Yuan Shaoxin, Gao Yusong, Ji Wenqing, Song Junshuai, Mei Xue
Department of Emergency Medicine, Miyun Teaching Hospital Affiliated to Capital Medical University Department of Emergency Medicine, Peking University First Hospital Department of Emergency Medicine, Chao-Yang Hospital Affiliated to Capital Medical University, Beijing Department of Emergency Medicine, Rushan Peoples Hospital, Shandong, China.
Medicine (Baltimore). 2018 May;97(21):e10862. doi: 10.1097/MD.0000000000010862.
The aim of this study was to assess the ability of acute physiology and chronic health evaluation II (APACHE II) score, poisoning severity score (PSS) as well as sequential organ failure assessment (SOFA) score combining with lactate (Lac) to predict mortality in the Emergency Department (ED) patients who were poisoned with organophosphate.A retrospective review of 59 stands-compliant patients was carried out. Receiver operating characteristic (ROC) curves were constructed based on the APACHE II score, PSS, SOFA score with or without Lac, respectively, and the areas under the ROC curve (AUCs) were determined to assess predictive value. According to SOFA-Lac (a combination of SOFA and Lac) classification standard, acute organophosphate pesticide poisoning (AOPP) patients were divided into low-risk and high-risk groups. Then mortality rates were compared between risk levels.Between survivors and non-survivors, there were significant differences in the APACHE II score, PSS, SOFA score, and Lac (all P < .05). The AUCs of the APACHE II score, PSS, and SOFA score were 0.876, 0.811, and 0.837, respectively. However, after combining with Lac, the AUCs were 0.922, 0.878, and 0.956, respectively. According to SOFA-Lac, the mortality of high-risk group was significantly higher than low-risk group (P < .05) and the patients of the non-survival group were all at high risk.These data suggest the APACHE II score, PSS, SOFA score can all predict the prognosis of AOPP patients. For its simplicity and objectivity, the SOFA score is a superior predictor. Lac significantly improved the predictive abilities of the 3 scoring systems, especially for the SOFA score. The SOFA-Lac system effectively distinguished the high-risk group from the low-risk group. Therefore, the SOFA-Lac system is significantly better at predicting mortality in AOPP patients.
本研究旨在评估急性生理学与慢性健康状况评价系统II（APACHE II）评分、中毒严重程度评分（PSS）以及序贯器官衰竭评估（SOFA）评分联合乳酸（Lac）对有机磷中毒急诊患者死亡率的预测能力。对59例符合标准的患者进行了回顾性研究。分别基于APACHE II评分、PSS、有无Lac的SOFA评分构建受试者工作特征（ROC）曲线，并确定ROC曲线下面积（AUC）以评估预测价值。根据SOFA-Lac（SOFA与Lac的组合）分类标准，将急性有机磷农药中毒（AOPP）患者分为低风险组和高风险组。然后比较不同风险水平的死亡率。在幸存者和非幸存者之间，APACHE II评分、PSS、SOFA评分和Lac存在显著差异（均P<0.05）。APACHE II评分、PSS和SOFA评分的AUC分别为0.876、0.811和0.837。然而，与Lac联合后，AUC分别为0.922、0.878和0.956。根据SOFA-Lac，高风险组的死亡率显著高于低风险组（P<0.05），且非存活组患者均为高风险。这些数据表明，APACHE II评分、PSS、SOFA评分均可预测AOPP患者的预后。SOFA评分因其简单性和客观性，是一种更优的预测指标。Lac显著提高了这3种评分系统的预测能力，尤其是对SOFA评分。SOFA-Lac系统有效地将高风险组与低风险组区分开来。因此，SOFA-Lac系统在预测AOPP患者死亡率方面明显更优。
