老年多脏器功能不全综合征患者中应用不同预后评分的比较

Application of different scoring systems in predicting the prognosis of old patients with multiple organ dysfunction syndrom

目的建立老年多器官功能不全综合征(Multiple Organ Dysfunction Syndrome in the Elderly,MODSE)患者数据库,比较现行四种评分系统对MODSE患者预后评价效果。方法收集解放军总医院2009-2010年收住的MODSE患者206例,分别应用急性生理及慢性健康状态评分(APACHEⅡ、APACHEⅢ)、简化的急性生理学评分(SAPSⅡ)、多器官功能不全评分(MODS)四种评分评价患者预后,并比较其诊断效能。结果纳入MODSE患者206例,男性133例,女性73例,平均年龄(75.40±7.84)岁,总体病死率54.9%;死亡组患者各种评分均明显高于生存组(P<0.001);APACHEⅡ、APACHEⅢ、SAPSⅡ、MODS评分ROC曲线下面积分别为:0.825 7、0.847 2、0.849 4、0.818 4,SAPSⅡ敏感度最高,而特异度以APACHEⅢ为最优。结论现行四类评分均可较好地预测MODSE患者预后情况。

Objective To establish the database of old patients with multiple organ dysfunction syndrome（MODS） and to compare the efficiency of 4 currently available scoring systems in predicting the prognosis of old patients with MODSE.Methods A total of 206 patients with MODSE admitted to our hospital in 2009-2010 were enrolled in this study.Their prognosis was evaluated with the 4 scoring systems,known as APACHE II,APACHE III,SAPS II and MODS,respectively.The diagnostic efficiency of the 4 systems was compared.Results The mean age of 206 patients with MODSE（133 males and 73 females） was 75.40±7.84 years.The total mortality was 54.9%.The scores were significantly higher for non-survivors than for survivors（P0.001）.The score of APACHE II,APACHE III,SAPS II and MODS according to the area under the ROC curve was 0.825 7,0.847 2,0.849 4 and 0.818 4,respectively.The sensitivity of SAPS II was the highest,while the sensitivity of APACHE III was the best.Conclusion The 4 currently available scoring systems can predict the prognosis of old patients with MODSE with a rather good sensitivity and specificity.