不同的危重症评分系统对于热射病患者预后的预测价值

Comparison of different critical care scoring systems in prognosis evaluation of heat stroke

目的探讨不同危重症评分系统对于热射病患者28 d存活率的评估价值。方法于2019年3月,收集2015年7月至2018年9月首都医科大学附属北京潞河医院急救医学部收治的71例热射病患者的临床资料,依据患者入院时的一般资料及24 h内生命体征和相关病理生理学指标的最差值计算序贯器官衰竭评分(sequential organ failure assessment,SOFA)、多器官功能障碍评分(multiple organ dysfunction,MODS)、简化急性生理学评分Ⅱ(simplified acute physiological scoreⅡ,SAPSⅡ)和急性生理学与慢性健康状况评分Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)。根据患者28 d的预后情况分为存活组(n=45)和死亡组(n=26)两组,比较两组患者的临床资料和各项评分结果;绘制受试者工作特征(ROC)曲线,分析各项评分系统对患者预后的评估价值;采用Kaplan-Meier法绘制患者的生存曲线。结果存活组和死亡组患者的年龄、性别、24 h内的生命体征及实验室指标差异无统计学意义(P>0.05)。与存活组比较,死亡组患者SOFA、SAPSⅡ、APACHEⅡ评分均明显升高,差异有统计学意义(P<0.05)。ROC曲线分析显示,SOFA评分预测热射病患者28 d存活率的ROC曲线下面积(AUC)最大,且明显大于APACHEⅡ、SAPSⅡ评分。当SOFA评分的截断值为9.0分时,敏感度为84.6%,特异度为71.1%。Kaplan-Meier生存曲线分析显示,与SOFA评分≥9.0分患者比较,SOFA评分<9.0分患者28 d存活率明显增高,差异有统计学意义(χ2=1.0,P<0.01)。结论危重症评分系统SOFA、APACHEⅡ、SAPSⅡ均能较好地预测热射病患者28 d预后,其中SOFA评分更为准确。

Objective To evaluate the prognostic value of different critical care scoring systems in 28-day survival rate of patients with heat stroke.Methods A retrospective analysis was conducted on the clinical data of 71 patients with heat stroke admitted to the department of emergency medicine of Beijing Luhe Hospital.Capital Medical University from July 2015 to September 2018.The general information and the worst values of vital signs and related pathophysiological indicators within 24 hours were collected and the sequential organ failure assessment(SOFA),multiple organ dysfunction(MODS),simplified acute physiological scoreⅡ(SAPSⅡ)and acute physiology and chronic health evaluationⅡ(APACHEⅡ)were calculated.The patients were divided into the survival group(n=45)and the non-survival group(n=26)according to 28-day prognosis,and the clinical data and scores of the two groups were compared.The ROC curve was drawn to analyze the evaluation value of each scoring system on the survival rate of patients at 28-day.Kaplan-Meier method was used to plot the survival curve of patients.Results There were no significant differences in age,sex,vital signs and laboratory parameters between two groups(P>0.05).In non-survival patients,SOFA,SAPSⅡ,APACHEⅡscores were significantly elevated in the survival group(P<0.05).ROC curve analysis showed that the area under ROC curve(AUC)of SOFA score for predicting 28-day survival rate was the highest,which was significantly higher than the APACHEⅡ,SAPSⅡ,MODS score.When the best cut-off value of SOFA score was 9.0,the sensitivity was 84.6%,and the specificity was 71.1%.Kaplan-Meier survival analysis showed that 28-day survival rate after hospital discharge in patients with SOFA score<9(n=27)was significantly higher than that in patients with SOFA score≥9.0(χ2=1.0,P<0.01).Conclusion SOFA,APACHEⅡ,SAPSⅡon admission have been proved to have good prognostic ability to predict 28-day prognosis in heat stroke patients.Among them,SOFA score system has more accurate prediction value.