病情严重程度及预后评分系统对脓毒症患者的临床应用价值

Clinical application of disease severity and prognosis evaluation system in sepsis patients

  • 摘要: 目的 比较急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)及脓毒症相关性器官功能衰竭评分(SOFA)在脓毒症患者的病情严重程度判断及死亡预后评估的价值。方法 收集解放军总医院52例脓毒症患者入院24h内及第3、5、7、10、14d的相关指标,比较APACHEⅡ评分及SOFA评分。结果 52例中有16例死亡,病死率30.8%。脓毒症(Sepsis)、严重脓毒症(Severe Sepsis)及脓毒性休克(Septic Shock)组的APACHEⅡ评分分别为12.0±6.9、16.8±6.8、23.1±5.6(P=0.002),SOFA评分分别为2.9±2.1、5.9±3.1、11.6±2.9(P<0.001)。以28d生存期分为生存组(≥28d)和死亡组(<28d)。死亡组(n=16)第1天的APACHEⅡ评分及SOFA评分均高于生存组(n=36)(分别为14.9±7.1 vs 19.7±7.3,P=0.03;4.6±3.2 vs 8.8±4.0,P<0.001),且随病程时间推移,生存组SOFA评分渐降,死亡组呈增高趋势。SOFA评分评估脓毒症者死亡预后的受试者工作特征曲线下面积(AUCROC)为0.795(95%CI,0.662-0.929),高于APACHEⅡ评分的0.670(95%CI,0.514-0.826)。结论 SOFA评分及其动态变化能更好地评估脓毒症患者病情严重程度及死亡预后。

     

    Abstract: Objective To compare the clinical values of acute physiology and chronic health evaluation II(APACHE II) and sepsis-related organ failure assessment(SOFA) scoring systems for predicting the severity and prognosis of sepsis patients. Methods Clinical data about 52 sepsis patients were collected within 24h,and on days 3,5,7,10,14 after they were admitted to our hospital.Scores of their disease severity according to the APACHE II and SOFA scoring systems were compared. Results Of the 52 sepsis patients,16 died with a mortality rate of 30.8%.The APACHE II score was 12.0±6.9,16.8±6.8,and 23.1±5.6 for patients with sepsis,severe sepsis and severe sepsis shock,respectively(P=0.002),while the SOFA score was 2.9±2.1,5.9±3.1,and 11.6±2.9 for patients with sepsis,severe sepsis and severe sepsis shock,respectively(P<0.001).The patients were divided into survival group(≥28d) and death group(<28d).The APACHE II and SOFA scores were higher for death group(n=16) than for survival group(n=36)(14.9±7.1 vs 19.7±7.3 and 4.6±3.2 vs 8.8±4.0,P<0.001).The SOFA score decreased in survival group and increased in death group with the disease course.The SOFA score for predicting death in death group according to the area under the receiver operating characteristic curve was 0.795(95% CI=0.662-0.929),which was higher than that(0.670,95% CI=0.514-0.826) of the APACH II score. Conclusion SOFA score is better than APACHE II score for predicting the severity and prognosis of sepsis patients.

     

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