Logistic器官功能障碍评分系统与序贯器官衰竭评估评分对脓毒性休克预后预测价值的比较

doi:10.3969/j.issn.1002-1949.2019.04.014

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摘要目的比较Logistic器官功能障碍系统（LODS）评分与序贯器官衰竭评估（SOFA）评分对脓毒性休克患者的预后预测价值。方法回顾分析重症监护医学信息数据库（MIMIC）中脓毒性休克患者的临床资料，计算其进入ICU时的LODS与SOFA评分，以进入ICU后28 d内死亡为首要结局指标，以院内死亡和ICU内死亡为次要结局指标，绘制Kaplan-Meier生存曲线，比较不同疾病严重程度评分的患者28 d内生存状况差异，使用多因素Cox回归分析两个评分系统与首要结局指标的关联，通过受试者工作特征（ROC）曲线分析两个评分系统对各结局指标的预测价值差异。结果 1256例脓毒性休克患者纳入最终研究，其28 d内病死率为24.28%（305/1256）。与存活者相比，28 d内死亡患者具有更高的中位LODS与SOFA评分（LODS评分：6分 vs. 7分，Z=8.962，P＜0.001；SOFA评分：7分 vs. 9分，Z=6.776，P＜0.001）。多因素Cox回归分析显示，在校正潜在混杂因素后，LODS评分与SOFA评分均与患者28 d内死亡密切相关（风险比分别为1.17和1.11，P值均<0.0001）。Kaplan-Meier生存曲线分析显示，随着LODS或SOFA评分的增加，患者28 d内病死率相应上升（Log-rank检验，P值均<0.0001）。ROC曲线分析结果显示，LODS评分预测28 d内死亡、院内死亡的ROC曲线下面积（AUC）均大于SOFA评分（AUC分别为0.669 vs. 0.628，P=0.0071与0.685 vs. 0.637，P=0.0020），但预测ICU内死亡的AUC差异无统计学意义（AUC 0.723 vs. 0.705，P=0.3416）。结论相较于SOFA评分，LODS评分对脓毒性休克患者的预后可能具有更好的预测价值。

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	黄金桔
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关键词 ：危重症评分系统, 脓毒性休克, 病死率, 序贯器官衰竭评估（SOFA）, Logistic嚣官功能障碍系统（LODS）

作者简介: 黄金桔（1982-），男，硕士，主治医师，E-mail：4698163@qq.com。

引用本文:

黄金桔，陈钦昌，林转娣. Logistic器官功能障碍评分系统与序贯器官衰竭评估评分对脓毒性休克预后预测价值的比较[J]. 中国急救医学, 2019, 39(4): 360-365.
Huang Jin-ju, Chen Qin-chang, Lin Zhuan-di. Comparison of Logistic organ dysfunction system and sequential organ failure assessment score in prognosis of septic shock. Chinese Journal of Critical Care Medicine, 2019, 39(4): 360-365.

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http://www.cnemergency.org.cn/CN/10.3969/j.issn.1002-1949.2019.04.014 或 http://www.cnemergency.org.cn/CN/Y2019/V39/I4/360

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