三种器官功能不全评分系统对重症脓毒症患者的预后评估

目的 比较多脏器功能不全评分(MODS)、序贯性脏器衰竭评价评分(SOFA)和Logistic脏器功能不全评分(LODS)3种评分系统对重症脓毒症患者院内病死率的预测能力.方法 将2004年12月至2007年11月入住ICU的重症脓毒症患者403例纳入本研究中,计算入住ICU 24h内(初始值)及ICU期间最高MODS、SOFA和LODS,应用3种评分系统计算出病死概率并与实际病死率比较.通过受试者工作特征曲线(ROC)下的面积,比较3种评分系统对重症脓毒症患者的预后分辨力.结果 403例患者MODS、SOFA、LODS的初始值和急性生理学与慢性健康状况评分系统Ⅱ(APACHE Ⅱ)的ROC下而积分别为0.725、0.787、0.811和0.770;MODS、SOFA、LODS的最高值预测预后的能力均优于其初始值(P<0.01);LODS和SOFA(初始值、最高值)的分辨力均高于相应的MODS(P<0.01),而初始或最高的LODS和相应的SOFA间差异无统计学意义(P>0.05).APACHEⅡ的ROC下面积低于仞始LODS(P<0.01),与初始SOFA和MODA无统计学差异(P>0.05).结论 MODS、SOFA和LODS对重症脓毒症患者死亡或生存的分辨力均较好,LODS的最高值对重症脓毒症预后的预测能力最强.

Comparison of three different organ failure assessment score systems in predicting outcome of severe sepsis

Objective To compare multiple organ dysfunction score (MOBS), the sequential organ failure assessment (SOFA) and the logistic organ dysfunction score (LOBS) in predicting hospital mortality in severe sepsis. Methods Four hundred and three patients admitted to the ICU from December 2004 to November 2007 with a diagnosis of severe sepsis were enrolled in this study. Their MOBS, SOFA, LOBS and Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ at admission and the highest score during hospitalization were respectively recorded and collated in regard to mortality. The discrimination of three multiple organ dysfunction score systems were assessed by the areas under the receiver operating characteristic curves (AUC). Results The AUC of admission scores was 0. 811 for LOBS, 0. 787 for SOFA, 0. 725 for MOBS, and 0. 770 for APACHE Ⅱ in predicting hospital mortality. All maximum scores had better power of discrimination than the admission scores ( P < 0. 01 ). The power of discrimination of LOBS and SOFA were better than the MOBS, either the admission or the highest, respectively (P < 0. 01 ). However, no significant difference was observed between the LODS and the SOFA regarding mortality prediction (P > 0. 05 ). The AUC value for the APACHE Ⅱ score was much lower compared to LOBS ( P < 0. 01 ). However, there was no difference in AUC value among APACHE Ⅱ ,SOFA and MOBS (P >0. 05). Conclusion LOBS, SOFA and MOBS show a good discrimination power, while maximum LOBS is of the highest discrimination power to predict the outcome of patient with severe sepsis.