老年多器官功能不全综合征预后评估五种评分系统比较

Application of five scoring systems to prognostic evaluation in multiple organ dysfunction syndrome in the elderly

目的比较五种评分系统对评估老年多器官功能不全综合征(multiple organ dysfunction syndrome in the elderly,MODSE)患者预后的价值。方法共纳入465例MODSE患者并录入相应的各项临床指标,计算急性生理及慢性健康状况评分Ⅱ/Ⅲ(APACHEⅡ/Ⅲ)、简化急性生理评分Ⅱ(SAPSⅡ)、序贯脏器衰竭评估评分(SOFA)、老年多器官功能不全评分(MODSES)五种评分。利用受试者工作曲线(ROC)分析得出评估预后的最佳评分系统。结果 APACHEⅡ、APACHEⅢ、SAPSⅡ、SOFA和MODSES的ROC曲线下面积分别为:0.768(95%CI,0.725-0.811)、0.796(95%CI,0.755-0.837)、0.789(95%CI,0.748-0.830)、0.746(95%CI,0.701-0.791)和0.783(95%CI,0.740-0.825);五种评分系统中APACHEⅢ评分的灵敏度最高(0.780)和Youden指数(0.461)最大。APACHEⅡ评价预后的特异度最高(0.835)。结论五种评分系统均能较好地评估MODSE患者的预后,诊断效能前3位的评分依次为APACHEⅢ、SAPSⅡ和MODSES。

Objective To compare the prognostic value of five scoring systems in patients with multiple organ dysfunction syndrome in the elderly（ MODSE）. Methods In this study,we collected the clinical data of 465 patients with MODSE. Acute Physiology and Chronic Health Evaluation Ⅱ（ APACHE Ⅱ） score,Acute Physiology and Chronic Health Evaluation Ⅲ（ APACHE Ⅲ） score,Simplified Acute Physiology Score Ⅱ（ SAPS Ⅱ）,Sequential Organ Failure Assessment（ SOFA） score and Multiple Organ Dysfunction Syndrome in the Elderly Score（ MODSES） were all calculated. The prognostic values of five scoring systems were evaluated by receiver operator characteristic（ ROC） curve. Results In receiver operating characteristic curve analysis,the area under the curve was0. 768（ 95% CI,0. 725-0. 811） for APACHE Ⅱ,0. 796（ 95% CI,0. 755-0. 837） for APACHE Ⅲ,0. 789（ 95% CI,0. 748-0. 830）for SAPS Ⅱ,0. 746（ 95% CI,0. 701-0. 791） for SOFA and 0. 783（ 95% CI,0. 740-0. 825） for MODSES,APACHE Ⅲ had the highest sensitivity of 0. 780,and APACHE Ⅱ had the highest specificity of 0. 835. Conclusions The five scoring systems showed satisfactory forecasting ability in prognostic prediction of patients with MODSE. The scoring systems with high prognostic values are APACHE Ⅲ,SAPS Ⅱ and MODSES.