SOFA评分对心搏骤停后综合征患者28 d病死率的预测价值

Predictive value of sequential organ failure assessment on 28-day mortality in patients with post-cardiac arrest syndrome

目的评估序贯器官衰竭评分(SOFA)对心搏骤停后综合征(PCAS)患者28 d病死率的预测价值。方法回顾分析2016年7月1日至2021年7月31日温州市人民医院急诊重症监护病房(EICU)收治的125例PCAS患者的临床资料,包括年龄、性别、合并慢性病及入EICU时急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)和SOFA评分,追踪患者28 d的预后结局。通过构建单因素和多因素Logistic回归模型,评估PCAS患者28 d病死率的影响因素及其与SOFA评分之间的独立关联性。绘制受试者工作特征曲线(ROC曲线),评估SOFA评分对PCAS患者28 d病死率的最佳预测值。结果纳入125例PCAS患者,其中男性91例,女性34例;平均年龄(58.7±15.1)岁;28 d内死亡97例,存活28例。总体SOFA评分为7~15分,平均10.9(10.0,12.0)分。死亡组SOFA评分显著高于存活组〔分:11.0(10.0,12.0)比9.5(9.0,10.0),P<0.05〕,两组SOFA评分之间的差异主要由神经系统和循环系统导致。排除神经系统因素后,死亡组的SOFA评分仍显著高于存活组〔分:8.0(6.0,8.0)比6.5(6.0,7.0),P<0.05〕。多因素Logistic回归模型提示,SOFA评分是预测PCAS患者28 d死亡的独立危险因素〔优势比(OR)=1.97,95%可信区间(95%CI)为1.24~3.04〕;其亚组中神经系统评分与28 d病死率的相关性最高(OR=3.47,95%CI为1.04~11.52)。SOFA评分预测PCAS患者28 d死亡的ROC曲线下面积(AUC)为0.81(95%CI为0.73~0.89)。当SOFA评分截断值为10.5分(即10分或11分)时,其预测PCAS患者28 d病死率的敏感度和特异度分别为67.0%、82.1%。结论SOFA评分对预测PCAS患者28 d病死率方面具有较好的准确性。

Objective To evaluate the predictive value of sequential organ failure assessment(SOFA)for 28-day mortality in patients with post-cardiac arrest syndrome(PCAS).Methods Retrospective analysis of 125 patients with PCAS who were treated in Emergency Intensive Care Unit(EICU)of Wenzhou People's Hospital from July 2016 to July 2021.Clinical data were collected,including age,gender,underlying diseases,acute physiology and chronic health evaluationⅡ(APACHEⅡ),SOFA score on admission to EICU and 28-day mortality.Univariate and multivariate Logistic regression model was constructed to analyze the influencing factors of PCAS patients,which was used to examine the independent correlation between SOFA score and 28-day mortality.Receiver operator characteristic curve(ROC curve)was used to determine the best predictive value of SOFA score and 28-day mortality in PCAS patients.Results Among the 125 PCAS patients,there were 91 males and 34 females with an average age of(58.7±15.1)years old,and 97 died and 28 survived within 28 days.The overall SOFA score ranged from 7 to 15 points,with an average of 10.9(10.0,12.0)points.The SOFA score of non-survival group was significantly higher than that of the survival group[points:11.0(10.0,12.0)vs.9.5(9.0,10.0),P<0.05].This difference between SOFA score mainly caused by the neurological and cardiovascular systems.After excluding neurological factors,the SOFA score of the non-survival group was still significantly higher than that of the survival group[points:8.0(6.0,8.0)vs.6.5(6.0,7.0),P<0.05].SOFA score was found to be an independent risk factor for 28-day mortality in PCAS patients by multifactorial Logistic regression analysis[odds ratio(OR)=1.97,95%confidence interval(95%CI)was 1.24-3.04].The correlation between neurological score and mortality was the highest in subgroups(OR=3.47,95%CI was 1.04-11.52).The area under the ROC curve(AUC)predicted by SOFA score was 0.81(95%CI was 0.73-0.89).When SOFA score cut-off value was 10.5 points(10 or 11 points),the sensitivity and specificity of SOFA score for predicting 28-day mortality in patients with PCAS were 67.0%and 82.1%,respectively.Conclusions The SOFA score is quite accurate in predicting 28-day mortality in patients with PCAS.