脓毒症的异质性受到感染部位的显著影响。本研究旨在探讨多重评分系统对评估不同感染部位脓毒症患者预后的预测价值。这项回顾性队列研究的数据来自重症监护IV医学信息集市数据库(MIMIC-IV)(v2.2)。纳入符合脓毒症3.0标准并进入重症监护病房(ICU)的成年患者。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.评估的主要结果是28天死亡率。序贯器官衰竭评估(SOFA)评分,牛津急性疾病严重程度评分(OASIS),比较两组患者的Logistic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,分析了评分系统中受试者工作特征(ROC)曲线下面积(AUC)的差异.总共4721名患者被纳入分析。平均28天死亡率为9.4%。在LODS中观察到显着差异,绿洲,不同感染部位28天存活组和非存活组之间的SOFA评分(p<0.01)。在肺炎组和腹腔感染组中,LODS和OASIS评分系统均成为脓毒症患者死亡率的独立危险因素(比值比[OR]:1.165,95%置信区间[CI]:1.109-1.224,p<0.001;OR:1.047,95%CI:1.028-1.065,p<0.001)(OR:1.200,95%CI:1.091-1.319,p<0.001;OR:1.060,95%CI:1.025-1.095,p<0.001)对于UTI患者,LODS,绿洲,和SOFA评分系统被确定为死亡率的独立危险因素(OR:1.142,95%CI:1.068-1.220,p<0.001;OR:1.062,95%CI:1.037-1.087,p<0.001;OR:1.146,95%CI:1.046-1.255,p=0.004),LODS评分和OASIS的AUC明显高于SOFA评分(p=0.006)。在蜂窝织炎患者中,OASIS和SOFA评分系统被确定为死亡率的独立危险因素(OR:1.055,95%CI:1.007-1.106,p=0.025;OR:1.187,95%CI:1.005-1.403,p=0.044),在预后预测方面没有显着差异(p=0.243)。在菌血症组,LODS评分系统被确定为死亡率的独立危险因素(OR:1.165,95%CI:1.109-1.224,p<0.001).研究结果表明,LODS评分为预测脓毒症肺炎患者的死亡风险提供了更好的预后准确性。腹部感染,菌血症,和UTI与SOFA分数相比。
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 (p < 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, p < 0.001; OR: 1.047, 95% CI: 1.028-1.065, p < 0.001) (OR: 1.200, 95% CI: 1.091-1.319, p < 0.001; OR: 1.060, 95% CI: 1.025-1.095, p < 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, p < 0.001; OR: 1.062, 95% CI: 1.037-1.087, p < 0.001; OR: 1.146, 95% CI: 1.046-1.255, p = 0.004), with the AUC of LODS score and OASIS significantly higher than that of the SOFA score (p = 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, p = 0.025; OR: 1.187, 95% CI: 1.005-1.403, p = 0.044), with no significant difference in prognosis prediction observed (p = 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, p < 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.