Wang Lingling, Chen Rui, Mo Zexun, Dong Jiahui, Sun Zhaokun, Xiao Fei, Hu Shaoting, Xiong Richeng, Sun Jie, Yu Zhou, Guo Zhenhui
Department of Critical Care Medicine, General Hospital of Guangzhou Military Command, Guangdong Provincial Key Laboratory of Geriatric Infection and Organ Function Support, Guangzhou Key Laboratory of Geriatric Infection and Organ Function Support, Guangzhou 510010, Guangdong, China. Corresponding author: Guo Zhenhui, Email:
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2017 Feb;29(2):145-149. doi: 10.3760/cma.j.issn.2095-4352.2017.02.010.
To explore the predictive value of sequential organ failure assessment (SOFA) score combined the acute gastrointestinal injury (AGI) grading system in critical elderly patients with sepsis.
A retrospective analysis was conducted. Elderly patients with sepsis aged > 60 years admitted to medical intensive care unit (MICU) of General Hospital of Guangzhou Military Command from March 2014 to December 2015 and experiencing critical care over 48 hours were enrolled. Age, gender, acute physiology and chronic health evaluation II (APACHE II) score, sequential organ failure assessment (SOFA) score and AGI score at admission (SOFA, AGI), the highest SOFA score and AGI score within the first week (SOFA, AGI), serum procalcitonin (PCT), C-reactive protein (CRP), albumin (ALB), platelet (PLT), hemoglobin (Hb) and lactate (Lac) levels, length of ICU stay, usage of mechanical ventilation and renal replacement therapy were recorded. The primary end point was 28-day mortality. To extract factors affecting 28-day mortality, the risk factor of death of the senile sepsis patients were analyzed by binary logistic regression analysis (stepwise method). Fitness of the model was assessed by the Hosmer-Lemeshow test and calibration plot (P > 0.05). Receiver operating characteristic (ROC) analysis was performed for APACHE II score, SOFA score, SOFA score, AGI score, AGI score and SOFA and combined AGI score.
Ninety-one patients were enrolled, the incidence of AGI in elderly patients with sepsis was 100%; 34 patients died 28 days after the admission, and the 28-day mortality rate was 37.4%. Non-survivors presented a higher APACHE II score, SOFA score, SOFA score, AGI score, AGI score and longer usage of mechanical ventilation and renal replacement therapy. SOFA score [odds ratio (OR) = 1.576] and AGI score (OR = 5.695) were associated with 28-day mortality in binary logistic regression analysis (both P < 0.01). The area under the curve (AUC) and 95% confidence interval (95%CI) of SOFA score combined AGImax score was significantly higher than that of SOFA score, SOFA score, AGI score, AGI score and APACHE II score [0.806 (0.710-0.881) vs. 0.723 (0.619-0.812), 0.786 (0.688-0.865), 0.641 (0.533-0.739), 0.633 (0.526-0.881), 0.638 (0.531-0.736), all P < 0.05]. The Youden index (55.37) and positive predict value (5.51) of SOFA score combined AGI score were the largest. When its cut-off value reached 14, the sensitivity and specificity was 67.65% and 87.72%, respectively. According to score of APACHE II, SOFA, SOFA or AGI, the higher of each score, the higher mortality rate could be.
The combination of SOFA score and AGIscore enable accurate prediction in elderly patients with sepsis.
探讨序贯器官衰竭评估（SOFA）评分联合急性胃肠损伤（AGI）分级系统对老年重症脓毒症患者的预测价值。
进行回顾性分析。选取2014年3月至2015年12月入住广州军区总医院医学重症监护病房（MICU）、年龄>60岁、脓毒症且接受48小时以上重症监护的老年患者。记录患者的年龄、性别、急性生理与慢性健康状况评分系统II（APACHE II）评分、入院时的序贯器官衰竭评估（SOFA）评分和AGI评分（SOFA、AGI）、第一周内最高的SOFA评分和AGI评分（SOFA、AGI）、血清降钙素原（PCT）、C反应蛋白（CRP）、白蛋白（ALB）、血小板（PLT）、血红蛋白（Hb）和乳酸（Lac）水平、ICU住院时间、机械通气和肾脏替代治疗的使用情况。主要终点为28天死亡率。采用二元逻辑回归分析（逐步法）分析老年脓毒症患者死亡的危险因素，以提取影响28天死亡率的因素。通过Hosmer-Lemeshow检验和校准图评估模型的拟合优度（P>0.05）。对APACHE II评分、SOFA评分、SOFA评分、AGI评分、AGI评分以及SOFA与AGI联合评分进行受试者操作特征（ROC）分析。
共纳入91例患者，老年脓毒症患者AGI发生率为100%；34例患者入院后28天死亡，28天死亡率为37.4%。死亡患者的APACHE II评分、SOFA评分、SOFA评分、AGI评分、AGI评分更高，机械通气和肾脏替代治疗的使用时间更长。二元逻辑回归分析显示，SOFA评分[比值比（OR）=1.576]和AGI评分（OR=5.695）与28天死亡率相关（均P<0.01）。SOFA评分联合AGImax评分的曲线下面积（AUC）及95%置信区间（95%CI）显著高于SOFA评分、SOFA评分、AGI评分、AGI评分及APACHE II评分[0.806（0.710-0.881）对0.723（0.619-0.812）、0.786（0.688-0.865）、0.641（0.533-0.739）、0.633（0.526-0.881）、0.638（0.531-0.736），均P<0.05]。SOFA评分联合AGI评分的约登指数（55.37）和阳性预测值（5.51）最大。当截断值达到第14时，其敏感性和特异性分别为67.65%和87.72%。根据APACHE II、SOFA、SOFA或AGI评分，各评分越高，死亡率越高。
SOFA评分与AGI评分相结合能够准确预测老年脓毒症患者病情。
