不同评分系统对ICU脓毒症休克患者预后判断的临床对比

Clinical Comparison of Different Scoring Systems for Prognosis of Patients with Sepsis and Shock in ICU

目的分析评价4种不同的评分系统对ICU脓毒症休克患者30d内的预后判定效果。方法选取2016年10月-2018年12月我院ICU收治的被确诊为脓毒症休克的病人124例。入住ICU后完善每例患者的急性生理与慢性健康评分Ⅱ(APACHEⅡ)、序贯器官衰竭评分系统(SOFA)、简化急性生理学评分Ⅱ(SAPSⅡ)以及急诊脓毒症死亡风险评估(MEDS)4种评分系统,明确患者的感染部位及基础疾病。根据患者30天内是否存活分为生存组与死亡组。对各评分系统及其他预后影响因素进行分析,绘制并通过受试工作特征曲线(ROC曲线),确定最佳评分系统及其最佳预后界值。结果生存组年龄[(62.55±15.55)岁]小于死亡组年龄[(73.78±12.16)岁](P<0.05)。死亡组的以上各项评分均大于生存组(P<0.05)。死亡组中肺部感染比例高于生存组(P<0.05),说明肺部感染并发的脓毒症休克患者预后更差。采用Logisitic回归分析来进一步分析影响预后的各种因素,最终结果显示APACHEⅡ、SOFA、SAPSⅡ、MEDS、患者基础心、肺、肾慢性疾病和肺部感染这6种因素的回归系数为0.175~1.021(P<0.05)。ROC曲线显示4种评分系统ROC曲线下面积MEDS最大,其与余下3种评分系统相比差异有统计学意义(P<0.05),而余下3种评分系统之间的曲线下面积差异无统计学意义(P>0.05)。同时结果还显示,当MEDS评分达到13.5分时,其阳性预测值达到了80.2%,对于预测脓毒症休克患者的预后有重要价值。结论对比4种不同的评分系统,MEDS在预测脓毒症休克患者的预后上更具优势。

Objective To analyze and evaluate the prognostic effects of four different scoring criteria on ICU patients with sepsis and shock within 30 days.Methods Total of 124 patients admitted to the ICU of our hospital from October 2016 to February 2018 who were diagnosed as sepsis with shock were selected.According to the survival status after 30 days,the enrolled patients were divided into two groups: survival group and death group.The acute physiology and chronic health score II(APACHE II),sequential organ failure score system (SOFA),simplified acute physiology score II(SAPS II) and emergency sepsis mortality risk assessment (MEDS) were improved after admission to ICU,and the infection site and underlying diseases were identified.Patients were divided into survival group and death group according to whether they survived within 30 days.The scoring system and other prognostic factors were analyzed,and the best scoring system and its optimal prognostic threshold were determined by drawing the working characteristic curve(ROC curve).Results There was significant difference in the age of survival group (62.55+15.55) and death group (73.78+12.16)(P<0.05).The above scores in the death group were higher than those in the survival group,showed statistical significance(P<0.05).The proportion of pulmonary infection in death group was significantly higher than that in survival group(P<0.05),indicating that the prognosis of septic shock patients with pulmonary infection was worse.Logisitic regression analysis was used to further analyze the prognostic factors.The final results showed that the regression coefficients of APACHE II,SOFA,SAPS II,MEDS,patients with basic heart,lung,kidney chronic diseases and pulmonary infection were 0.175~1.021,showed statistical significance(P<0.05).The ROC curve showed that the area under the ROC curve of the four scoring systems was the largest.There was significant difference between the four scoring systems and the other three scoring systems(P<0.05),while the area under the curve of the other three scoring systems had no significant difference(P>0.05).At the same time,when the MEDS score reached 13.5,the positive predictive value reached 80.2%,which was of great value in predicting the prognosis of septic shock patients.Conclusion Comparing four different scoring methods,MEDS has more advantages in predicting the prognosis of patients with septic shock.