7种评分系统对大肠埃希菌血流感染患者预后的评估价值

The evaluation value of 7 scoring systems in the prognosis of patients with Escherichia coli bloodstream infection

目的评价与比较序贯器官衰竭评分(SOFA)、Logistic脏器功能不全评分(LODS)、牛津急性疾病严重程度评分(OASIS)、简明急性生理功能评分Ⅱ(SAPSⅡ)、简明急性生理功能评分(SAPS)、全身炎症反应综合征(SIRS)和Elixhauser共病指数(ECI)评分系统对大肠埃希菌血流感染脓毒症患者住院病死率的预测能力。方法从MIMIC-Ⅲ(Medical Information Mart for Intensive Care)重症医学数据库中筛选出入重症监护病房(ICU)且早期血培养结果为大肠埃希菌的成年患者。提取性别,年龄,体质量,合并症[高血压、糖尿病、慢性阻塞性肺疾病(COPD)、慢性肾脏病(CKD)],入住ICU首个24 h内生命体征,实验室指标,SOFA、LODS、OASIS、SAPSⅡ、SAPS、SIRS和ECI评分及住院预后等资料。使用各评分系统绘制受试者工作特征(ROC)曲线、校准曲线,并计算净重新分类指数(NRI)、综合判别改善指数(IDI),分析与比较各评分系统对大肠埃希菌血流感染的脓毒症患者住院死亡的预测价值。结果共筛选出280例早期大肠埃希菌血培养阳性的脓毒症患者,其中住院生存组216例,死亡组64例。两组年龄、性别、BMI及SIRS评分差异均无统计学意义(P>0.05),两组生命体征、ICU住院时间、总住院时间、WBCmax、PLTmax、Lacmax、首日机械通气比例、SOFA、OASIS、LODS、SAPSⅡ、SAPS及ECI差异均有统计学意义(均P<0.05)。ROC曲线及校准曲线显示,SOFA、LODS、OASIS、SAPSⅡ、SAPS评分及ECI均能预测大肠埃希菌感染患者预后,其中SOFA和OASIS评分的预测效能最强,ROC曲线下面积(AUC)分别为0.786和0.790,截断值分别为10和39。ROC及校准曲线均显示,SIRS评分具有较差的预测能力。NRI及IDI显示,SOFA与OASIS、LODS、SAPSⅡ、SAPS等评分差异无统计学意义,但与SIRS、ECI差异有统计学意义。结论SOFA、LODS、OASIS、SAPSⅡ、SAPS及ECI评分均能预测大肠埃希菌血流感染脓毒症患者的预后,临床上可根据实际情况选择合适的评分系统及时判断患者预后。而SIRS预测能力较差,并不适用于判断大肠埃希菌血流感染脓毒症患者的预后。

Objective To evaluate and compare the predictive ability of sequential organ failure assessment(SOFA),Logistic organ dysfunction score(LODS),Oxford acute severity of illness score(OASIS),simplified acute physiology score Ⅱ(SAPS Ⅱ),SAPS,systemic inflammatory response syndrome(SIRS),and Elixhauser comorbidity index(ECI) scoring systems on the inpatient mortality of sepsis patients with Escherichia coli bloodstream infection.Methods Adult patients in the intensive care unit(ICU) were extracted from Medical Information Mart for Intensive Care-Ⅲ(MIMIC-Ⅲ)intensive care database,whose early blood culture results were Escherichia coli.Information of these patients was extracted including age,gender,weight,comorbidities [hypertension,diabetes,chronic obstructive pulmonary disease(COPD),chronic kidney disease(CKD) ],vital signs and laboratory indexes within the first 24 hours of admission to the ICU,SOFA,LODS,OASIS,SAPS Ⅱ,SAPS,SIRS,ECI,and the prognosis of hospitalization.We used each scoring system to draw the receiver operator characteristic curve(ROC) and calibration curve,calculated net reclassification improvement(NRI) and integrated discrimination improvement(IDI),and compared each scoring system’s predictive value of hospital deaths in sepsis patients with Escherichia coli bloodstream infection.Results A total of 280 sepsis patients with positive blood culture of early Escherichia coli were screened,including 216 patients in the hospitalized survival group and 64 patients in the death group.There were no significant differences in age,gender,BMI,and SIRS scores between the two groups(P > 0.05).But there were significant differences in the vital signs,ICU length of stay,the total length of stay,WBCmax,PLTmax,Lacmax,first-day mechanical ventilation ratio,SOFA,OASIS,LODS,SAPSⅡ,SAPS and ECI(all P < 0.05).ROC and calibration curve showed that SOFA,LODS,OASIS,SAPS Ⅱ,SAPS and ECI could predict the prognosis of patients with Escherichia coli infection.SOFA and OASIS had the most potent predictive ability.The area under the ROC curve(AUC) was 0.786 and 0.790 respectively,cut-off values were 10 and 39,respectively.ROC and calibration curve both showed that the SIRS score had a poor predictive ability.NRI and IDI showed that SOFA was not significantly different from OASIS,LODS,SAPSⅡ,SAPS,but there were significant differences with SIRS and ECI.Conclusions SOFA,LODS,OASIS,SAPS Ⅱ,SAPS and ECI scores can predict the prognosis of sepsis patients with Escherichia coli bloodstream infection.Clinically, we should select some appropriate scoring systems according to the actual situation to predict patients’ prognosis in time.SIRS shows poor predictive ability and is not suitable for judging patients’ prognosis.