入院前FRAIL评分和入室后SOFA评分与脓毒性休克患者预后的关系
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摘要
目的探讨脓毒性休克患者入院前FRAIL评分及入室的第一个24小时序贯器官衰竭评分(SOFA)与其预后的关系,以指导临床医师选择合适治疗时机及时救治。方法选择2016年1月～2018年2月首都医科大学附属复兴医院ICU收治住院的113例脓毒性休克患者,以入室28 d作为观察终点,将28 d内继续在ICU治疗或者治愈出院或者转至普通病房者作为生存组,将入ICU 28 d内死亡者作为死亡组。比较两组患者的一般资料、FRAIL评分、急性生理和慢性健康状况评分(APACHEⅡ)、动脉血乳酸(LAC)及降钙素原(PCT)水平等;采用Logistic回归模型分析患者预后的影响因素;单独使用SOFA、FRAIL和联合SOFA和FRAIL预测脓毒性休克的死亡风险,并绘制出ROC曲线,观察FRAIL评分和SOFA评分对脓毒症休克患者预后的预测价值。结果 28 d观察终点时,生存53例,死亡60例。两组入室PCT、FRAIL、SOFA比较,差异有统计学意义(P <0.05);将上述3个指标作为自变量,将生存和死亡作为因变量,进行Logistic回归分析,脓毒性休克死亡的预警方程为logit(P)=-16.045+1.608×FRAIL+1.235×SOFA。SOFA和FRAIL联用对预测脓毒性休克死亡的预测价值最大(AUC=0.928,P <0.01)。结论影响ICU脓毒症患者预后的因素较多,联合FRAIL评分和SOFA评分是预测ICU脓毒症患者死亡较为简单有效的指标。
Objective To investigate the relationship between the pre-admission FRAIL score and the first 24-hour sequential organ failure score(SOFA) after admission of patients with septic shock and their prognosis, so as to guide clinicians to choose appropriate treatment time and timely treatment. Methods From January 2016 to February 2018,113 patients with septic shock who were hospitalized in the ICU of the Fuxing Hospital Affiliated to Capital Medical University, were enrolled. The 28-day entry was used as the end point of observation endpoint, and those who continued to be treated or cured or discharged from ICU within 28 days as survival group observation, and those who died within 28 days as death group. The general data, FRAIL score, acute physiology and chronic health evaluation score(APACHEⅡ), arterial blood lactate(LAC) and procalcitonin(PCT) levels were compared between the two groups. Logistic regression model was used to analyze the prognostic factors of patients. The mortality risk of septic shock was predicted by SOFA, FRAIL alone and combined with SOFA and FRAIL, and the ROC curve was drawn to observe the predictive value of FRAIL scores and SOFA scores for prognosis in patients with septic shock. Results At the end of 28 days, 53 patients survived and 60 died. There were significant differences in PCT, FRAIL and SOFA between the two groups(P < 0.05). The above three indicators were used as independent variables, survival and death were used as dependent variables, Logistic regression analysis was performed, and the early warning equation of septic shock death was used. It is logit(P) =-16.045 +1.608 ×FRAIL +1.235 ×SOFA. The combination of SOFA and FRAIL had the greatest predictive value for predicting septic shock death(AUC=0.928, P < 0.01). Conclusion There are many factors influencing the prognosis of patients with sepsis in ICU. Combined FRAIL score and SOFA score are simple and effective indicators for predicting death in patients with sepsis in ICU.
Objective To investigate the relationship between the pre-admission FRAIL score and the first 24-hour sequential organ failure score(SOFA) after admission of patients with septic shock and their prognosis, so as to guide clinicians to choose appropriate treatment time and timely treatment. Methods From January 2016 to February 2018,113 patients with septic shock who were hospitalized in the ICU of the Fuxing Hospital Affiliated to Capital Medical University, were enrolled. The 28-day entry was used as the end point of observation endpoint, and those who continued to be treated or cured or discharged from ICU within 28 days as survival group observation, and those who died within 28 days as death group. The general data, FRAIL score, acute physiology and chronic health evaluation score(APACHEⅡ), arterial blood lactate(LAC) and procalcitonin(PCT) levels were compared between the two groups. Logistic regression model was used to analyze the prognostic factors of patients. The mortality risk of septic shock was predicted by SOFA, FRAIL alone and combined with SOFA and FRAIL, and the ROC curve was drawn to observe the predictive value of FRAIL scores and SOFA scores for prognosis in patients with septic shock. Results At the end of 28 days, 53 patients survived and 60 died. There were significant differences in PCT, FRAIL and SOFA between the two groups(P < 0.05). The above three indicators were used as independent variables, survival and death were used as dependent variables, Logistic regression analysis was performed, and the early warning equation of septic shock death was used. It is logit(P) =-16.045 +1.608 ×FRAIL +1.235 ×SOFA. The combination of SOFA and FRAIL had the greatest predictive value for predicting septic shock death(AUC=0.928, P < 0.01). Conclusion There are many factors influencing the prognosis of patients with sepsis in ICU. Combined FRAIL score and SOFA score are simple and effective indicators for predicting death in patients with sepsis in ICU.
