心脏手术后重症监护病房患者中序贯器官衰竭评估（SOFA）评分对死亡率的预测；与传统预后模型的比较
Mortality prediction by SOFA score in ICU-patients after cardiac surgery; comparison with traditional prognostic-models.
作者信息
Schoe Abraham, Bakhshi-Raiez Ferishta, de Keizer Nicolette, van Dissel Jaap T, de Jonge Evert
机构信息
Department of Intensive Care, Leiden University Medical Center, University of Leiden, Albinusdreef 2, P.O. Box 9600, 2300 RC, Leiden, the Netherlands.
Department of Medical Informatics, Amsterdam Public Health research institute, Amsterdam Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
出版信息
BMC Anesthesiol. 2020 Mar 13;20(1):65. doi: 10.1186/s12871-020-00975-2.
BACKGROUND
There are many prognostic models and scoring systems in use to predict mortality in ICU patients. The only general ICU scoring system developed and validated for patients after cardiac surgery is the APACHE-IV model. This is, however, a labor-intensive scoring system requiring a lot of data and could therefore be prone to error. The SOFA score on the other hand is a simpler system, has been widely used in ICUs and could be a good alternative. The goal of the study was to compare the SOFA score with the APACHE-IV and other ICU prediction models.
METHODS
We investigated, in a large cohort of cardiac surgery patients admitted to Dutch ICUs, how well the SOFA score from the first 24 h after admission, predict hospital and ICU mortality in comparison with other recalibrated general ICU scoring systems. Measures of discrimination, accuracy, and calibration (area under the receiver operating characteristic curve (AUC), Brier score, R, and Ĉ-statistic) were calculated using bootstrapping. The cohort consisted of 36,632 Patients from the Dutch National Intensive Care Evaluation (NICE) registry having had a cardiac surgery procedure for which ICU admission was necessary between January 1st, 2006 and June 31st, 2018.
RESULTS
Discrimination of the SOFA-, APACHE-IV-, APACHE-II-, SAPS-II-, MPM-II - models to predict hospital mortality was good with an AUC of respectively: 0.809, 0.851, 0.830, 0.850, 0.801. Discrimination of the SOFA-, APACHE-IV-, APACHE-II-, SAPS-II-, MPM-II - models to predict ICU mortality was slightly better with AUCs of respectively: 0.809, 0.906, 0.892, 0.919, 0.862. Calibration of the models was generally poor.
CONCLUSION
Although the SOFA score had a good discriminatory power for hospital- and ICU mortality the discriminatory power of the APACHE-IV and SAPS-II was better. The SOFA score should not be preferred as mortality prediction model above traditional prognostic ICU-models.
背景
目前有许多预后模型和评分系统用于预测重症监护病房（ICU）患者的死亡率。唯一针对心脏手术后患者开发并验证的通用ICU评分系统是急性生理与慢性健康状况评分系统IV（APACHE-IV）模型。然而，这是一个劳动强度大的评分系统，需要大量数据，因此可能容易出错。另一方面，序贯器官衰竭评估（SOFA）评分是一个更简单的系统，已在ICU中广泛使用，可能是一个很好的替代方案。本研究的目的是比较SOFA评分与APACHE-IV及其他ICU预测模型。
方法
我们在一大群入住荷兰ICU的心脏手术患者中进行调查，将入院后最初24小时的SOFA评分与其他重新校准的通用ICU评分系统相比，评估其预测医院和ICU死亡率的效果如何。使用自抽样法计算区分度、准确性和校准度指标（受试者工作特征曲线下面积（AUC）、Brier评分、R和C统计量）。该队列由来自荷兰国家重症监护评估（NICE）登记处的36632名患者组成，这些患者在2006年1月1日至2018年6月31日期间接受了需要入住ICU的心脏手术。
结果
SOFA、APACHE-IV、APACHE-II、简化急性生理学评分-II（SAPS-II）、死亡率预测模型-II（MPM-II）模型预测医院死亡率的区分度良好，AUC分别为：0.809、0.851、0.830、0.850、0.801。SOFA、APACHE-IV、APACHE-II、SAPS-II、MPM-II模型预测ICU死亡率的区分度稍好，AUC分别为：0.809、0.906、0.892、0.919、0.862。这些模型的校准度总体较差。
结论
尽管SOFA评分对医院和ICU死亡率具有良好的区分能力，但APACHE-IV和SAPS-II的区分能力更好。在作为死亡率预测模型方面，SOFA评分不应优于传统的预后ICU模型。
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