Vincent J L, Ferreira F, Moreno R
Department of Intensive Care, Erasme Hospital, Free University of Brussels, Belgium.
Crit Care Clin. 2000 Apr;16(2):353-66. doi: 10.1016/s0749-0704(05)70114-7.
Sepsis is an ongoing disease process carrying a high risk of organ failure and death. Scoring systems to determine disease severity and risk of mortality may be useful in patient management and clinical trial enrollment, although the role of either type of score in the determination of admission or discharge criteria or in decisions relating to the continuation or withholding of treatment remains controversial. General scoring systems have been developed to quantify the severity of illness and the risk of mortality in ICU patients. Ideally, these should be customized before use in patients with septic shock, but in general noncustomized models are used, and this potential limitation should be acknowledged. Prognostic scores are remarkably reliable at predicting outcome in groups of patients and give an indication of severity of disease on admission, but they are unable to provide detail on how a patient is responding to treatment or on the disease progression. Organ function scores, however, can be assessed repeatedly and used to define a patient's progress. This approach can thus be used to evaluate individual patient care, to identify patients for enrollment in clinical trials or epidemiologic analyses, and to assess morbidity measures in clinical trials of new interventions. Organ dysfunction scores are just that, descriptors of organ dysfunction, and although high values correlate well with mortality, prognostication is not their prime aim; organ dysfunction scores and outcome prediction scores should rather be viewed as complementary systems in the description of ICU populations.
脓毒症是一种持续的疾病过程，伴有器官衰竭和死亡的高风险。用于确定疾病严重程度和死亡风险的评分系统可能有助于患者管理和临床试验入组，尽管这两种评分在确定入院或出院标准或在与继续或停止治疗相关的决策中的作用仍存在争议。已开发出通用评分系统来量化重症监护病房（ICU）患者的疾病严重程度和死亡风险。理想情况下，在用于感染性休克患者之前应进行定制，但一般使用的是非定制模型，应认识到这一潜在局限性。预后评分在预测患者群体的结局方面非常可靠，并能显示入院时疾病的严重程度，但它们无法提供患者对治疗的反应情况或疾病进展的详细信息。然而，器官功能评分可以反复评估并用于确定患者的病情进展。因此，这种方法可用于评估个体患者的治疗情况，确定纳入临床试验或流行病学分析的患者，并评估新干预措施临床试验中的发病率指标。器官功能障碍评分正是对器官功能障碍的描述，虽然高分与死亡率密切相关，但预测并非其主要目的；在描述ICU患者群体时，器官功能障碍评分和结局预测评分应被视为互补系统。
