Li Wen, Wang Meiping, Zhu Bo, Zhu Yibing, Xi Xiuming
Department of Critical Care Medicine, Fuxing Hospital, Capital Medical University. 20A Fuxingmenwai Street, Xicheng District, Beijing 100038, China.
Department of Epidemiology and Health Statistics, School of Public Health, Capital Medical University. 10 Xitoutiao, Youanmenwai, Fengtai District, Beijing 100069, China.
Burns Trauma. 2020 Jan 16;8:tkz006. doi: 10.1093/burnst/tkz006. eCollection 2020.
Sepsis is the leading cause of intensive care unit (ICU) admission. The purpose of this study was to explore the prognostic value of the Sequential Organ Failure Assessment (SOFA) score, the Acute Physiological and Chronic Health Evaluation II (APACHE II) score, and procalcitonin (PCT), albumin (ALB), and lactate (LAC) levels in patients with sepsis.
Consecutive adult patients with suspected or documented sepsis at ICU admission were recruited. Their basic vital signs and related auxiliary examinations to determine their PCT and ALB levels and APACHE II score were recorded at ICU admission, and their LAC levels and SOFA scores were recorded for one week after admission. The influence of these variables on hospital mortality was evaluated. Logistic regression was used to derive the Sepsis Hospital Mortality Score (SHMS), a prediction equation describing the relationship between predictors and hospital mortality. The median survival time was calculated by the Kaplan-Meier method. In the validation group, the kappa value was calculated to evaluate the stability of the derived formula.
This study included 894 sepsis patients admitted to 18 ICUs in 16 tertiary hospitals. Patients were randomly assigned to an experimental group (626 cases) and validation group (258 cases). In addition, a nonsurvival group (248 patients) of the experimental group was established according to the outcome at the time of discharge. The hospital mortality rate in the experimental group was 39.6% (248/626). Univariate and multivariate regression analyses revealed that the APACHE II score (odds ratio [OR] = 1.178), △SOFA (OR = 1.186), △LAC (OR = 1.157), and SOFA mean score (OR = 1.086) were independently associated with hospital mortality. The SHMS was calculated as logit(p) = 4.715 - (0.164 × APACHE II) - (0.171 × △SOFA) - (0.145 × △LAC) - (0.082 × SOFA mean). A receiver operating characteristic curve was constructed to further investigate the accuracy of the SHMS, with an area under the curve of 0.851 (95% confidence interval [CI] 0.821-0.882; < 0.001) for hospital mortality. In the low-risk group and high-risk groups, the corresponding median survival times were 15 days and 11 days, respectively.
The APACHE II score, △SOFA, △LAC and SOFA mean score were independently associated with hospital mortality in sepsis patients and accurately predicted the hospital mortality rate and median survival time. Data on the median survival time in sepsis patients could be provided to clinicians to assist in the rational use of limited medical resources by facilitating prudent resource allocation.
ChiCTR-ECH-13003934, retrospectively registered on August 03, 2013.
脓毒症是重症监护病房（ICU）收治患者的主要病因。本研究旨在探讨序贯器官衰竭评估（SOFA）评分、急性生理与慢性健康状况评分系统II（APACHE II）评分以及降钙素原（PCT）、白蛋白（ALB）和乳酸（LAC）水平在脓毒症患者中的预后价值。
纳入入住ICU时疑似或确诊脓毒症的成年连续患者。记录其入住ICU时的基本生命体征及相关辅助检查结果，以确定其PCT和ALB水平及APACHE II评分，并记录入住后一周内的LAC水平和SOFA评分。评估这些变量对医院死亡率的影响。采用逻辑回归推导脓毒症医院死亡率评分（SHMS），即描述预测指标与医院死亡率之间关系的预测方程。采用Kaplan-Meier法计算中位生存时间。在验证组中，计算kappa值以评估所推导公式的稳定性。
本研究纳入了16家三级医院18个ICU的894例脓毒症患者。患者被随机分为试验组（626例）和验证组（258例）。此外，根据试验组出院时的结局设立了非存活组（248例患者）。试验组的医院死亡率为39.6%（248/626）。单因素和多因素回归分析显示，APACHE II评分（比值比[OR]=1.178）、△SOFA（OR=1.186）、△LAC（OR=1.157）和SOFA平均评分（OR=1.086）与医院死亡率独立相关。SHMS计算公式为logit(p)=4.715-(0.164×APACHE II)-(0.171×△SOFA)-(0.145×△LAC)-(0.082×SOFA平均)。构建受试者工作特征曲线以进一步研究SHMS的准确性，其预测医院死亡率的曲线下面积为0.851（95%置信区间[CI]0.821 - 0.882；P<0.001）。在低风险组和高风险组中，相应的中位生存时间分别为15天和11天。
APACHE II评分、△SOFA、△LAC和SOFA平均评分与脓毒症患者的医院死亡率独立相关，并能准确预测医院死亡率和中位生存时间。可为临床医生提供脓毒症患者中位生存时间的数据，通过促进谨慎的资源分配来协助合理使用有限的医疗资源。
ChiCTR-ECH-13003934，于2013年8月3日进行回顾性注册。
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