重症感染患者评分系统的诊断应用及其预后评估价值

Scoring systems for infection diagnosis and prognostic assessment of critically ill patients

目的比较APACHEⅡ评分、SAPSⅡ评分和SOFA评分对确定重症患者是否存在感染及预后评估的临床价值。方法选取2012-10至2012-12入我院外科监护病房、呼吸监护病房和急诊监护病房的患者作为研究对象。收集该时间段内的所有危重症患者的临床数据。根据病原学检查结果,分为非感染组和感染组。追踪并根据患者28 d生存情况,分为生存组和死亡组。运用诊断效能曲线法比较APACHEⅡ、SAPSⅡ、SOFA评分。结果本研究共纳入156例重症监护病房患者。感染组患者的APACHEⅡ和SAPSⅡ评分高于非感染组患者(14.7±9.1 vs 11.8±9.0,P=0.07;33.1±18.4 vs 26.8±19.1,P=0.048)。SAPSⅡ评分对诊断感染的曲线下面积为0.641。当该评分>15时,对确诊感染的敏感性>80%。死亡组患者的APACHEⅡ、SAPSⅡ和SOFA评分高于生存组患者的评分(23.9±6.6 vs 11.0±7.1;49.8±18.9 vs 26.4±13.3;9.4±3.6 vs 3.2±2.8,P均<0.001)。根据ROC诊断效能曲线分析,SOFA评分的曲线下面积最大(AUC=0.907)。当SOFA评分在5.5以上时,该评分对于不良预后预测的敏感性达86.7%,特异性达88%。结论 SAPSⅡ评分能够提示感染的存在,SOFA评分能够提示患者的不良预后。

Objective To compare the APACHE II score, SAPS lI score and SOFA score in determining whether there is in- fection in critically ill patients and prognostic assessment. Methods The patients involved in this study were recruited from surgical intensive care unit （SICU）, respiratory intensive care units （RICU） and emergency intensive care unit （EICU） of Chinese PLA Gen- eral Hospital from October 2012 to December 2012. All of the clinical data were collected during hospitalization. According to patho- genic examination results, the patients were divided into non - infected group and infected group. Based on 28 - day survival, the pa- tients were further divided into surviving group and the dead group. Diagnostic performance curves were employed to compare APACHE II, SAPS lI and SOFA scores. Results The study included 156 cases of ICU patients. The APACHE II and SAPS U score in pa- tients with infection were higher than those of non - infected patients （ 14.7 ±9.1 vs 11.8 ±9.0, P = 0.07 ; 33.1 ±18.4 vs 26.8 ±19.1, P =0.048）. The area under the curve of SAPS II score used in the diagnosis of infection was 0. 641. When this score 〉 15, the sensitivity for the diagnosis of infection 〉 80%. APACHE H, SAPS U and SOFA scores in dead group were higher than those in the surviving group （ 23.9 ±6.6 vs 11.0 ±7.1 ; 49.8 ±18.9 vs 26.4 ±13.3 ; 9.4 ±3.6 vs 3.2 ±2.8, P all 〈 0. 001 ）. According to diagnostic performance under ROC curve analysis, SOFA score had the largest area under the curve （ AUC = 0. 907 ）. When the SOFA score reached 5.5, sensitivity rate for bad prognosis was 86.7% , specificity rate was 88%. Conclusions SAPS I1 score can suggest the presence of infection; while SOFA score can indicate poor prognosis of patients.