牛津急性疾病严重程度评分对老年重症患者病情评估的价值

Value of Oxford Acute Severity of Illness Score to assess disease condition of elderly patients with critical disease

目的探讨牛津急性疾病严重程度评分(OASIS评分)对ICU老年患者病情的评估和预后判断的价值。方法回顾性分析2015-2017年在黄山市2家综合性医院ICU住院的667例患者的临床资料,按年龄分为老年组383例(57.42%),中青年组284例(42.58%)。计算所有患者OASIS评分并进行统计学分析。结果中青年组和老年组患者OASIS评分和病死率分别为(27.32±9.13)分、(30.61±8.29)分,22.89%、30.55%,差异有统计学意义(P<0.05)。中青年组OASIS评分的ROC曲线下面积0.817(95%CI:0.759~0.876,P<0.01),评分31.5分时Youden指数最大(0.473);老年组OASIS评分的ROC曲线下面积0.737(95%CI:0.683~0.790,P<0.01),评分34.5分时Youden指数最大(0.365)。中青年组的ROC曲线下面积高于老年组(Z=-1.982,P=0.048)。随着OASIS评分分数的增加,患者的病死率逐渐上升。双变量相关分析显示,中青年组Spearman相关系数r_P=0.950,老年组Spearman相关系数r_P=0.986。结论 OASIS评分对老年ICU患者病情评估与预后判断有较好的价值。

Objective To explore the value of Oxford Acute Severity of Illness Score(OASIS)in the severity evaluation and prognosis judgment of elderly ICU patients.Methods The clinical data of 667 patients admitted to ICU of Huangshan Shoukang Hospital from January 2015 to December 2017 were retrospectively analyzed.The patients were divided into the elderly group(n=383,57.4%)and young and middle-aged group(n=284,42.58%)according to age.The OASIS score was calculated in all cases and then performed the statistical processing and analysis.Results The OASIS score and mortality rate of the young and middle-aged groups and the elderly group were(27.32±9.13)vs.(30.61±8.29),and 22.89%vs.30.55%respectively,and the differences were statistically significant(P<0.05).The area under the ROC curve of the OASIS score in the young and middle-aged group was 0.817(95%CI:0.759-0.876,P<0.01),and the Youden index was the highest(0.473)when the score was 31.5.In the elderly group,the area under the ROC curve of the OASIS score was 0.737(95%CI:0.683-0.790,P<0.01),and the Youden index was the highest(0.365)when OASIS was 34.5.The area under the ROC curve of the young and middle-aged group was higher than that of the elderly group(Z=-1.982,P=0.048).As the OASIS score increasing,the mortality rate gradually increased.The bivariate correlation analysis showed that the Spearman correlation coefficient of the young and middle-aged group was r_p=0.950,which of the elderly group was r_p=0.986(P<0.01).Conclusion The OASIS score has a good value for the disease condition assessment and prognosis judgment of elderly ICU patients.