急性胃肠损伤分级联合多因素评估对危重患者死亡的预测价值

Prediction value of acute gastrointestinal injury grade combined with multifactorial evaluation on death in critical patients

目的探讨急性胃肠损伤(AGI)分级联合多因素组成的新评分系统对危重症患者死亡的预测价值。方法回顾性分析2016年1月~2020年3月肇庆市第二人民医院ICU收治的危重患者658例,根据28 d的存活情况分为死亡组(112例)和存活组(546例)。评估两组患者入院1周内AGI的最高分级,依据AGI最高分级,赋予相应分值(0~4分),得出AGI评分;记录患者入院24 h内急性生理慢性健康评分(APACHEⅡ)、序贯器官功能衰竭(SOFA)评分、多器官功能障碍综合征(MODS)评分、改良早期预警评分(MEWS)。两组资料进行单因素分析,对具有统计学意义的相关因素进一步行Logistic回归分析,筛选危重患者死亡的独立危险因素,绘制受试者工作特征(ROC)曲线,对比各评分的曲线下面积(AUC),评价AGI分级联合多因素评估组成的新评分系统对危重患者死亡的预测价值。结果死亡组患者年龄、第1周内AGI得分、24 h内APACHEⅡ、SOFA评分高于存活组,差异有统计学意义(P<0.05);依据ROC曲线判别出AGI、APACHEⅡ、SOFA、AGE的最佳诊断临界值分别为AGI≥2分、APACHEⅡ≥21分、SOFA≥7分、年龄≥71岁。以患者生存状态为因变量,多因素分析结果显示:AGI≥2分(β=1.608,OR=4.994,95%CI=3.258~7.654)、APACHEⅡ≥21分(β=0.762,OR=1.587,95%CI=1.328~1.896)、SOFA≥7分(β=1.590,OR=4.904,95%CI=3.354~7.171)、年龄≥71岁(β=0.715,OR=1.122,95%CI=1.063~1.183)均是危重症患者不良预后的独立危险因素(P<0.05)。死亡预警评分、AGI、APACHEⅡ、SOFA评分再绘制ROC曲线,死亡预警评分AUC值为0.909,高于单用AGI评分、APACHEⅡ评分、SOFA评分的AUC值(0.796、0.715、0.805),差异有统计学意义(P<0.05)。结论AGI分级评分联合多因素评估组成的新评分系统能够预警危重症患者的死亡风险,对危重患者死亡的预测价值优于单独使用任何一种评分。

Objective To explore the value of a new rating system for acute gastrointestinal injury(AGI)grade combined with multiple factors to predict death in critically ill patients.Methods A single-center retrospective cohort study was used,658 critically ill patients admitted to ICU at the Second People′s Hospital of Zhaoqing from January 2016 to March 2020 were enrolled.They were divided into death group(112 cases)and survival group(546 cases)according to 28 days survival.The highest grade of AGI within 1 week of admission was evaluated,according to the highest grade to give the score(0-4 points),as the AGI score.Physiological chronic health score(APACHEⅡ),sequential organ failure(SOFA)score,MODS score,and MEWS score which of within 24 h of admission in both groups were recorded.Data of two groups were analyzed by one-way analysis,and further Logistic regression analysis was performed factors,screening independent risk factors of death in critically ill patients,and drawing the receiver operating characteristic(ROC)curve of subjects to evaluate the predictive value of a new rating system for acute gastrointestinal injury grading combined with multifactorial critical patient death.Results The age,the AGI score in the first week,APACHEⅡ,SOFA score in the death group were higher than those in the survival group,and the differences were statistically significant(P<0.05).According to the ROC curve,the best diagnostic thresholds for AGI,APACHEⅡ,SOFA,and AGE were AGI≥2 points,APACHEⅡ≥21 points,SOFA≥7 points,and age≥71 years old.Results of multivariate analysis showed that AGI≥2 points(β=1.608,OR=4.994,95%CI=3.258-7.654),APACHEⅡ≥21 points(β=0.762,OR=1.587,95%CI=1.328-1.896),SOFA≥7 points(β=1.590,OR=4.904,95%CI=3.354-7.171),age≥71 years(β=0.715,OR=1.122,95%CI=1.063-1.183)were independent risk factors for poor prognosis in critically ill patients(P<0.05).The ROC curve was drawn for the death warning score,AGI,APACHEⅡ,and SOFA score,the death warning score AUC value was 0.909,which was higher than the AUC value of the AGI score,APACHEⅡscore and SOFA score alone(0.796,0.715,0.805),the differences were statistically significant(P<0.05).Conclusion The new scoring system of acute gastrointestinal injury rating combined with multi-factor evaluation can warn the death risk of critically ill patients,and the predictive value of critical patients′death is better than that of any single score.