多器官功能障碍综合征病情严重度评分及预后评估系统在预测住院病死率中的作用

Multiple organ dysfunction syndrome scoring system in predicting inhospital mortality

目的比较多器官功能障碍综合征(MODS)诊断标准、病情严重度评分及预后评估系统(简称MODS诊断草案)与急性生理和慢性健康评分Ⅱ(APACHEⅡ)系统对MODS患者住院病死率的预测力。方法前瞻性搜集725例MODS患者的临床和实验室数据,应用MODS诊断草案判定该组患者器官系统功能状态并计算相应的MODS总分,另外计算该组患者的APACHEⅡ评分分值,应用受试者工作特征(ROC)曲线比较二者对MODS患者住院病死率的预测能力。结果总的住院病死率58．2%,ICU病死率55．3%。住院天数的中位数16 d,住ICU天数的中位数8 d。APACHEⅡ分值7～50分,中位数22分。725例MODS患者严重度评分分值为1～25分,平均9．7分,中位数9．0分。按照MODS诊断草案判断出障碍器官系统的数目与住院病死率、本草案病情严重度分值和APACHEⅡ分值呈正相关。上述三者均随着障碍器官数目的增加而升高,且差异有统计学意义。在预测住院病死率方面,MODS诊断草案总分ROC曲线下面积为0．720,标准误(SE)为0．019,P值为0．000,95%可信限为0．683～0．757；APACHEⅡROC曲线下面积为0．746,SE为0．018,P值为0．000,95%可信限为0．710～0．782。结论本课题组所建立的MODS诊断草案在预测MODS患者的住院转归方面(死亡或生存)有较好的辨别力。

Objective To compare multiple organ dysfunction syndrome （MODS） scoring system （ MODS diagnostic script） and acute physiology and chronic health evaluation （APACHE） Ⅱ in predicting inhospital mortality of MODS patients. Methods This was a prospective, observational and validation cohort study. The clinical and laboratory data from 725 MODS patients were collected prospectively. APACHE Ⅱ and MODS scores were calculated and compared for predicting inhospital mortality. The areas under receiver operating （ROP） curves for APACHE Ⅱ and MODS score were calculated. Results The total inhospital mortality rate of MODS patients was 58.2%, and the mortality rate of MODS patients in intensive care unit was 55.3%. The median length of hospital stay was 16 days, and the median length of ICU stay was 8 days. The APACHE Ⅱ was 7 - 50, and its median was 22. The MODS score was 1 - 25, and its median was 9. The MODS score, APACHE Ⅱ and inhospital mortality inceased with the increase of the number of dysfunctioned organs according to MODS diagnostic script. In terms of predicting inhospital mortality , the areas under ROC for MODS score were 0. 720, standard error was 0. 019, P value was 0. 000, and 95% confidence intervals were 0. 683 -0.757. The areas under ROC for APACHE Ⅱ was 0.746, standard error was 0.018, P value was 0.000, and 95% confidence intervals were 0.710 - 0. 782. Conclusion Our MODS diagnostic script is helpful in predicting inhospital mortality.