牛津急性疾病严重程度评分对重症患者病情评估的价值：单中心470例病例分析

The study of the value of Oxford Acute Severity of Illness Score in assessing the severity of critical illness patients： a single-center analysis of 470 cases

目的探讨牛津急性疾病严重程度评分（ Oxford acute severity of illness score, OASIS）在重症患者病情评估和预后判断中的价值。方法选择我科2012年8月至2014年7月收治的重症患者为研究对象进行回顾性研究，分别计算每一位患者牛津急性疾病严重程度评分和APACHEⅢ评分，然后进行统计学处理与分析。结果共470例患者被纳入本研究，其中男321例，女149例，年龄（18-97）岁，（59±18）岁，存活347例，死亡123例，病死率26．170％。牛津急性疾病严重程度评分ROC曲线下面积0．760（95％CI：0．712-0．808，P〈0．01），评分30．5时Youden指数最大，为0．352。APACHEⅢ评分ROC曲线下面积0．844（95％CI：0．806-0．882，P〈0．01），评分70．5分时Youden指数最大，为0．503。随牛津急性疾病严重程度评分的增加，患者的病死率逐渐上升，牛津急性疾病严重程度评分≥40分时，病死率在70％以上，Spearman双变量相关分析，rs=0．976，（P〈0．01）。结论牛津急性疾病严重程度评分对重症患者病情评估与预后判断有较好的效果．相对APACHEⅢ评分更简单、依从性好。

Objective To explore the value of Oxford acute severity of illness score in evaluating the severity and prognosis of critical illness patients. Methods All adult patients admitted to the Department of Critical Care Medicine from August 2012 to July 2014 were retrospectively analyzed. The severity in survivors and non-survivors was evaluated by using Oxford acute severity of illness score and APACHE Ⅲ score, and then statistic analysis were performed. Results Of 470 patients, 321 （68. 297% ） were male, the range of age and （x±s） age were 18 to 97 years and （59 ± 18） years respectively, and 123 patients （26. 170% ） were in non-survivors group and 347 patients in survivors group. The area under the ROC of Oxford acute severity of illness score was 0. 760 （95% CI： 0. 712-0. 808, P 〈 0. 001 ）, and Youden index was biggest when Oxford acute severity of illness score was 30. 5. The area under the ROC of APACHEⅢscore was 0. 844 （95% CI：0. 806-0. 882, P 〈 0.01 ）, and Youden index was biggest when APACHE Ⅲ score was 70. 5. Mortality was high （ above 70% ） as Oxford acute severity of illness score increased （ 〉 40） , and Spearman r was 0. 976 （ P 〈 0. 01 ）. Conclusions Oxford Acute Severity of Illness Score was useful to evaluating the severity and prognosis of critical illness patients and it was easy in clinical practice.