入院前FRAIL评分和入室后SOFA评分与脓毒性休克患者预后的关系

Relationship between the pre-admission FRAIL score and SOFA score after admission of patients with septic shock and their prognosis

目的探讨脓毒性休克患者入院前FRAIL评分及入室的第一个24小时序贯器官衰竭评分(SOFA)与其预后的关系,以指导临床医师选择合适治疗时机及时救治。方法选择2016年1月~2018年2月首都医科大学附属复兴医院ICU收治住院的113例脓毒性休克患者,以入室28 d作为观察终点,将28 d内继续在ICU治疗或者治愈出院或者转至普通病房者作为生存组,将入ICU 28 d内死亡者作为死亡组。比较两组患者的一般资料、FRAIL评分、急性生理和慢性健康状况评分(APACHE Ⅱ)、动脉血乳酸(LAC)及降钙素原(PCT)水平等;采用Logistic回归模型分析患者预后的影响因素;单独使用SOFA、FRAIL和联合SOFA和FRAIL预测脓毒性休克的死亡风险,并绘制出ROC曲线,观察FRAIL评分和SOFA评分对脓毒症休克患者预后的预测价值。结果 28 d观察终点时,生存53例,死亡60例。两组入室PCT、FRAIL、SOFA比较,差异有统计学意义(P < 0.05);将上述3个指标作为自变量,将生存和死亡作为因变量,进行Logistic回归分析,脓毒性休克死亡的预警方程为logit(P)=-16.045+1.608×FRAIL+1.235×SOFA。SOFA和FRAIL联用对预测脓毒性休克死亡的预测价值最大(AUC=0.928,P < 0.01)。结论影响ICU脓毒症患者预后的因素较多,联合FRAIL评分和SOFA评分是预测ICU脓毒症患者死亡较为简单有效的指标。

Objective To investigate the relationship between the pre-admission FRAIL score and the first 24-hour sequential organ failure score (SOFA) after admission of patients with septic shock and their prognosis, so as to guide clinicians to choose appropriate treatment time and timely treatment. Methods From January 2016 to February 2018, 113 patients with septic shock who were hospitalized in the ICU of the Fuxing Hospital Affiliated to Capital Medical University, were enrolled. The 28-day entry was used as the end point of observation endpoint, and those who continued to be treated or cured or discharged from ICU within 28 days as survival group observation, and those who died within 28 days as death group. The general data, FRAIL score, acute physiology and chronic health evaluation score (APACHEⅡ), arterial blood lactate (LAC) and procalcitonin (PCT) levels were compared between the two groups. Logistic regression model was used to analyze the prognostic factors of patients. The mortality risk of septic shock was predicted by SOFA, FRAIL alone and combined with SOFA and FRAIL, and the ROC curve was drawn to observe the predictive value of FRAIL scores and SOFA scores for prognosis in patients with septic shock. Results At the end of 28 days, 53 patients survived and 60 died. There were significant differences in PCT, FRAIL and SOFA between the two groups (P < 0.05). The above three indicators were used as independent variables, survival and death were used as dependent variables, Logistic regression analysis was performed, and the early warning equation of septic shock death was used. It is logit (P)=-16.045+1.608×FRAIL+1.235×SOFA. The combination of SOFA and FRAIL had the greatest predictive value for predicting septic shock death (AUC=0.928, P < 0.01). Conclusion There are many factors influencing the prognosis of patients with sepsis in ICU. Combined FRAIL score and SOFA score are simple and effective indicators for predicting death in patients with sepsis in ICU.