探讨序贯器官衰竭评估（SOFA）评分的效用并创建改良的SOFA评分以预测约旦一家三级医院重症监护病房的死亡率。

Investigating the Utility of the SOFA Score and Creating a Modified SOFA Score for Predicting Mortality in the Intensive Care Units in a Tertiary Hospital in Jordan.

作者信息

Abu-Humaidan Anas H A, Ahmad Fatima M, Theeb Laith S, Sulieman Abdelrahman J, Battah Abdelkader, Bani Hani Amjad, Abu Abeeleh Mahmoud

机构信息

Department of Pathology, Microbiology, and Forensic Medicine, School of Medicine, The University of Jordan, Amman, Jordan.

Department of Clinical Sciences, School of Science, The University of Jordan, Amman, Jordan.

出版信息

Crit Care Res Pract. 2023 Aug 7;2023:3775670. doi: 10.1155/2023/3775670. eCollection 2023.

DOI:10.1155/2023/3775670

PMID:37583653

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10425253/

Abstract

BACKGROUND

The utility of the Sequential Organ Failure Assessment (SOFA) score in predicting mortality in the intensive care unit (ICU) has been demonstrated before, but serial testing in various settings is required to validate and improve the score. This study examined the utility of the SOFA score in predicting mortality in Jordanian ICU patients and aimed to find a modified score that required fewer laboratory tests.

METHODS

A prospective observational study was conducted at Jordan University Hospital (JUH). All adult patients admitted to JUH ICUs between June and December 2020 were included in the study. SOFA scores were measured daily during the whole ICU stay. A modified SOFA score (mSOFA) was constructed from the available laboratory, clinical, and demographic data. The performance of the SOFA, mSOFA, qSOFA, and SIRS in predicting ICU mortality was assessed using the area under the receiver operating characteristic curve (AUROC).

RESULTS

194 patients were followed up. SOFA score (mean ± SD) at admission was significantly higher in non-survivors (7.5 ± 3.9) compared to survivors (2.4 ± 2.2) and performed the best in predicting ICU mortality (AUROC = 0.8756, 95% CI: 0.8117-0.9395) compared to qSOFA (AUROC = 0.746, 95% CI: 0.655-0.836) and SIRS (AUROC = 0.533, 95% CI: 0.425-0.641). The constructed mSOFA included points for the hepatic and CNS SOFA scores, in addition to one point each for the presence of chronic kidney disease or the use of breathing support; it performed as well as the SOFA score in this cohort or better than the SOFA score in a subgroup of patients with heart disease.

CONCLUSION

SOFA score was a good predictor of mortality in a Jordanian ICU population and better than qSOFA, while SIRS could not predict mortality. Furthermore, the proposed mSOFA score which employed fewer laboratory tests could be used after validation from larger studies.

摘要

背景

序贯器官衰竭评估（SOFA）评分在预测重症监护病房（ICU）患者死亡率方面的效用此前已得到证实，但需要在各种情况下进行系列测试以验证和改进该评分。本研究探讨了SOFA评分在预测约旦ICU患者死亡率方面的效用，并旨在找到一种需要较少实验室检查的改良评分。

方法

在约旦大学医院（JUH）进行了一项前瞻性观察性研究。纳入了2020年6月至12月期间入住JUH ICU的所有成年患者。在整个ICU住院期间每天测量SOFA评分。根据可用的实验室、临床和人口统计学数据构建了改良SOFA评分（mSOFA）。使用受试者工作特征曲线下面积（AUROC）评估SOFA、mSOFA、快速SOFA（qSOFA）和全身炎症反应综合征（SIRS）在预测ICU死亡率方面的表现。

结果

对194例患者进行了随访。与幸存者（2.4±2.2）相比，非幸存者入院时的SOFA评分（均值±标准差）显著更高（7.5±3.9），并且在预测ICU死亡率方面表现最佳（AUROC = 0.8756，95%可信区间：0.8117 - 0.9395），优于qSOFA（AUROC = 0.746，95%可信区间：0.655 - 0.836）和SIRS（AUROC = 0.533，95%可信区间：0.425 - 0.641）。构建的mSOFA除了为慢性肾脏病的存在或使用呼吸支持各计1分外，还包括肝脏和中枢神经系统SOFA评分的分值；在该队列中，其表现与SOFA评分相当，在心脏病患者亚组中比SOFA评分更好。