摘要
目的评价简化急性生理评分(SAPS-Ⅱ)、序贯器官衰竭评分(SOFA)、logistic器官功能障碍系统评分(LODS)、牛津急性疾病严重程度评分(OASIS)以及血管活性药物评分(VIS)对脓毒性休克患者住院死亡风险的预测价值。方法收集MIMIC-Ⅲ数据库(v1.4版)中脓毒性休克患者组成训练集(1249例),收集2018年1月1日至2021年12月31日就诊于复旦大学附属中山医院厦门医院的脓毒性休克患者组成验证集(61例)。根据住院期间生存情况分为生存组和死亡组,比较两组患者的临床资料。在训练集中绘制各评分系统的受试者工作特征曲线(ROC),采用多因素二元logistic回归分析构建脓毒性休克住院死亡概率的预测模型。最后分别用训练集及验证集对回归模型进行内外部验证。结果训练集中SAPS-Ⅱ、SOFA、LODS、OASIS及VIS评分预测脓毒性休克病死率的ROC曲线下面积分别为0.779、0.723、0.748、0.724及0.676(P<0.001)。多因素二元logistic分析表明,年龄>65岁(OR 1.50,95%CI 1.115~2.016,P=0.007)、Elixhauser合并症指数>10分(OR 1.39,95%CI 1.062~1.814,P=0.016)、乳酸>4.7 mmol/L(OR 2.02,95%CI1.525~2.680,P<0.001)、VIS>28分(OR 1.44,95%CI 1.083~1.916,P=0.012)、SAPS-Ⅱ>50分(OR 2.15,95%CI 1.516~3.054,P<0.001)、SOFA>10分(OR 1.58,95%CI 1.143~2.191,P=0.006)、LODS>8分(OR 1.89,95%CI 1.349~2.640,P<0.001)及OASIS>33分(OR 1.70,95%CI 1.232~2.357,P=0.001)是脓毒性休克患者住院死亡的独立危险因素。回归模型在训练集中进行内部验证的ROC曲线下面积为0.787,在验证集中进行外部验证的ROC曲线下面积为0.739,期望值∶观察值=1.1。结论SAPS-Ⅱ、SOFA、LODS、OASIS及VIS均可预测成人脓毒性休克患者的死亡风险,其中SAPS-Ⅱ对脓毒性休克患者预后的预测价值更高。
Objective To evaluate the predictive value of simplified acute physiological score(SAPS-Ⅱ),sequential organ failure score(SOFA),Logistic organ dysfunction system score(LODS),Oxford acute disease severity score(OASIS),and vasoactive-inotropic score(VIS)for the risk of in-hospital death in patients with septic shock.Methods The patients with septic shock from the MIMIC-Ⅲdatabase(v1.4)were collected to form the training set(1249 cases),and the patients with septic shock who were admitted to Xiamen Branch Zhongshan Hospital Fudan University,from January 1,2018 to December 31,2021 were collected to form the validation set(61 cases).They were divided into survival group and death group according to their survival during hospitalization.Clinical data of the patients were compared.Receiver operating characteristic curve(ROC)was plotted in the training set for each scoring system,and a predictive model for inhospital morbidity and mortality in septic shock was constructed using multifactorial binary logistic regression analysis.Finally,the regression models were internally and externally validated using the training set and validation set,respectively.Results The areas under the ROC of SAPS-Ⅱ,SOFA,LODS,OASIS,and VIS in the training set for predicting septic shock morbidity and mortality were 0.779,0.723,0.748,0.724 and 0.676,respectively(P<0.001).Multivariate binary logistic analysis showed that age 65 years old(OR 1.50,95%CI 1.115-2.016,P=0.007),Elixhauser index 10(OR 1.39,95%CI 1.062-1.814,P=0.016),lactate acid4.7 mmol/L(OR 2.02,95%CI 1.525-2.680,P<0.001),VIS>28(OR 1.44,95%CI 1.083-1.916,P=0.012),SAPS-Ⅱ>50(OR 2.15,95%CI 1.516-3.054,P<0.001),SOFA>10(OR 1.58,95%CI 1.143-2.191,P=0.006),LODS8(OR 1.89,95%CI 1.349-2.640,P<0.001),and OASIS>33(OR 1.70,95%CI 1.232-2.357,P=0.001)were independent risk factors for in-hospital death in patients with septic shock.The regression model had an area under the ROC curve of 0.787 for internal validation in the training set and 0.739 for external validation in the validation set,with E∶O=1.1.Conclusion SAPS-Ⅱ,SOFA,LODS,OASIS and VIS can predict mortality in patients with septic shock,with SAPS-Ⅱhaving a higher predictive value for the prognosis of patients with septic shock.
作者
王雨婷
林小明
黄挺
谢榕城
WANG Yu-ting;LIN Xioo-ming;HUANG Ting;XIE Rong-cheng(Intensire Care Unit,Xiamen Branch,Zhongshan Hospital,Fudan Unirersity,Xiamen 361015,China)
出处
《中国实用内科杂志》
CSCD
北大核心
2023年第9期749-754,共6页
Chinese Journal of Practical Internal Medicine
基金
复旦大学附属中山医院孵化课题(2019ZSXMYS04)
厦门市医疗卫生指导性项目(3502Z20214ZD1082)。
