摘要
目的探讨序贯器官衰竭评估(SOFA)评分及其动态变化(ΔSOFA)在血液重症监护病房(HCU)中预测死亡率的价值。方法回顾性收集2024年5月至2024年6月中国医学科学院血液病医院重症医学诊疗中心收治的79例血液病危重症患者的临床数据,计算患者自住院于HCU前2 d至后2 d的SOFA评分及ΔSOFA。应用受试者工作特征曲线(ROC)研究SOFA评分及ΔSOFA在死亡率预测中的价值。结果79例患者的HCU死亡率为54.4%。死亡组全体患者、白血病患者和造血干细胞移植(HSCT)患者住院第1~3天SOFA(D_1、D_2、D_3)评分和第1天ΔSOFA(ΔD_1)均较非死亡组明显增高(P值均<0.05)。ROC曲线分析显示,D_1、D_2、D_3评分和ΔD_1均可预测患者死亡率(P<0.001),曲线下面积(AUC)分别为0.786、0.866、0.901、0.843,灵敏度分别为74.36%、57.89%、62.85%、86.84%,特异度分别为70.00%、100%、100%、67.65%。HSCT组中,D_-1、D_1、D_2、D_3评分和ΔD_1均可预测HCU死亡率,AUC分别为0.833、0.794、0.871、0.846、0.795;灵敏度分别为100%、85.71%、71.43%、57.14%、57.14%;特异度分别为73.33%、70.59%、91.33%、100%、100%。白血病组中,D_1、D_2、D_3评分和ΔD_1可预测HCU死亡率,AUC分别为0.760、0.829、0.846、0.756;灵敏度分别为71.43%、78.57%、53.85%、71.43%;特异度分别为76.19%、78.95%、100%、63.16%。对于全体患者,D_3评分特异度最高,ΔD_1灵敏度最高。对于HSCT组和白血病组患者,D_1和D_3评分的灵敏度及特异度均高于ΔD_1。结论对于住院于HCU的血液危重症、白血病和HSCT患者,D_1、D_2、D_3评分和ΔD_1与HCU死亡率明显相关。
ObjectiveTo investigate the value of Sequential Organ Failure(SOFA)score and its dynamics(ΔSOFA)in predicting mortality in hematology care unit(HCU).MethodsA retrospective clinical study was conducted on 79 critically ill hematologic patients admitted to the Center for Critical Care Medicine,Institute of Hematology&Blood Diseases Hospital,Chinese Academy of Medical Sciences,between May and June 2024.SOFA scores andΔSOFA were calculated within 2 days before and after HCU admission.The predictive value of SOFA andΔSOFA in mortality was assessed using receiver operating characteristic(ROC)curve analysis.ResultsAmong the 79 patients,the HCU mortality rate was 54.4%.The SOFA scores on days 1–3(D1,D2,and D3)andΔSOFA on day 1(ΔD_1)of all patients,leukemia patients and hematopoietic stem cell transplantation(HSCT)patients were significantly higher in the death group compared with the non-death group(all P<0.05).ROC curve analysis revealed that the D_1,D_2,D_3 scores,andΔD_1 significantly predicted mortality(P<0.001),with areas under the curve(AUCs)of 0.786,0.866,0.901,and 0.843,respectively.The sensitivity values were 74.36%,57.89%,62.85%,and 86.84%,while specificity values were 70%,100%,100%,and 67.65%,respectively.In the HSCT group,the D_-1,D_1,D_2,D_3,scores andΔD_1 were predictive of HCU mortality,with AUCs of 0.833,0.794,0.871,0.846,and 0.795,respectively.Sensitivity values for these scores were 100%,85.71%,71.43%,57.14%,and 57.14%,while specificity values were 73.33%,70.59%,91.33%,100%,and 100%,respectively.In the leukemia group,the D_1,D_2,D_3 scores,andΔD_1 were predictive of HCU mortality,with AUCs of 0.760,0.829,0.846,and 0.756,respectively.Sensitivity values were 71.43%,78.57%,53.85%,and 71.43%,while specificity values were 76.19%,78.95%,100%,and 63.16%,respectively.For all patients,the D_3 score exhibited the highest specificity,while theΔD_1 demonstrated the highest sensitivity.For patients in both the HSCT and leukemia groups,the sensitivity and specificity values of the D_1 and D_3 scores exceeded those of theΔD_1.ConclusionFor patients with hematologic critical illness,including leukemia and those undergoing HSCT hospitalized in the HCU,D_1,D_2,D_3 scores andΔD_1 are significantly associated with HCU mortality.
作者
王佳婧
张建
张斌
曹云聪
郭怡麟
于沛然
张晓庆
张晓娟
宋毅军
Wang Jiajing;Zhang Jian;Zhang Bin;Cao Yuncong;Guo Yilin;Yu Peiran;Zhang Xiaoqing;Zhang Xiaojuan;Song Yijun(State Key Laboratory of Blood and Health,National Clinical Research Center for Blood Diseases,Haihe Laboratory of Cell Ecosystem,Institute of Hematology&Blood Diseases Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Tianjin 300020,China;Tianjin Institutes of Health Science,Tianjin 301600,China;Tianjin Medical University,Tianjin 300070,China;Tianjin University of Traditional Chinese Medicine,Tianjin 301617,China)
出处
《中华血液学杂志》
北大核心
2025年第1期31-38,共8页
Chinese Journal of Hematology
基金
中国医学科学院医学与健康科技创新工程项目资助项目(2023-I2M-2-007)。
关键词
血液病
危重病
重症监护病房
死亡率
序贯器官衰竭评估
Hematologic diseases
Critical illness
Intensive care units
Mortality
Sequential organ failure assessment
