Moemen Mohamed Ezzat
Mohamed Ezzat Moemen, Department of Anaesthesia and Intensive Care, Faculty of medicine, Zagazig University, Zagazig 44519, Egypt.
World J Crit Care Med. 2012 Jun 4;1(3):67-79. doi: 10.5492/wjccm.v1.i3.67.
Sepsis is one of the leading worldwide causes of morbidity and mortality in critically-ill patients. Prediction of outcome in patients with sepsis requires repeated clinical interpretation of the patients' conditions, clinical assessment of tissue hypoxia and the use of severity scoring systems, because the prognostic categorization accuracy of severity scoring indices alone, is relatively poor. Generally, such categorization depends on the severity of the septic state, ranging from systemic inflammatory response to septic shock. Now, there is no gold standard for the clinical assessment of tissue hypoxia which can be achieved by both global and regional oxygen extractabilities, added to prognostic pro-inflammatory mediators. Because the technology used to identify the genetic make-up of the human being is rapidly advancing, the structure of 30 000 genes which make-up the human DNA bank is now known. This would allow easy prognostic categorization of critically-ill patients including those suffering from sepsis. The present review spots lights on the main severity scoring systems used for outcome prediction in septic patients. For morbidity prediction, it discusses the Multiple Organ Dysfunction score, the sequential organ failure assessment score, and the logistic organ dysfunction score. For mortality/survival prediction, it discusses the Acute Physiology and Chronic Health Evaluation scores, the Therapeutic Intervention Scoring System, the Simplified acute physiology score and the Mortality Probability Models. An ideal severity scoring system for prognostic categorization of patients with systemic sepsis is far from being reached. Scoring systems should be used with repeated clinical interpretation of the patients' conditions, and the assessment of tissue hypoxia in order to attain satisfactory discriminative performance and calibration power.
脓毒症是全球危重症患者发病和死亡的主要原因之一。预测脓毒症患者的预后需要反复对患者病情进行临床解读、对组织缺氧进行临床评估以及使用严重程度评分系统，因为仅靠严重程度评分指标进行预后分类的准确性相对较差。一般来说，这种分类取决于脓毒症状态的严重程度，范围从全身炎症反应到脓毒性休克。目前，对于组织缺氧的临床评估尚无金标准，可通过整体和局部氧摄取率以及预后促炎介质来实现。由于用于识别人类基因组成的技术正在迅速发展，构成人类DNA库的3万个基因的结构现已为人所知。这将使包括脓毒症患者在内的危重症患者的预后分类变得容易。本综述重点介绍了用于预测脓毒症患者预后的主要严重程度评分系统。对于发病率预测，讨论了多器官功能障碍评分、序贯器官衰竭评估评分和逻辑器官功能障碍评分。对于死亡率/生存率预测，讨论了急性生理与慢性健康状况评价评分、治疗干预评分系统、简化急性生理评分和死亡概率模型。用于系统性脓毒症患者预后分类的理想严重程度评分系统远未达成。评分系统应与对患者病情的反复临床解读以及组织缺氧评估一起使用，以获得令人满意的鉴别性能和校准能力。
