Hernández-Palazón J, Fuentes-García D, Burguillos-López S, Domenech-Asensi P, Sansano-Sánchez T V, Acosta-Villegas F
Servicio de Anestesiología y Reanimación, Hospital Universitario Virgen de la Arrixaca, Murcia, España.
Med Intensiva. 2013 Oct;37(7):461-7. doi: 10.1016/j.medin.2012.07.010. Epub 2012 Oct 6.
To identify the organs most susceptible to develop multiorgan dysfunction syndrome (MODS) in patients with sepsis due to secondary peritonitis, and to determine the outcome and mortality predicting utility of the SOFA (Sequential Organ Failure Assessment) system.
A prospective, observational cohort study was made.
The resuscitation unit of a third-level university hospital.
A prospective, observational cohort study was made of 102 patients with sepsis of abdominal origin and failure of at least one organ related to the infection. The demographic characteristics were documented, along with the abdominal origin of sepsis, mortality after 28 days, and the daily SOFA score.
The mortality rate after 28 days was 55%. A total of 53% of the patients presented failure of two or more organs on the first day of admission. The mean daily SOFA score was significantly higher among the patients that died after day 4 of admission. The variables showing a statistically significant correlation to increased mortality were: MODS (P=.000), central nervous system failure (P=.000) and SOFA score on day 4 of admission (P=.012). The area under the ROC curve showed the mortality predicting capacity of the SOFA score on day 4 of admission to be 0.703 (95%CI 0.538-0.853; P=.026). The maximum discriminating capacity was recorded for MODS, with an area under the ROC curve of 0.776 (95%CI 0.678-0.874; P=.000).
Organ failure outcome as predicted by the SOFA score showed high precision - the mean SOFA score on day 4 of admission being a good mortality predictor. MODS was the main cause of death, while central nervous system, renal and respiratory failure were identified as the mortality risk factors.
确定继发性腹膜炎所致脓毒症患者中最易发生多器官功能障碍综合征（MODS）的器官，并确定序贯器官衰竭评估（SOFA）系统对结局和死亡率的预测效用。
进行一项前瞻性观察队列研究。
一所三级大学医院的复苏单元。
对102例腹部源性脓毒症且至少有一个与感染相关器官功能衰竭的患者进行前瞻性观察队列研究。记录人口统计学特征、脓毒症的腹部来源、28天后的死亡率以及每日SOFA评分。
28天后的死亡率为55%。共有53%的患者在入院第一天出现两个或更多器官功能衰竭。入院第4天后死亡的患者每日平均SOFA评分显著更高。与死亡率增加具有统计学显著相关性的变量为：MODS（P = .000）、中枢神经系统衰竭（P = .000）以及入院第4天的SOFA评分（P = .012）。ROC曲线下面积显示入院第4天SOFA评分对死亡率的预测能力为0.703（95%CI 0.538 - 0.853；P = .026）。MODS的鉴别能力最强，ROC曲线下面积为0.776（95%CI 0.678 - 0.874；P = .000）。
SOFA评分预测的器官功能衰竭结局显示出高精度——入院第4天的平均SOFA评分是良好的死亡率预测指标。MODS是主要死亡原因，而中枢神经系统、肾脏和呼吸衰竭被确定为死亡风险因素。
