Zhang Di, Wang Changyong, Li Qianfeng, Zhu Yi, Zou Handong, Li Guang, Zhan Liying
Department of Critical Care Medicine, Renmin Hospital of Wuhan University, Wuhan 430060, China.
Department of Neurosurgery, Wuhan No. 1 Hospital, Wuhan 430022, China.
Biomedicines. 2024 Jun 25;12(7):1415. doi: 10.3390/biomedicines12071415.
The heterogeneity nature of sepsis is significantly impacted by the site of infection. This study aims to explore the predictive value of multiple scoring systems in assessing the prognosis of septic patients across different infection sites. Data for this retrospective cohort study were extracted from the Medical Information Mart for Intensive Care IV database (MIMIC-IV) (v2.2). Adult patients meeting the criteria for sepsis 3.0 and admitted to the intensive care unit (ICU) were enrolled. Infection sites included were pneumonia, urinary tract infection (UTI), cellulitis, abdominal infection, and bacteremia. The primary outcome assessed was 28-day mortality. The sequential Organ Failure Assessment (SOFA) score, Oxford Acute Severity of Illness Score (OASIS), and Logistic Organ Dysfunction System (LODS) score were compared. Binomial logistic regression analysis was conducted to evaluate the association between these variables and mortality. Additionally, differences in the area under the curve (AUC) of receiver operating characteristic (ROC) among the scoring systems were analyzed. A total of 4721 patients were included in the analysis. The average 28-day mortality rate was 9.4%. Significant differences were observed in LODS, OASIS, and SOFA scores between the 28-day survival and non-survival groups across different infection sites ( < 0.01). In the pneumonia group and abdominal infection group, both the LODS and OASIS scoring systems emerged as independent risk factors for mortality in septic patients (odds ratio [OR]: 1.165, 95% confidence interval [CI]: 1.109-1.224, < 0.001; OR: 1.047, 95% CI: 1.028-1.065, < 0.001) (OR: 1.200, 95% CI: 1.091-1.319, < 0.001; OR: 1.060, 95% CI: 1.025-1.095, < 0.001). For patients with UTI, the LODS, OASIS, and SOFA scoring systems were identified as independent risk factors for mortality (OR: 1.142, 95% CI: 1.068-1.220, < 0.001; OR: 1.062, 95% CI: 1.037-1.087, < 0.001; OR: 1.146, 95% CI: 1.046-1.255, = 0.004), with the AUC of LODS score and OASIS significantly higher than that of the SOFA score ( = 0.006). Among patients with cellulitis, the OASIS and SOFA scoring systems were identified as independent risk factors for mortality (OR: 1.055, 95% CI: 1.007-1.106, = 0.025; OR: 1.187, 95% CI: 1.005-1.403, = 0.044), with no significant difference in prognosis prediction observed ( = 0.243). In the bacteremia group, the LODS scoring system was identified as an independent risk factor for mortality (OR: 1.165, 95% CI: 1.109-1.224, < 0.001). The findings suggest that LODS scores offer better prognostic accuracy for predicting the mortality risk in septic patients with pneumonia, abdominal infections, bacteremia, and UTI compared to SOFA scores.
脓毒症的异质性受到感染部位的显著影响。本研究旨在探讨多种评分系统在评估不同感染部位脓毒症患者预后方面的预测价值。这项回顾性队列研究的数据取自重症监护医学信息数据库IV（MIMIC-IV）（版本2.2）。纳入符合脓毒症3.0标准并入住重症监护病房（ICU）的成年患者。纳入的感染部位包括肺炎、尿路感染（UTI）、蜂窝织炎、腹部感染和菌血症。评估的主要结局是28天死亡率。比较了序贯器官衰竭评估（SOFA）评分、牛津急性疾病严重程度评分（OASIS）和逻辑器官功能障碍系统（LODS）评分。进行二项逻辑回归分析以评估这些变量与死亡率之间的关联。此外，分析了各评分系统的受试者工作特征曲线（ROC）下面积（AUC）的差异。分析共纳入4721例患者。平均28天死亡率为9.4%。在不同感染部位的28天生存组和非生存组之间，LODS、OASIS和SOFA评分存在显著差异（<0.01）。在肺炎组和腹部感染组中，LODS和OASIS评分系统均成为脓毒症患者死亡的独立危险因素（比值比[OR]：1.165，95%置信区间[CI]：1.109 - 1.224，<0.001；OR：1.047，95%CI：1.028 - 1.065，<0.001）（OR：1.200，95%CI：1.091 - 1.319，<0.001；OR：1.060，95%CI：1.025 - 1.095，<0.001）。对于UTI患者，LODS、OASIS和SOFA评分系统被确定为死亡的独立危险因素（OR：1.142，95%CI：1.068 - 1.220，<0.001；OR：1.062，95%CI：1.037 - 1.087，<0.001；OR：1.146，95%CI：1.046 - 1.255，=0.004），LODS评分和OASIS的AUC显著高于SOFA评分（=0.006）。在蜂窝织炎患者中，OASIS和SOFA评分系统被确定为死亡的独立危险因素（OR：1.055，95%CI：1.007 - 1.106，=0.025；OR：1.187，95%CI：1.005 - 1.403，=0.044），在预后预测方面未观察到显著差异（=0.243）。在菌血症组中，LODS评分系统被确定为死亡的独立危险因素（OR：1.165，95%CI：1.109 - 1.224，<0.001）。研究结果表明，与SOFA评分相比，LODS评分在预测肺炎、腹部感染、菌血症和UTI脓毒症患者的死亡风险方面具有更好的预后准确性。
