急性生理学评分对老年脓毒症患者院内死亡风险的预测价值

Predictive Value of Acute Physiological Score for the Risk of In-hospital Death in Elderly Patients with Sepsis

目的评价早期应用急性生理学评分(acute physiological score,APS)Ⅲ、简化急性生理学评分Ⅱ(simplified acute physiology scoreⅡ,SAPSⅡ)、全身炎症反应综合征评分(systemic inflammatory response syndrome score,SIRS)和Logistic器官功能障碍系统评分(Logistic organ dysfunction score,LODS)4种评分系统对重症监护室(ICU)老年脓毒症患者院内死亡风险的预警效能。方法采用回顾性队列研究,以美国贝斯以色列迪康医学中心重症监护室数据库(MIMIC-Ⅳ)中2008~2019年符合脓毒症3.0诊断标准的老年脓毒症患者为研究对象,分别采用受试者工作特征(ROC)曲线分析APSⅢ、SAPSⅡ、LODS及SIRS 4种评分系统对ICU老年脓毒症患者院内死亡风险的预警效能;采用决策曲线分析(DCA)比较各评分系统的临床应用价值。结果共纳入MIMIC-Ⅳ数据库15917例老年脓毒症患者进行分析,年龄为77(70,84)岁,男性8670例(54.5%),院内死亡3149例(19.8%)。APSⅢ、SAPSⅡ、LODS及SIRS评分系统预测老年脓毒症患者ICU死亡风险的AUC值分别为0.779(0.770~0.788)、0.713(0.703~0.723)、0.763(0.753~0.772)、0.587(0.576~0.598)。APSⅢ评分系统预测ICU老年脓毒症患者院内死亡风险的AUC值最大,明显高于SAPSⅡ、LODS及SIRS评分(P<0.05)。结论预测ICU老年脓毒症患者院内死亡风险时,APSⅢ均评分优于SAPSⅡ、LODS及SIRS评分。但由于ICU老年脓毒症患者病情危重,进展迅速,期待后续更多相关研究开发出更为便捷、准确的评分系统。

Objective To compare and analyze the predictive ability of APSⅢ,SAPSⅡ,SIRS and LODS scoring systems in predicting in-hospital death of elderly patients with sepsis in the intensive care unit(ICU)so as to offer some referential value for the clinical application later on.Methods A retrospective cohort study was employed in researching on elderly patients with sepsis who met the diagnostic criteria of sepsis 3.0 in the medical information market intensive care(MIMIC-Ⅳ)database from 2008 to 2019.The receiver operating characteristic(ROC)curve was used to analyze the efficacy of APSⅢ,SAPSⅡ,LODS and SIRS in predicting the risk of in-hospital death with sepsis in the ICU.In addition,decision curve analysis(DCA)was used to assess the clinical utility of these scoring systems.Results A total of 15917 elderly patients with sepsis were included in the MIMIC-Ⅳdatabase for analysis,with an average age of 77(70,84)years,8670 males(54.5%),and 3149 in-hospital deaths(19.8%).The AUC values of APSⅢ,SAPSⅡ,LODS and SIRS scoring systems for predicting the risk of in-hospital death in the ICU of elderly patients with sepsis are 0.779(0.770-0.788),0.713(0.703-0.723),0.763(0.753-0.772),0.587(0.576-0.598).When APSⅢscoring system was used to predict in-hospital death among elderly patients with sepsis in the ICU,the value of AUC was the largest,clearly higher than that of SAPSⅡ,LODS and SIRS.Conclusion APSⅢscoring system is preferred when predicting in-hospital death among elderly patients with sepsis in the ICU.But,as these elderly patients with sepsis were generally in critical condition and their condition evolved rapidly,it is expected that the following more relevant studies will develop a scoring system with higher convenience and accuracy.