不同时点序贯器官衰竭评估评分对重症医学科患者院内死亡的预测价值比较

Comparison of predictive value of sequential organ failure assessment scores at different time points for hospital mortality of patients in intensive care unit

目的比较不同时点序贯器官衰竭评估(SOFA)评分对重症医学科(ICU)患者院内死亡的预测价值,以期为实际临床工作中合理选用SOFA评分指标提供一定的研究证据。方法从美国重症监护数据库中选择住院时间>72h的成年ICU患者,提取其基本信息与相关检验指标并计算不同时点SOFA评分,以院内死亡为结局指标,采用多因素Logistic回归分析不同时点SOFA评分与院内死亡的关联,绘制受试者工作特征(ROC)曲线并计算曲线下面积(AUC)以评价各指标的预后预测价值。结果共有11968例患者纳入最终分析,其中男性患者占56.15%,平均年龄为(64.75±16.63)岁,院内病死率为10.41%(1246/11968)。多因素Logistic回归分析显示不同时点SOFA评分均与院内死亡密切相关(P均<0.0001),ROC曲线分析显示不同时点SOFA评分预测院内死亡的能力存在差异,以T72最高(AUC=0.7246,95%CI:0.7101~0.7391)。结论对于住院时间>72h的成年ICU患者,入院后72h的SOFA评分可能具有更好的预后预测价值。

Objective To compare the predictive value of sequential organ failure assessment(SOFA)scores at different time points for hospital mortality of patients in intensive care unit(ICU)and to provide research evidence for the rational selection of SOFA scores in actual clinical work.Methods Adult ICU patients with a length of hospital stay greater than 72 h were included from the American Critical Care Database.The basic information and related indicators were extracted and SOFA scores at different time points were calculated.Hospital mortality was chosen as the outcome and multivariable logistic regression analysis was performed to assess the associations between SOFA scores at different time points and the outcome.ROC curve analysis was also conducted and the area under the curve was calculated to evaluate their prognostic value.Results A total of 11 968 patients were included finally,of which male patients accounted for 56.15%with an average age of(64.75±16.63)years old and a hospital mortality rate of 10.41%(1246/11 968).Multivariable logistic regression analysis showed that SOFA scores at different time points were all closely related to hospital mortality(P<0.0001).ROC curve analysis showed that SOFA scores at different time points had different predictive value for hospital mortality and T72(AUC=0.7246,95%CI:0.7101-0.7391)had the highest AUC.Conclusion For adult ICU patients whose length of hospital stay is greater than 72 h,SOFA scores at 72 h after admission may have better prognostic value.