APACHEⅡ、APACHEⅢ、MODS(2004)与SOFA评分对ICU严重脓毒症患者病情评估价值的比较

The Comparison of APACHEⅡ,APACHEⅢ,MODS(2004),SOFA Scores on the Evaluation of the Condition of ICU Serious Sepsis Patients

目的探讨APACHEⅡ、APACHEⅢ、MODS(2004)与SOFA评分及联合评分对ICU严重脓毒症患者病情评估的价值,并比较其优劣。方法对34例严重脓毒症或感染性休克患者进入ICU24h及ICU期间疾病最重阶段24h的各项生理参数和实验室检查结果最差值分别进行APACHEⅡ、APACHEⅢ、MODS(2004)、SOFA评分,比较存活组与死亡组之间各种评分及同一组不同时间段的分值差异,并分别绘制疾病最重24h的APACHEⅡ、APACHEⅢ、MODS(2004)、SOFA及APACHEⅡ+MODS、APACHEⅢ+MODS、APACHEⅡ+SOFA、APACHEⅢ+SOFA受试者工作特征曲线,计算ROC曲线下面积,衡量各种评分系统对患者预后预测判别的能力。结果各种病情评分评价系统两个时间段在存活者与死亡者之间差异均有统计学意义(P<0.05)。APACHEⅡ、APACHEⅢ、MODS(2004)与SOFA的AUROCC分别为0.892、0.915、0.832和0.795,相互比较均有统计学意义(P<0.05)。APACHEⅡ+MODS、APACHEⅢ+MODS、APACHEⅡ+SOFA、APACHEⅢ+SOFA的AUROCC分别为0.874、0.906、0.887和0.911,均未能提高病情评估评价效果。结论APACHEⅢ对ICU严重脓毒症患者预后的预测效果优于APACHEⅡ、MODS(2004)和SOFA,APACHEⅡ、APACHEⅢ分别与MODS(2004)或SOFA联合评分不能提高其对病情预后的预测效果。

Objective To discuss the value of APACHEⅡ,APACHEⅢ,MODS（2004）,SOFA scores ,their joint scores on accessing the state of serious ill patients with sepsis, and compare their advantages and disadvantages. Methods Evaluate APACHEⅡ,APACHEⅢ ,MODS （2004）,SOFA scores by using the worst value of various physiology parameters and laboratory results from 34 patients with severe sepsis or septic shock. The value was measured within 24 hours when above-mentioned patients were taken into ICU and also when these patients were in their most critical stage during their stay in ICU. 34 patients were divided into two groups, the survival group and the death group,then compared the different scores between these two groups, and also the difference within each group during different period. Separately drew up these patients＇characteristic curve pictures of APACHEⅡ,APACHEⅢ, MODS（2004）, SOFA, APACHEⅡ＋MODS,APACHEⅢ＋MODS,APACHEⅡ ＋SOFA , APACHEⅢ＋SOFA when they were in their most serious situation. Calculate ROC under the curve area, and evaluate the different assessing systems using by different departments towards predicting the patients＇recovery. Results There is a significant difference of scores between the survival group and the death group while using different assessing systems during two different periods（P〈0.05）. For APACHEⅡ,APACHEⅢ ,MODS（2004）,SOFA, their AUROCC are 0.892,0.915,0.832 and 0.795 respectively, while comparing with each other, significant difference exists （P〈0.05）. For APACHEⅡ ＋MODS,APACHEⅢ ＋MODS,APACHEⅡ＋SOFA, APACHEⅢ ＋SOFA,their AUROCC were 0.874, 0.906, 0.887 and 0.911 respectively,they can＇t raise the result on accessing the patients＇ condition. Conclusion These results suggest that APACHEⅢ is more effective than APACHEⅢ ,MODS （2004）, SOFA in predicting the patients＇recovery. APACHEⅡ＋MODS, APACHEⅢ＋MODS, APACHEⅡ＋SOFA,APACHEⅢ＋SOFA joint score cann＇t raise the result on predicting the patients＇recovery.