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序贯器官衰竭评估可预测脉搏指示连续心输出量导向目标治疗的结果:一项前瞻性研究。

Sequential Organ Failure Assessment predicts outcomes of pulse indicator contour continuous cardiac output-directed goal therapy: A prospective study.

作者信息

Zhang Wei, Danzeng Quzhen, Feng Xiaoting, Cao Xing, Chen Weiwei, Kang Yan

机构信息

Department of Critical Care Medicine, Sichuan University West China Hospital, Chengdu, Sichuan Department of Critical Care Medicine, Affiliated Hospital of Zunyi Medical College Department of Critical Care Medicine, First People's Hospital of Zunyi, Zunyi, Guizhou, China.

出版信息

Medicine (Baltimore). 2017 Sep;96(39):e8111. doi: 10.1097/MD.0000000000008111.

Abstract

According to the new sepsis definitions, septic shock is defined as a subset of sepsis in which the underlying circulatory and cellular/metabolic abnormalities are profound enough to substantially increase mortality. We evaluated the predictive efficacy of the Sequential Organ Failure Assessment (SOFA) score in critically ill patients with septic shock undergoing pulse indicator contour continuous cardiac output (PiCCO)-directed goal therapy (PDGT).We conducted a single-center, prospective, observational study of 52 patients with septic shock undergoing PDGT. The putative prognostic factors, including the severity scores (SOFA and Acute Physiology and Chronic Health Evaluation II [APACHE II] scores), were analyzed within 24 hours after diagnosis of septic shock. We assessed and compared the predictive efficacy of risk factors for 28-day mortality of patients with septic shock undergoing PDGT.Among the patients with septic shock undergoing PDGT, the SOFA scores of nonsurvivors were significantly higher than those of survivors (P < .001); the area under the receiver operating characteristics curve was higher for SOFA than for APACHE II (P = .005). The outcomes of the logistic regression analysis for 28-day mortality showed that the odds ratio, 95% confidence interval, and P-value of SOFA were 1.6, 1.2 to 2.1, and <.001, respectively.The predictive model of the SOFA score is able to accurately predict the outcomes of critically ill patients with septic shock undergoing PDGT.

摘要

根据新的脓毒症定义,感染性休克被定义为脓毒症的一个子集,其中潜在的循环和细胞/代谢异常严重到足以大幅增加死亡率。我们评估了序贯器官衰竭评估(SOFA)评分对接受脉搏指示连续心输出量(PiCCO)导向目标治疗(PDGT)的感染性休克重症患者的预测效果。我们对52例接受PDGT的感染性休克患者进行了一项单中心、前瞻性观察研究。在感染性休克诊断后24小时内分析了包括严重程度评分(SOFA和急性生理与慢性健康状况评分II [APACHE II])在内的假定预后因素。我们评估并比较了接受PDGT的感染性休克患者28天死亡率危险因素的预测效果。在接受PDGT的感染性休克患者中,非幸存者的SOFA评分显著高于幸存者(P <.001);SOFA的受试者工作特征曲线下面积高于APACHE II(P =.005)。28天死亡率的逻辑回归分析结果显示,SOFA的比值比、95%置信区间和P值分别为1.6、1.2至2.1和<.001。SOFA评分预测模型能够准确预测接受PDGT的感染性休克重症患者的预后。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4d01/5626278/9784f54800d2/medi-96-e8111-g001.jpg

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