引文
[1]Fried LP,Tangen CM,Walston J,et al. Frailty in older adults:evidence for a phenotype[J]. J Gerontol A Biol Sci Med Sci,2001:56(3):146-157.
[2]Fried LP,Ferrucci L,Darer J,et al. Untangling the concepts of disability,frailty,and comorbidity:implication for improved targeting and care[J]. J Georontol A Biol Sci Med Sci,2004,59(3):255-263.
[3]Rhodes A,Evans LE,Alhazzani W. et al. Surviving sepsis campaign:international guidelines for management of sepsis and septic shock:2016[J]. Crit Care Med,2017,45(3):486-552.
[4]Knaus WA,Draper EA,Wagner DP,et al. APACHEⅡ:a severity of disease classification system[J]. Crit Care Med,1985,13(10):818-829.
[5]Levy MM,Fink MP,Marshall JC,et al. 2001 SCCM/ESICM/ACP/ATS/SIS international sepsis definitions conference[J]. Crit Care Med,2003,31(4):1250-1256.
[6]Dellinger RP,Levy MM,Rhodes A,el a1. Surviving Sepsis Campaign:international guidelines for management of severe sepsis and septic shock,2012[J]. Intensive Care Med,2013,39:165-228.
[7]Morley JE,Malmstrom TK,Miller DK. A simple frailty questionnaire(FRAIL)predicts outcomes in middle aged African Americans[J]. J Nutr Health Aging,2012,16:601-608.
[8]Schorr CA,Zanotti S,Dellinger RP. Severe sepsis and septic shock:management and performance improvement[J].Virulence,2014,5(1):190-199.
[9]Ratzinger F,Schuardt M,Eichbichler K,et a1. Utility of sepsis biomarkers and the infection probability score to discriminate sepsis and systemic inflammatory response syndrome in standard care patients[J]. PLoS One,2013,8(12):e82 946.
[10]Singer M,Deutschman CS,Seymour CW,et al. The Third International Consensus Definitions for Sepsis and Septic Shock(Sepsis-3)[J]. JAMA,2016,315(8):801-810.
[11]唐章,李福祥,朱忠立.ICU获得性衰弱研究进展[J].西南国防医药,2018,28(20):198-200.
[12]陈晓洁,余容容,陈慧珍.集束化护理措施在ICU获得性衰弱患者中的应用效果评价[J].浙江临床医学,2017,19(9):1733-1735.
[13]陈红,任小莉,程青虹,等.神经肌肉电刺激与早期被动活动对机械通气患者ICU获得性虚弱的影响[J].中国康复医学杂志,2018,33(2):146-150.
[14]Tominaga T,Nonaka T,Takeshita H,et al. A case of intensive care unit-acquired weakness after emergency surgery for acute abdomen[J]. Int J Surg Case Rep,2016,24:131-134.
[15]陈红梅,陈雪梅.APAEHE评分联合血乳酸清除率在评估老年重症肺炎患者预后中的价值[J].临床肺科杂志,2018,23(7):1271-1274.
[16]许晓文.血乳酸清除率指导Ⅰ型呼吸衰竭无创机械通气治疗的临床价值[J].临床肺科杂志,2016,21(11):1990-1992.
[17]杨挺,吴丁烨,阙军.乳酸清除率及APACHEⅡ评分与重症肺炎预后的关系[J].江苏医药,2016,42(17):1924-1925.
[18]Castelli GP,Pognani C,Cita M,et al. Procalcitonin,Creactive protein,white blood cells and SOFA score in ICU:diagnosis and monitoring of sepsis[J]. Minerva Anestesiol,2006,72(1/2):69-80.
[19]王合金,谢江霞,阳书坤.血小板计数和降钙素原在预警脓毒症致多器官功能障碍综合征中的意义[J].临床急诊杂志,2014,15(4):214-216.
[20]张越新,张玲,郭贤庆.PCT、CRP、血乳酸、APACHE、SOFA评分在脓毒症患者疾病严重程度及预后评估中的价值研究[J].中国急救医学,2017,12,37(12):1109-1113.
