两种评分预测持续炎症-免疫抑制-分解代谢综合征患者死亡的效能比较

Comparison of APACHEⅡ score and SOFA score in evaluating prognosis of patients with persistent inflammation-immunosuppression and catabolism syndrome

目的探讨急性生理学与慢性健康状况评分系统Ⅱ(APACHE II)评分和序贯器官衰竭评分(SOFA评分)对外科ICU并发持续炎症-免疫抑制-分解代谢综合征(PICS)患者的预后评估价值。方法收集2011年1月至2019年10月东阳市人民医院ICU收治的141例外科术后并发PICS患者相关临床资料,入ICU第1天及第14天APACHEⅡ评分、SOFA评分。采用多因素logistic回归分析筛选PICS死亡的独立危险因素,ROC曲线分析比较APACHEⅡ评分、SOFA评分预测PICS患者死亡的效能。结果141例PICS患者中死亡52例,存活89例。PICS患者入ICU第1天及第14天APACHEⅡ评分、SOFA评分比较差异均有统计学意义(均P<0.05)。APACHEⅡ评分、SOFA评分的AUC比较差异有统计学意义(P<0.05),入ICU第14天时SOFA评分预测患者死亡的效能最强,AUC为0.778,最佳截断值5.5分,灵敏度0.673,特异度0.800。年龄、血小板、血浆渗透压、气管切开、血清白蛋白及SOFA评分是PICS患者死亡的独立危险因素。结论对于外科术后入住ICU并发PICS患者,SOFA评分对预后的评估能力优于APACHEⅡ评分。

Objective To compare acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) and sequential organ failure assessment scores( SOFA) in evaluating the prognosis of surgical ICU patients with persistent inflammation-immunosuppression and catabolism syndrome( PICS). Methods Clinical data of patients with PICS in surgical ICU from January 2011 to October 2019 in Dongyang Hospital were retrospectively analyzed. The APACHE Ⅱ and SOFA scores were assessed on d1 and d14 after admission to ICU. Multiple logistic regression was used to analyze the risk factors of mortality in ICU patients with PICS. The prognostic value of APACHE Ⅱ and SOFA scores were analyzed with the receiver operating characteristic(ROC) curve. Results A total of 141 PICS patients were enrolled, 52 patients died(fatal group) and 89 survived(survival group). There were significant differences in APACHE Ⅱ score, SOFA score on d1 and d14 after admission between fatal group and survival group(P<0.05). Multivariate logistic regression analysis showed that the age, plasma osmotic pressure,tracheotomy, platelet count, serum albumin and SOFA score were independent risk factors of mortality in ICU patients with PICS.The area under the ROC curve(AUC) of the SOFA score on d14 for predicting the prognosis of PICS patients was 0.778, taking5.5 as the optimal threshold, the sensitivity and specificity of SOFA score was 0.673 and 0.800, respectively. Conclusion For surgical ICU patients with PICS, the SOFA score in predicting the prognosis is better than that APACHE Ⅱ score.