背景:老年人群是独特的,为成年人群开发的预后评分系统需要验证。我们评估了常用评分系统对危重老年脓毒症患者死亡率的预测价值。
方法:在这个单中心,观察,前瞻性研究,对危重老年脓毒症患者进行评估。序贯器官衰竭评估评分(SOFA),急性生理和慢性健康评估评分-II(APACHE-II),逻辑器官功能障碍评分(LODS),多器官功能障碍评分(MODS),并计算简化急性生理学评分-II(SAPS-II)。对参与者进行28天的住院死亡率随访。预后评分系统,人口特征,合并症条件,和基线实验室检查结果在\"幸存者\"和\"非幸存者\"组之间进行比较。
结果:202例患者,平均年龄79岁(四分位距,IQR:11)年包括在内,51%(n=103)为女性。总死亡率为41%(n=83)。SOFA,APACHE-II,LODS,MODS,和SAPS-II评分显著高于非幸存者组(p<0.001),较高的分数与较高的死亡率相关。SOFA的受试者操作特征(ROC)-曲线下面积(AUC)值分别为0.802、0.784、0.735、0.702和0.780,APACHE-II,LODS,MODS,还有SAPS-II,分别。所有预后评分模型对危重老年脓毒症患者的死亡率均有显著的判别能力(p<0.001)。
结论:这项研究表明,SOFA,APACHE-II,LODS,MODS,SAPS-II评分与危重老年脓毒症患者28天死亡率显著相关,并可成功用于预测死亡率。
BACKGROUND: The elderly population is unique and the prognostic scoring systems developed for the adult population need to be validated. We evaluated the predictive value of frequently used scoring systems on mortality in critically ill elderly sepsis patients.
METHODS: In this single-center, observational, prospective study, critically ill elderly sepsis patients were evaluated. Sequential organ failure evaluation score (SOFA), acute physiology and chronic health evaluation score-II (APACHE-II), logistic organ dysfunction score (LODS), multiple organ dysfunction score (MODS), and simplified acute physiology score-II (SAPS-II) were calculated. The participants were followed up for 28 days for in-hospital mortality. Prognostic scoring systems, demographic characteristics, comorbid conditions, and baseline laboratory findings were compared between \"survivor\" and \"non-survivor\" groups.
RESULTS: 202 patients with a mean age of 79 (interquartile range, IQR: 11) years were included, and 51% (n = 103) were female. The overall mortality was 41% (n = 83). SOFA, APACHE-II, LODS, MODS, and SAPS-II scores were significantly higher in the non-survivor group (p < 0.001), and higher scores were correlated with higher mortality. The receiver operator characteristics (ROC) - area under curve (AUC) values were 0.802, 0.784, 0.735, 0.702 and 0.780 for SOFA, APACHE-II, LODS, MODS, and SAPS-II, respectively. All prognostic scoring models had a significant discriminative ability on the prediction of mortality among critically ill elderly sepsis patients (p < 0.001).
CONCLUSIONS: This study showed that SOFA, APACHE-II, LODS, MODS, and SAPS-II scores are significantly associated with 28-day mortality in critically ill elderly sepsis patients, and can be successfully used for predicting mortality.