Holder Andre L, Overton Elizabeth, Lyu Peter, Kempker Jordan A, Nemati Shamim, Razmi Fereshteh, Martin Greg S, Buchman Timothy G, Murphy David J
Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Emory University School of Medicine, Atlanta, GA.
Graduate School of Arts and Sciences, Harvard University, Cambridge, MA.
Crit Care Med. 2017 Dec;45(12):2014-2022. doi: 10.1097/CCM.0000000000002708.
To identify circumstances in which repeated measures of organ failure would improve mortality prediction in ICU patients.
Retrospective cohort study, with external validation in a deidentified ICU database.
Eleven ICUs in three university hospitals within an academic healthcare system in 2014.
Adults (18 yr old or older) who satisfied the following criteria: 1) two of four systemic inflammatory response syndrome criteria plus an ordered blood culture, all within 24 hours of hospital admission; and 2) ICU admission for at least 2 calendar days, within 72 hours of emergency department presentation.
NoneMEASUREMENTS AND MAIN RESULTS:: Data were collected until death, ICU discharge, or the seventh ICU day, whichever came first. The highest Sequential Organ Failure Assessment score from the ICU admission day (ICU day 1) was included in a multivariable model controlling for other covariates. The worst Sequential Organ Failure Assessment scores from the first 7 days after ICU admission were incrementally added and retained if they obtained statistical significance (p < 0.05). The cohort was divided into seven subcohorts to facilitate statistical comparison using the integrated discriminatory index. Of the 1,290 derivation cohort patients, 83 patients (6.4%) died in the ICU, compared with 949 of the 8,441 patients (11.2%) in the validation cohort. Incremental addition of Sequential Organ Failure Assessment data up to ICU day 5 improved the integrated discriminatory index in the validation cohort. Adding ICU day 6 or 7 Sequential Organ Failure Assessment data did not further improve model performance.
Serial organ failure data improve prediction of ICU mortality, but a point exists after which further data no longer improve ICU mortality prediction of early sepsis.
确定重复测量器官功能衰竭的情况是否能改善对ICU患者死亡率的预测。
回顾性队列研究，并在一个经过身份识别处理的ICU数据库中进行外部验证。
2014年，一所学术医疗系统内三家大学医院的11个ICU。
符合以下标准的成年人（18岁及以上）：1）在入院24小时内满足四项全身炎症反应综合征标准中的两项，外加一次医嘱血培养；2）在急诊科就诊后72小时内入住ICU至少2个日历日。
无
收集数据直至患者死亡、从ICU出院或到ICU第7天，以先到者为准。将入住ICU当天（ICU第1天）的最高序贯器官衰竭评估（SOFA）评分纳入控制其他协变量的多变量模型。逐步加入入住ICU后前7天最差的SOFA评分，如果其具有统计学意义（p<0.05）则予以保留。将队列分为七个亚组，以使用综合鉴别指数便于进行统计学比较。在1290例推导队列患者中，83例（6.4%）在ICU死亡，而在验证队列的8441例患者中有949例（11.2%）死亡。在验证队列中，逐步加入直至ICU第5天的SOFA数据可改善综合鉴别指数。加入ICU第6天或第7天的SOFA数据并未进一步改善模型性能。
连续的器官衰竭数据可改善对ICU死亡率的预测，但存在一个时间点，在此之后进一步的数据不再能改善对早期脓毒症患者ICU死亡率的预测。
