MODS病情严重度评分及预后王宝恩名医工作室学术园地评估系统对MODS患者预后预测价值的

目的 验证多器官功能障碍综合征病情严重度评分及预后评估系统（MODS评分系统）对MODS患者病情严重程度的辨别力及预后预测的准确性;同时与APACHEⅡ评分系统、Marshall评分系统相比较,判断三者在预测多器官功能障碍综合征患者预后方面的关联性及准确性.方法 前瞻性的收集MODS患者183例,利用MODS评分系统判断每例患者器官功能障碍种类及数目并计算出每例患者MODS评分及死亡概率;利用APACHEⅡ评分系统计算每例患者的APACHEⅡ评分和死亡危险性;利用Marshall评分系统计算每例患者的Marshall评分;比较死亡组患者与存活组患者MODS评分有无差异;应用接受者操作特征曲线下面积（AURCC）,判断该评分系统在预测患者转归方面的准确性,同时与APACHEⅡ评分系统、Marshall评分系统相比较,判断三者的关系.结果 ①183例患者病死率为58.4%.存活组MODS评分均值为6.05,标准差为2.87;死亡组MODS评分为10.12,标准差为3.60.两组比较差异有显著性（P〈0.05）.②在预测病死率方面：MODS评分系统死亡概率与APACHEⅡ评分系统死亡危险性的ROC曲线下面积分别为0.831±0.031、0.820±0.031;MODS评分、APACHEⅡ评分以及Marshall评分的ROC曲线下面积分别为0.805±0.032、0.809±0.032、0.649±0.041.结论 ①死亡组与存活组MODS评分差异有统计学意义,且随着MODS评分的增加,病死率增加,MODS评分系统能较好地反映患者病情严重程度.②MODS评分系统中死亡概率计算方程及APACHEⅡ评分系统中死亡危险性计算公式对MODS患者病死率的预测准确性较高,MODS评分系统预测病死率的准确性优于APACHEⅡ评分系统;MODS评分系统、APACHEⅡ评分系统、Marshall评分系统三者所计算出来的评分区分存活与死亡的辨别力较好,但前两者准确性更高.

Study on multiple organ dysfunction syndrome scoring system in evaluating prognosis of patients with MODS.

Objective To explore multiple organ dysfunction syndrome （MODS） scoring system in evaluating the severity and prognosis of patients with MODS;meanwhile, to compare the accuracy and relevance of MODS scoring system, APACHE Ⅱ scoring system and Marshall scoring system in predicting the outcome of patients with this syndrome. Methods The clinical and laboratory data from 183 patients with MODS were prospectively collected. The calculation of MODS scores, the number and types of organ dysfunction and predicting mortality in hospital of each pa- tient by MODS scoring system. The calculation of APACHEⅡ scores and predicting mortality in hospital of each patient was performed with APACHE scoring system. The calculation of Marshall scores was calculated by Marshall scoring system. The difference between survivors and non - survivor groups on scores of patients was compared. The discriminative power of MODS scoring system and APACHE Ⅱ scoring system in predicting mortality in hospital was evaluated by the area under receiver operating characteristic curve （ AUROCC ）, and the discriminative power of scores from MODS scoring system, APACHE I1 scoring system and Marshall scoring system in predicting the outcome of patients with this syndrome was evaluated by the same way. Results （1） In 183 patients with MODS, the mortality was 58.5%. The mean of MODS scores in survivor group was 6.05, and the standard deviation （SD） was 2.87. The mean MODS scores in non - survivor group was 10.12, the standard deviation （SD） was 3.60. Their difference was statistically significant （ P 〈 0.05 ）. （2） Areas under ROC curve of predicting mortality in hospital with MODS scoring system and APACHE II scoring system were 0.831 and 0. 820 respectively, the standard errors were both 0. 031. And areas under ROC curve of MODS scoring system, APACHE Ⅱ scoring system and Marshall scoring system were 0. 805 ± 0. 032, 0. 809 ± 0. 032 and 0. 649 ±0. 041 respectively. Conclusion （1）The difference in MODS scores between survivors and non - survivor groups is statistically significant, and the increase in mortality is followed by the increase of MODS scores. The MODS scores indicate the severity of patients with MODS. The area under ROC curve indicated that MODS scoring system is helpful in predicting mortality in hospital and MODS scoring system is better than APACHE Ⅱ scoring system in predicting mortality in hospital, and scores from MODS scoring system and APACHEⅡscoring system are better than Marshall scoring system in discriminating the outcome of patients with MODS.