Wu Jiali, Xiao Hongke, Li Xue, Cao Rui, Kang Xiangfei, Ma Hanning, Wang Xingyi, Yang Lishan
Department of Emergency, General Hospital of Ningxia Medical University, Yinchuan 750004, Ningxia Hui Autonomous Region, China. Corresponding author: Yang Lishan, Email:
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2021 Sep;33(9):1057-1062. doi: 10.3760/cma.j.cn121430-20210115-00076.
To explore the evaluation value of sequential organ failure assessment (SOFA) score at different time points in the prognosis of patients with severe pneumonia combined with acute respiratory distress syndrome (ARDS).
A retrospective cohort study method was conducted, including patients with severe pneumonia and ARDS admitted to the emergency intensive care unit (ICU) of General Hospital of Ningxia Medical University from January 2015 to December 2019. General clinical data such as gender, age, and the SOFA scores at 1, 2, 3, and 7 days after admission were recorded. According to the diagnostic test, the prognostic evaluation value of SOFA score in patients with severe pneumonia combined with ARDS at different time points and different ages was analyzed.
A total of 88 cases were included in this study, eventually, 42 cases were survived and 46 cases died, the mortality was 52.27%. The age of the death group was significantly older than the survival group (years old: 60.67±14.66 vs. 51.91±15.97), the SOFA score at each time point were significantly higher than those in the survival group (9.83±3.50 vs. 7.54±2.67, 9.98±3.75 vs. 7.48±2.92, 10.84±4.14 vs. 7.23±2.94, 11.71±4.03 vs. 6.51±3.22, respectively at 1, 2, 3, 7 days after admission, all P < 0.01). The receiver operator characteristic curve (ROC curve) showed that the SOFA score at 1, 2, 3, and 7 days after admission had a certain predictive value for the prognosis of patients with severe pneumonia combined with ARDS (all P < 0.01), and with the prolong of ICU stay, the area under ROC curve (AUC) of SOFA score had gradually increased. On the 7th day after admission, the SOFA score had the highest sensitivity in predicting severe pneumonia combined with ARDS patients, which was 92.86%, and the specificity was the highest on the 3rd day after admission, which was 88.10%. The AUC in day 7 was significantly higher than day 2 (0.85 vs. 0.72), there was no statistically significant difference of AUC at other time points. After stratifying by age, the diagnostic of sensitivity, specificity, accuracy, and AUC of SOFA score for the prognosis had gradually increased, and the predictive value was better. However, only on day 3 after admission, the AUC of SOFA score was significantly higher than day 1 (0.80 vs. 0.77, P < 0.05), and there was no significant difference in AUC at other time points. In patients older than 60 years old, the AUC of the SOFA score predicting the prognosis of patients was relatively small on day 1 and day 2 (0.67, 0.68, respectively), the ability was poor. There was no statistically significant difference in the AUC of SOFA scores at each time point in evaluating the prognosis of patients. The trends over time of patients at different ages and time points showed that regardless of age, the SOFA scores of the patients in the death group showed an upward trend, while showed a downward trend in the survival group, the difference reached the largest on the 7th day after admission, and the death group was significantly higher than the survival group (age < 60 years old: 12.50 vs. 6.69; age ≥ 60 years old: 11.58 vs. 6.21).
The initial SOFA score has a certain value in the evaluation of prognosis of severe pneumonia patients combined with ARDS, but the effect is poor for elderly patients.
探讨序贯器官衰竭评估（SOFA）评分在不同时间点对重症肺炎合并急性呼吸窘迫综合征（ARDS）患者预后的评估价值。
采用回顾性队列研究方法，纳入2015年1月至2019年12月在宁夏医科大学总医院急诊重症监护病房（ICU）收治的重症肺炎合并ARDS患者。记录患者的性别、年龄等一般临床资料以及入院后1、2、3、7天的SOFA评分。根据诊断试验，分析SOFA评分在不同时间点及不同年龄段对重症肺炎合并ARDS患者预后的评估价值。
本研究共纳入88例患者，最终42例存活，46例死亡，死亡率为52.27%。死亡组年龄显著大于存活组（岁：60.67±14.66 vs. 51.91±15.97），各时间点的SOFA评分均显著高于存活组（入院后1、2、3、7天分别为9.83±3.50 vs. 7.54±2.67、9.98±3.75 vs. 7.48±2.92、10.84±4.14 vs. 7.23±2.94、11.71±4.03 vs. 6.51±3.22，均P<0.01）。受试者工作特征曲线（ROC曲线）显示，入院后1、2、3、7天的SOFA评分对重症肺炎合并ARDS患者的预后有一定预测价值（均P<0.01），且随着ICU住院时间延长，SOFA评分的ROC曲线下面积（AUC）逐渐增大。入院第7天，SOFA评分预测重症肺炎合并ARDS患者的敏感度最高，为92.86%，入院第3天特异性最高，为88.10%。第7天的AUC显著高于第2天（0.85 vs. 0.72），其他时间点的AUC差异无统计学意义。按年龄分层后，SOFA评分对预后诊断的敏感度、特异性、准确性及AUC逐渐升高，预测价值更好。但仅入院后第3天，SOFA评分的AUC显著高于第1天（0.80 vs. 0.77，P<0.05），其他时间点的AUC差异无统计学意义。在年龄大于60岁的患者中，入院第1天和第2天SOFA评分预测患者预后的AUC相对较小（分别为0.67、0.68），预测能力较差。各时间点SOFA评分评估患者预后的AUC差异无统计学意义。不同年龄和时间点患者的随时间变化趋势显示，无论年龄大小，死亡组患者的SOFA评分呈上升趋势，而存活组呈下降趋势，入院第7天差异最大，死亡组显著高于存活组（年龄<60岁：12.50 vs. 6.69；年龄≥60岁：11.58 vs. 6.21）。
初始SOFA评分对重症肺炎合并ARDS患者的预后评估有一定价值，但对老年患者效果较差。
