Hutchings Lynn, Watkinson Peter, Young J Duncan, Willett Keith
From the Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences (L.H., K.W.), and Department of Clinical Neurosciences (J.D.Y., P.W.) University of Oxford, United Kingdom.
J Trauma Acute Care Surg. 2017 Mar;82(3):534-541. doi: 10.1097/TA.0000000000001328.
Postinjury multiple organ failure (MOF) remains a significant cause of morbidity and mortality. A large number of scoring systems have been proposed to define MOF, with no criterion standard. The purpose of this study was to compare three commonly used scores: the Denver Postinjury Multiple Organ Failure Score, the Sequential Organ Failure Assessment (SOFA), and the Marshall Multiple Organ Dysfunction Score, by descriptive analysis of the populations described by each score, and their predictive ability for mortality.
An observational cohort study was performed at a UK trauma center on major trauma patients requiring intensive care unit admission from 2003 to 2011. A novel trauma database was created, merging national audit data with local electronic monitoring systems. Data were collected on demographics, laboratory results, pharmacy, interventions, and hourly physiological monitoring. The primary outcome measure was mortality within 100 days from injury. Sensitivity analyses and receiver operating characteristic curves were used to assess the predictive ability of MOF scores for mortality.
In total, 491 patients were included in the trauma database. MOF incidence ranged from 22.8% (Denver) to 40.5% (Marshall) to 58.5% (SOFA). MOF definition did not affect timing of onset, but did alter duration and organ failure patterns. Overall mortality was 10.6%, with Denver MOF associated with the greatest increased risk of death (hazard ratio 3.87, 95% confidence interval, 2.24-6.66). No significant difference was observed in area under the receiver operating characteristic curve values between scores. Marked differences were seen in relative predictors, with Denver showing highest specificity (81%) and SOFA highest sensitivity (73%) for mortality.
The choice of MOF scoring system affects incidence, duration, organ dysfunction patterns, and mortality prediction. We would recommend use of the Denver score since it is simplest to calculate, identifies a high-risk group of patients, and has the strongest association with early trauma mortality.
Epidemiological study, level III.
创伤后多器官功能衰竭（MOF）仍然是发病和死亡的重要原因。已经提出了大量的评分系统来定义MOF，但没有标准准则。本研究的目的是通过对每个评分所描述的人群进行描述性分析，比较三种常用的评分：丹佛创伤后多器官功能衰竭评分、序贯器官衰竭评估（SOFA）和马歇尔多器官功能障碍评分，以及它们对死亡率的预测能力。
在英国一家创伤中心对2003年至2011年需要入住重症监护病房的重大创伤患者进行了一项观察性队列研究。创建了一个新的创伤数据库，将国家审计数据与当地电子监测系统合并。收集了人口统计学、实验室结果、药房、干预措施和每小时生理监测的数据。主要结局指标是受伤后100天内的死亡率。采用敏感性分析和受试者工作特征曲线来评估MOF评分对死亡率的预测能力。
创伤数据库共纳入491例患者。MOF发生率从22.8%（丹佛评分）到40.5%（马歇尔评分）再到58.5%（SOFA评分）不等。MOF的定义不影响发病时间，但会改变持续时间和器官衰竭模式。总体死亡率为10.6%，丹佛MOF与死亡风险增加最大相关（风险比3.87，95%置信区间，2.24 - 6.66）。各评分之间受试者工作特征曲线下面积值未观察到显著差异。在相对预测指标上存在明显差异，丹佛评分对死亡率的特异性最高（81%），SOFA评分的敏感性最高（73%）。
MOF评分系统的选择会影响发生率、持续时间、器官功能障碍模式和死亡率预测。我们建议使用丹佛评分，因为它计算最简单，能识别出高危患者群体，并且与早期创伤死亡率的关联最强。
流行病学研究，III级。
