干旱区生态环境知识资源中心(Arid): 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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	四种评分系统对脓毒症患者ICU死亡风险的预测价值比较
其他题名	Comparison of four scoring systems for predicting ICU mortality in patients with sepsis
	胡畅; 胡波; 李志峰; 杨晓; 宋慧敏; 李建国
来源期刊	南方医科大学学报
ISSN	1673-4254
出版年	2020
卷号	40 期号:4 页码:513-518
中文摘要	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SO FA评分及LODS评分。
英文摘要	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 SOFAand LODS scores.
中文关键词	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
英文关键词	sepsis Sequential Organ Failure Assessment Simplified Acute Physiology Score II Oxford Acute Severity of Illness Score LogisticOrganDysfunction System
类型	Article
语种	中文
收录类别	CSCD
WOS类目	General & Internal Medicine
CSCD记录号	CSCD:6714058
资源类型	期刊论文
条目标识符	http://119.78.100.177/qdio/handle/2XILL650/353662
作者单位	胡畅, 武汉大学中南医院重症医学科, 武汉, 湖北 430071, 中国. 胡波, 武汉大学中南医院重症医学科, 武汉, 湖北 430071, 中国. 李志峰, 武汉大学中南医院重症医学科, 武汉, 湖北 430071, 中国. 杨晓, 武汉大学中南医院重症医学科, 武汉, 湖北 430071, 中国. 宋慧敏, 武汉大学中南医院重症医学科, 武汉, 湖北 430071, 中国. 李建国, 武汉大学中南医院重症医学科, 武汉, 湖北 430071, 中国.
推荐引用方式 GB/T 7714	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],2020,40(4):513-518.
APA	胡畅,胡波,李志峰,杨晓,宋慧敏,&李建国.(2020).四种评分系统对脓毒症患者ICU死亡风险的预测价值比较.南方医科大学学报,40(4),513-518.
MLA	胡畅,et al."四种评分系统对脓毒症患者ICU死亡风险的预测价值比较".南方医科大学学报 40.4(2020):513-518.