[21]姜雅珍,翁金龙.APACHEⅡ评分及乳酸乳酸清除率联合应用于脓毒症患者预后的评估价值[J].浙江临床医学,2017,19(1):90-91.
[22]Maguet PL,Malledant Y,Seguin P,et al. Prevalence and impact of frailty on mortality in elderly ICU patients:a prospective,multicenter,observational study[J]Intensive Care Med,2014,40:674-682.
[2]Fried LP,Ferrucci L,Darer J,et al. Untangling the concepts of disability,frailty,and comorbidity:implication for improved targeting and care[J]. J Georontol A Biol Sci Med Sci,2004,59(3):255-263.
[3]Rhodes A,Evans LE,Alhazzani W. et al. Surviving sepsis campaign:international guidelines for management of sepsis and septic shock:2016[J]. Crit Care Med,2017,45(3):486-552.
[4]Knaus WA,Draper EA,Wagner DP,et al. APACHEⅡ:a severity of disease classification system[J]. Crit Care Med,1985,13(10):818-829.
[5]Levy MM,Fink MP,Marshall JC,et al. 2001 SCCM/ESICM/ACP/ATS/SIS international sepsis definitions conference[J]. Crit Care Med,2003,31(4):1250-1256.
[6]Dellinger RP,Levy MM,Rhodes A,el a1. Surviving Sepsis Campaign:international guidelines for management of severe sepsis and septic shock,2012[J]. Intensive Care Med,2013,39:165-228.
[7]Morley JE,Malmstrom TK,Miller DK. A simple frailty questionnaire(FRAIL)predicts outcomes in middle aged African Americans[J]. J Nutr Health Aging,2012,16:601-608.
[8]Schorr CA,Zanotti S,Dellinger RP. Severe sepsis and septic shock:management and performance improvement[J].Virulence,2014,5(1):190-199.
[9]Ratzinger F,Schuardt M,Eichbichler K,et a1. Utility of sepsis biomarkers and the infection probability score to discriminate sepsis and systemic inflammatory response syndrome in standard care patients[J]. PLoS One,2013,8(12):e82 946.
[10]Singer M,Deutschman CS,Seymour CW,et al. The Third International Consensus Definitions for Sepsis and Septic Shock(Sepsis-3)[J]. JAMA,2016,315(8):801-810.
[11]唐章,李福祥,朱忠立.ICU获得性衰弱研究进展[J].西南国防医药,2018,28(20):198-200.
[12]陈晓洁,余容容,陈慧珍.集束化护理措施在ICU获得性衰弱患者中的应用效果评价[J].浙江临床医学,2017,19(9):1733-1735.
[13]陈红,任小莉,程青虹,等.神经肌肉电刺激与早期被动活动对机械通气患者ICU获得性虚弱的影响[J].中国康复医学杂志,2018,33(2):146-150.
[14]Tominaga T,Nonaka T,Takeshita H,et al. A case of intensive care unit-acquired weakness after emergency surgery for acute abdomen[J]. Int J Surg Case Rep,2016,24:131-134.
[15]陈红梅,陈雪梅.APAEHE评分联合血乳酸清除率在评估老年重症肺炎患者预后中的价值[J].临床肺科杂志,2018,23(7):1271-1274.
[16]许晓文.血乳酸清除率指导Ⅰ型呼吸衰竭无创机械通气治疗的临床价值[J].临床肺科杂志,2016,21(11):1990-1992.
[17]杨挺,吴丁烨,阙军.乳酸清除率及APACHEⅡ评分与重症肺炎预后的关系[J].江苏医药,2016,42(17):1924-1925.
[18]Castelli GP,Pognani C,Cita M,et al. Procalcitonin,Creactive protein,white blood cells and SOFA score in ICU:diagnosis and monitoring of sepsis[J]. Minerva Anestesiol,2006,72(1/2):69-80.
[19]王合金,谢江霞,阳书坤.血小板计数和降钙素原在预警脓毒症致多器官功能障碍综合征中的意义[J].临床急诊杂志,2014,15(4):214-216.
[20]张越新,张玲,郭贤庆.PCT、CRP、血乳酸、APACHE、SOFA评分在脓毒症患者疾病严重程度及预后评估中的价值研究[J].中国急救医学,2017,12,37(12):1109-1113.
[21]姜雅珍,翁金龙.APACHEⅡ评分及乳酸乳酸清除率联合应用于脓毒症患者预后的评估价值[J].浙江临床医学,2017,19(1):90-91.
[22]Maguet PL,Malledant Y,Seguin P,et al. Prevalence and impact of frailty on mortality in elderly ICU patients:a prospective,multicenter,observational study[J]Intensive Care Med,2014,40:674-682.