入院时APACHEⅡ评分、SOFA评分及ALB水平对严重脓毒症患者预后结局的影响

APACHEⅡ score,SOFA score and ALB level at admission could affect the prognosis of patients with severe sepsis

目的分析入院时急性生理与慢性健康(APACHEⅡ)评分、序贯器官衰竭估计(SOFA)评分及白蛋白(ALB)水平对严重脓毒症患者预后结局的影响,为严重脓毒症患者预后的早期预测提供参考依据。方法选取本院重症医学科2013年5月至2016年5月收治的183例严重脓毒症患者,按照其入院后28 d预后,将存活患者纳入存活组(n=136),病死患者纳入病死组(n=47)。比较两组患者入院时APACHEⅡ评分、SOFA评分及ALB水平差异,运用受试者工作特征(ROC)曲线评价上述指标单独预测、联合预测严重脓毒症患者预后的临床价值。结果 183例患者中,47例于入院后28 d内病死,病死率为25.68%。病死组与存活组年龄、性别、病因、合并症等基线临床资料比较,差异无统计学意义(P>0.05);病死组APACHEⅡ评分、SOFA评分高于存活组,而ALB水平低于存活组,差异有统计学意义(P<0.05)。ROC曲线示,以严重脓毒症患者28 d预后为因变量,APACHEⅡ评分、SOFA评分联合ALB水平的曲线下面积(AUC)为0.839 5,其AUC高于APACHEⅡ评分、SOFA评分或ALB水平单项分析。结论入院时APACHEⅡ评分、SOFA评分联合ALB水平对严重脓毒症患者预后结局的预测具有积极意义,值得进一步关注。

Objective To analyze the relationship of acute physiology and chronic health evaluation （APACHE Ⅱ ） score, sequential organ failure assessment （SOFA） score and albumin （ALB） level at admission and the prognosis of patients with severe sepsis, and provide some references for the early prediction of patients with severe sepsis. Methods 183 patients with severe sepsis admitted to ICU in Beijing Shijitan Hospital Affiliated to Capital Medical University from May 2013 to May 2016 were selected and divided into two groups according to the prognosis of 28 d after admission, including survival patients as the survivor group, and fatality patients as the fatality group. The APACHE Ⅱ score, SOFA score and ALB level at admission between the two groups were compared, the clinical value of prediction on the patients with severe sepsis with the single or multiple above indexes was determined by using receiver operating characteristic （ROC） curve. Results 47 cases of 183 patients died within 28 d after admission, the mortality rate was 25.68%. There was no statistical difference of baseline data such as age, gender, etiology, complications between the two groups （P〉O.05）. The APACHEⅡ score and SOFA score of the survivor group were significantly higher, and the ALB were significantly lower than those of the fatality group （P〈O.05）. The ROC curve showed that, with the prognosis of patients within 28 d as the dependent variable, the area under the curve （AUC） of the APACHE Ⅱ score, SOFA score combined with ALB level was 0.839 5, which was higher than the AUC analyzed by the single index. Conclusion The APACHE Ⅱ score, SOFA score combined with ALB level at admission could predict the prognosis of patients with severe sepsis, and it is worthy of further attention.