Abstract
Objective To evaluate the value of acute gastrointestinal injury(AGI)grading combined with sequential organ failure assessment(SOFA)scoring systems in prognosis assessment of severe sepsis. Methods Forty - six patients with severe sepsis admitted in the Department of Intensive Care Unit,Zhoushan Hospital from July 2012 to July 2013 were selected as the subjects and divided into survival group(n = 26)and death group(n = 20)based on they survived or died within 4 weeks after admission. In the 1st week after admission,the AGI of enrolled patients was evaluated daily according to the diagnostic criteria of AGI and scored. At the same time,SOFA scoring,Acute Physiology and Chronic Health Evaluation Ⅱ(APACHEⅡ)scoring and MODS ( 2004 ) scoring and modified SOFA scoring ( adding AGI and SOFA scores together ) were performed. Receiver - operating characteristic(ROC)curve and Hosmer - Lemeshow goodness - of - fit test were used to analyze the resolution and calibration of modified SOFA scoring system and other 4 scoring systems in prognosis assessment of severe sepsis. Multivariate Logistic regression model was used to evaluate the values of these systems in prognosis. Results Compared with the death group,the survival group had lower modified SOFA,AGI,SOFA and MODS(2004)scores on the 2nd,3rd, 5th and 7th days after admission( P < 0. 05),as well as lower highest scores of modified SOFA,AGI,SOFA and MODS (2004)during this period(P < 0. 05). The daily and highest APACHEⅡ scores on the 1st,2nd,3rd,5th and 7th days after admission in the survival group were lower than those in the death group,respectively(P < 0. 05). The AUC values of modified SOFA scoring in daily scoring and the highest scoring for prognosis assessment on the 1st,2nd,3rd,5th and 7th days after admission were 0. 60,0. 84,0. 92,0. 93,0. 97,0. 86. AUC values of AGI scoring were 0. 56,0. 84,0. 95,0. 96,0. 99, 0. 85. AUC values of SOFA scoring were 0. 59,0. 82,0. 87,0. 86,0. 92,0. 83,respectively. AUC values of APACHEⅡscoring were 0. 74,0. 88,0. 92,0. 96,0. 97,0. 83,respectively. AUC values of MODS(2004)scoring were 0. 61,0. 85, 0. 87,0. 87,0. 92,0. 80,respectively. Hosmer - Lemeshow goodness - of - fit test showed that the results of prognosis assessment of the 5 scoring systems did not differ significantly from the clinical outcomes of the patients(all P > 0. 05),which demonstrated that the goodness - of - fit of these 5 scoring systems was relatively good. Results of the analysis with a multivariate Logistic regression model indicated that modified SOFA scoring≥ 8. 1( OR = 3. 167),AGI scoring ≥1. 3( OR = 6. 000), SOFA scoring ≥7. 7(OR = 3. 600),APACHE Ⅱ scoring≥11. 8( OR = 6. 333),MODS(2004) scoring≥8. 6( OR =5. 000)were independent predictors of poor outcome of patients with severe sepsis(P < 0. 05). Conclusion The resolution and calibration of SOFA scoring in the prognosis assessment of severe sepsis can be improved through modified SOFA scoring. Modified SOFA scoring≥8. 1 is a predictor for death in patients with severe sepsis.关键词
脓毒症/急性胃肠损伤/序贯器官衰竭评估/预后/预测Key words
Sepsis/Acute gastrointestinal injury/Sequential organ failure assessment/Prognosis/Forecasting分类
医药卫生
