干旱区生态环境知识资源中心(Arid): 牛津急性疾病严重程度评分鉴别快速序贯器官功能衰竭评分阴性脓毒症患者的临床价值

Arid

	牛津急性疾病严重程度评分鉴别快速序贯器官功能衰竭评分阴性脓毒症患者的临床价值
其他题名	Clinical value of Oxford acute severity of illness score in identifying quick sequential organ failure assessment-negative patients with sepsis
	陈钦桂; 谢锐杰; 陈燕珠; 曾勉
来源期刊	中华结核和呼吸杂志
ISSN	1001-0939
出版年	2018
卷号	41 期号:9 页码:701-708
中文摘要	目的评价牛津急性疾病严重程度评分(OASIS)对快速序贯器官功能衰竭评分(qSOFA)阴性(qSOFA<2)脓毒症患者的鉴别价值。方法从存储了美国贝斯以色列迪康医学中心重症监护室2001年至2012年住院患者医疗信息的监护室医学信息数据集(MIMIC-Ⅲ)中选取qSOFA阴性的脓毒症患者,同时筛选qSOFA <2、无可疑感染且SOFA <2的其他患者作为对照,并构建倾向性评分匹配队列以减少选择偏倚,运用ROC曲线分析OASIS鉴别qSOFA阴性脓毒症患者的价值并确定其阈值,进一步运用多因素Cox回归、logistic回归分析基于该阈值的OASIS水平与研究对象临床结局的关联。结果2 273例qSOFA阴性脓毒症患者与3 342例作为对照的非脓毒症患者纳入最终分析,其中1 677对患者成功匹配。受试者工作特征曲线(ROC曲线)分析结果显示,OASIS鉴别qSOFA阴性脓毒症患者的曲线下面积为0.753(95% CI为0.741~0.765),Youden指数法确定的阈值为26.5,相应的敏感度为67.2%,特异度为70.8%。多因素回归分析显示,OASIS >26分别是患者28 d死亡(风险比为2.80,95% CI为2.15~3.65,P <0.01)、ICU内死亡(比值比为4.69,95% CI为2.60~8.49,P<0.01)以及院内死亡(比值比为4.48,95%CI为3.13~6.42,P<0.01)的独立危险因素。对匹配队列的分析结果亦类似。结论OASIS对qSOFA阴性脓毒症患者具有较高的鉴别能力。
英文摘要	Objective The quick sequential organ failure assessment (qSOFA) score has been proposed as part of diagnostic criteria for sepsis,but there might be an underestimation of the incidence of qSOFA-negative sepsis according to a few recent studies. The purpose of this study was to evaluate the value of Oxford acute severity of illness score (OASIS) in identifying qSOFA-negative (qSOFA <2) patients with sepsis. Methods Sepsis patients with negative qSOFA scores were selected from the Medical Information Mart for Intensive Care Ⅲ ( MIMIC-Ⅲ ), a database comprising de-identified health-related data from patients staying in the critical care units of Beth Israel Deaconess Medical Center between 2001 and 2012. Non-infectious patients with both qSOFA and SOFA scores less than 2 were enrolled as controls. Propensity score matching (PSM) analysis was used to reduce the effects of selection bias. Receiver operating characteristic (ROC) curve analysis was performed to assess the value of OASIS in discriminating qSOFA-negative patients with sepsis and to determine its optimal cut-off. Associations of OASIS with 28-day mortality after intensive care unit (ICU) admission,ICU mortality,and hospital mortality were further examined using multivariate Cox regression and multivariate logistic regression analysis. Results 2 273 qSOFA-negative patients with sepsis and 3 342 non-sepsis controls were included finally with a PSM cohort consisted of 1 677 sepsis patients and 1 677 controls. Results of ROC analysis showed that the area under ROC curve was 0.753 [95% confidence interval (CI) 0.741 -0.765] and the optimal OASIS threshold according to the Youden index was 26.5 and yielded a 67.2% sensitivity and 70.8% specificity. Multivariate regression analysis indicated that OASIS > 26 was an independent risk factor for 28-day mortality (hazard ratio 2.80,95% CI 2.15 -3.65, P<0.1), ICU mortality (odds ratio 4.69,95% CI 2.60 - 8.49, P<0.01), and hospital mortality (odds ratio 4.48, 95% CI 3.13-6.42, P<0.01). Analysis of the PSM cohort presented consistent results. Conclusions OASIS had a good discriminative value to differentiate qSOFA-negative patients with sepsis from those without sepsis.
中文关键词	脓毒症 ; 危重病 ; 牛津急性疾病严重程度评分 ; 快速序贯器官功能衰竭评分
英文关键词	Sepsis Critical illness Oxford acute severity of illness score Quick sequential organ failure assessment
语种	中文
国家	中国
收录类别	CSCD
WOS类目	MEDICINE GENERAL INTERNAL
WOS研究方向	General & Internal Medicine
CSCD记录号	CSCD:6328902
资源类型	期刊论文
条目标识符	http://119.78.100.177/qdio/handle/2XILL650/238876
作者单位	广东省广州市中山大学附属第一医院内科重症监护病房, 广州, 广东 510080, 中国
推荐引用方式 GB/T 7714	陈钦桂,谢锐杰,陈燕珠,等. 牛津急性疾病严重程度评分鉴别快速序贯器官功能衰竭评分阴性脓毒症患者的临床价值[J],2018,41(9):701-708.
APA	陈钦桂,谢锐杰,陈燕珠,&曾勉.(2018).牛津急性疾病严重程度评分鉴别快速序贯器官功能衰竭评分阴性脓毒症患者的临床价值.中华结核和呼吸杂志,41(9),701-708.
MLA	陈钦桂,et al."牛津急性疾病严重程度评分鉴别快速序贯器官功能衰竭评分阴性脓毒症患者的临床价值".中华结核和呼吸杂志 41.9(2018):701-708.