, but SAPS-II and OASIS scores have better predictive value than SOFA and LODS scores.

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更新日期/Last Update: 2020-04-30