南方医科大学学报

南方医科大学学报 ›› 2020, Vol. 40 ›› Issue (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

胡 畅，胡 波，李志峰，杨 晓，宋慧敏，李建国   

  • 出版日期:2020-04-30 发布日期:2020-04-20
  • 基金资助:

Comparison of four scoring systems for predicting ICU mortality in patients with sepsis

  

  • Online:2020-04-30 Published:2020-04-20

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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.