Jawaharlal Nehru Medical College, Belagavi.
J Assoc Physicians India. 2022 Apr;70(4):11-12.
Sepsis is a life-threatening organ dysfunction with high mortality and morbidity. Various mortality prediction scores are currently in use for prediction of mortality. Although combination of various scores have not been used before. The aim of the study was to compare SOFA, APACHE II, SAPS II, as a predictor of mortality and to assess the usefulness of combination of different scores.
A one-year hospital based prospective study conducted from 1st January 2020 to 31st December 2020 in medical ICU, where 100 patients of sepsis admitted in ICU with evidence of organ dysfunction were included in the study and various scores like SOFA, APACHE II, and SAPS II were calculated at 24 and 48 hours of admission, using laboratory results and clinical examination. and an attempt to access for predictive accuracy of combination of scores was undertaken.
Majority of the patients (37%) were in the age group of 60-79 years with maximum mortality in this age group of (39.22 %). Mortality rate was 51%, with higher mortality in the female group being 68.63%. Diabetes was most common comorbid in our study (41%). No significant difference was observed in physiological variable over 24 and 48 hours, however decrease in WBC and platelet count was noted at the end of 48 hours; Mean SOFA, APACHE II, SAPS II were significantly higher in the mortality group than the recovery group; All three scores had good diagnostic performance, with max sensitivity at 24 and 48 hours with APACHE II being 64.10% and 78.79% respectively, max specificity at 24 and 48 hours was noticed with SAPS II being 96.97% and 87.88% respectively. On further combination of scores, maximum sensitivity was seen with SOFA plus APACHE II at 48 hours of 74.36%, maximum specificity was seen at 24 hours with SOFA plus SAPS II of 93.94%. Upon application of Youden's index to the combination of scores, best diagnostic performance was seen with SOFA plus SAPS II at 48 hours.
All the three scores showed good mortality prediction rate but among the scores higher sensitivity was seen with APACHE II score at 24 and 48 hours and higher specificity was seen with SAPS II at 24 and 48 hours. Combination of scores did show a slightly better predictability with combination of SAPS II and SOFA showing maximum Youden's index at 48 hours. Mortality was comparatively higher among the females and elderly group with most common risk factor being diabetes.
比较 SOFA、APACHE II 和 SAPS II 作为死亡率预测指标的作用，并评估不同评分组合的有用性。
这是一项为期一年的医院前瞻性研究，于 2020 年 1 月 1 日至 2020 年 12 月 31 日在 ICU 进行，共纳入了 100 例 ICU 中患有器官功能障碍的败血症患者，在入院后 24 小时和 48 小时计算 SOFA、APACHE II 和 SAPS II 评分，使用实验室结果和临床检查。并尝试评估评分组合的预测准确性。
大多数患者（37%）年龄在 60-79 岁之间，该年龄段的死亡率最高（39.22%）。死亡率为 51%，女性组死亡率更高，为 68.63%。糖尿病是我们研究中最常见的合并症（41%）。在 24 小时和 48 小时内，生理变量无显著差异，但在 48 小时末，白细胞和血小板计数下降；死亡组的平均 SOFA、APACHE II 和 SAPS II 评分显著高于恢复组；所有三种评分的诊断性能均较好，APACHE II 在 24 小时和 48 小时时的灵敏度最高，分别为 64.10%和 78.79%，SAPS II 在 24 小时和 48 小时时的特异性最高，分别为 96.97%和 87.88%。进一步联合评分后，SOFA 联合 APACHE II 在 48 小时时的灵敏度最高，为 74.36%，SOFA 联合 SAPS II 在 24 小时时的特异性最高，为 93.94%。应用约登指数对评分组合进行分析，SOFA 联合 SAPS II 在 48 小时时的诊断性能最佳。
所有三种评分都显示出良好的死亡率预测率，但在评分中，APACHE II 评分在 24 小时和 48 小时时的灵敏度更高，SAPS II 评分在 24 小时和 48 小时时的特异性更高。评分组合显示出稍好的预测性，SAPS II 和 SOFA 的组合在 48 小时时的约登指数最高。女性和老年组的死亡率较高，最常见的危险因素是糖尿病。
