不同评分系统对老年导管相关性血流感染预后评估的比较研究

Values of scoring systems in assessment of prognosis of elderly patients with catheter-related bloodstream infections

目的比较急性生理和慢性健康状况评分(APACHE-Ⅱ评分)、序贯性脏器衰竭评价评分(SOFA评分)和简化急性生理评分(SAPS-Ⅱ评分)3种评分系统对老年导管相关性血流感染患者1周、4周预后的评估价值。方法收集2009年1月-2015年12月260例老年导管相关性血流感染患者临床资料,整理感染前24h(Day-1)、感染后24h(Day1)的APACHE-Ⅱ、SOFA、SAPS-Ⅱ评分,比较不同时间节点(1周、4周)各个评分系统死亡组与生存组的评分差异,绘制ROC曲线,通过比较ROC曲线下面积(AUC)比较不同评分系统对预后的评估价值。结果患者平均年龄(88.6+5.8)岁,感染前后APACHE-Ⅱ评分、SOFA评分、SAPS-Ⅱ评分在发生导管相关性血流感染1周、4周的死亡组与生存组之间均存在差异性(P<0.001),ROC曲线的AUC分别为(0.849、0.878、0.786、0.887、0.843、0.867)、(0.805、0.829、0.789、0.850、0.794、0.817)。结论对于老年导管相关性血流感染4周内预后评估,感染前24小时评分优于感染24小时评分,SOFA评分优于APACHE-Ⅱ评分及SAPS-Ⅱ评分。

OBJECTIVE To compare the values of three scoring systems such as the acute physiology and chronic health evaluation（APACHE）II score,sequential organ failure assessment（SOFA）score and simplified acute physiology scores（SAPS）Ⅱin assessment of 1-week and 4-week prognosis of elderly patients with catheter-related bloodstream infections（CRBSI）.METHODS The clinical data were collected from 260 elderly patients with CRBSI who were treated from Jan 2009 to Dec 2015.The APACHE-Ⅱ score,SOFA score and SAPS-Ⅱ were recorded 24 hours before infection（Day-1）and 24 hours after infection（Day1）,the scores of the scoring systems were compared between the death group and the survival group at Week 1 and Week 4,the ROC curves were drawn,and the areas under ROC curves（AUC）were compared so as to compare the values of the scoring systems in assessment of the prognosis.RESULTS The mean age of the patients was（88.6＋5.8）years old.There were significant differences in the APACHE-Ⅱ score,SOFA score,and SAPS-Ⅱ before and after the infection between the death group and the survival group at week 1 and week 4 of CRBSI（P〈0.001）.The AUCs of ROCs were respectively（0.849,0.878,0.786,0.887,0.843,0.867）and（0.805,0.829,0.789,0.850,0.794,0.817）.CONCLUSION The scores of evaluation of prognosis of the elderly patients with CRBSI within 4 weeks are higher at 24 hours before the infections than at 24 hours after the infections,and the SOFA score is superior to the APACHE-Ⅱ score and SAPS-Ⅱ.