Mica L, Furrer E, Keel M, Trentz O
Division of Trauma Surgery, University Hospital of Zürich, 8091, Zurich, Switzerland.
Division of Biostatistics, University of Zürich, Zurich, Switzerland.
Eur J Trauma Emerg Surg. 2012 Dec;38(6):665-71. doi: 10.1007/s00068-012-0227-5. Epub 2012 Sep 18.
Systemic inflammatory response syndrome (SIRS) and sepsis as causes of multiple organ dysfunction syndrome (MODS) remain challenging to treat in polytrauma patients. In this study, the focus was set on widely used scoring systems to assess their diagnostic quality.
A total of 512 patients (mean age: 39.2 ± 16.2, range: 16-88 years) who had an Injury Severity Score (ISS) ≥17 were included in this retrospective study. The patients were subdivided into four groups: no SIRS, slight SIRS, severe SIRS, and sepsis. The ISS, New Injury Severity Score (NISS), Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, and prothrombin time were collected at admission. The Kruskal-Wallis test and χ(2)-test, multinomial regression analysis, and kernel density estimates were performed. Receiver operating characteristic (ROC) analysis is reported as the area under the curve (AUC). Data were considered as significant if p < 0.05.
All variables were significantly different in all groups (p < 0.001). The odds ratio increased with increasing SIRS severity for NISS (slight vs. no SIRS, 1.06, p = 0.07; severe vs. no SIRS, 1.07, p = 0.04; and sepsis vs. no SIRS, 1.11, p = 0.0028) and APACHE II score (slight vs. no SIRS, 0.97, p = 0.44; severe vs. no SIRS, 1.08, p = 0.02; and sepsis vs. no SIRS, 1.12, p = 0.0028). ROC analysis revealed that the NISS (slight vs. no SIRS, AUC 0.61; severe vs. no SIRS, AUC 0.67; and sepsis vs. no SIRS, AUC 0.77) and APACHE II score (slight vs. no SIRS, AUC 0.60; severe vs. no SIRS, AUC 0.74; and sepsis vs. no SIRS, AUC 0.82) had the best predictive ability for SIRS and sepsis.
Quick assessment with the NISS or APACHE II score could preselect possible candidates for sepsis following polytrauma and provide guidance in trauma surgeons' decision-making.
全身炎症反应综合征（SIRS）和脓毒症作为多器官功能障碍综合征（MODS）的病因，在多发伤患者中的治疗仍然具有挑战性。在本研究中，重点关注广泛使用的评分系统以评估其诊断质量。
本回顾性研究纳入了512例损伤严重程度评分（ISS）≥17的患者（平均年龄：39.2±16.2岁，范围：16 - 88岁）。患者被分为四组：无SIRS、轻度SIRS、重度SIRS和脓毒症。入院时收集ISS、新损伤严重程度评分（NISS）、急性生理与慢性健康状况评估II（APACHE II）评分和凝血酶原时间。进行了Kruskal - Wallis检验和χ²检验、多项回归分析以及核密度估计。采用受试者工作特征（ROC）分析并报告曲线下面积（AUC）。若p < 0.05，则数据被视为具有显著性。
所有组的所有变量均存在显著差异（p < 0.001）。NISS的优势比随SIRS严重程度增加而升高（轻度SIRS与无SIRS相比，1.06，p = 0.07；重度SIRS与无SIRS相比，1.07，p = 0.04；脓毒症与无SIRS相比，1.11，p = 0.0028），APACHE II评分亦是如此（轻度SIRS与无SIRS相比，0.97，p = 0.44；重度SIRS与无SIRS相比，1.08，p = 0.02；脓毒症与无SIRS相比，1.12，p = 0.0028）。ROC分析显示，NISS（轻度SIRS与无SIRS相比，AUC 0.61；重度SIRS与无SIRS相比，AUC 0.67；脓毒症与无SIRS相比，AUC 0.77）和APACHE II评分（轻度SIRS与无SIRS相比，AUC 0.60；重度SIRS与无SIRS相比，AUC 0.74；脓毒症与无SIRS相比，AUC 0.82）对SIRS和脓毒症具有最佳预测能力。
使用NISS或APACHE II评分进行快速评估可以预先筛选出多发伤后可能发生脓毒症的患者，并为创伤外科医生的决策提供指导。
