Objective: To evaluate the value of Sequential Organ Failure Assessment (SOFA), Simplified Acute Physiology Score Ⅱ (SAPS-Ⅱ), Oxford Acute Severity of Illness Score (OASIS) and Logistic Organ Dysfunction System (LODS) scoring systems for predicting ICU mortality in patients with sepsis.
Methods: We collected the data of a total of 2470 cases of sepsis recorded in the MIMIC-III database from 2001 to 2012 and retrieved the scores of SOFA, SAPS-Ⅱ, OASIS and LODS of the patients within the first day of ICU admission. We compared with the score between the survivors and the non-survivors and analyzed the differences in the area under the ROC curve (AUC) of the 4 scoring systems. Binomial logistic regression was performed to compare the predictive value of the 4 scoring systems for ICU mortality of the patients.
Results: In the 2470 patients with sepsis, 1966 (79.6%) survived and 504 (20.4%) died in the ICU. Compared with the survivors, the non-survivors had a significantly older mean age, higher proportion of patients receiving mechanical ventilation, and higher initial lactate level, creatinine, urea nitrogen, SOFA score, SAPS-Ⅱ score, OASIS score and LODS score (P < 0.05) but with significantly lower body weight and platelet counts (P < 0.05). The AUCs of the SOFA score, SAPS-Ⅱ score, OASIS score, and LODS score were 0.729 (P < 0.001), 0.768 (P < 0.001), 0.757 (P < 0.001), and 0.739 (P < 0.001), respectively. The AUC of SAPS-Ⅱ score was significantly higher than those of SOFA score (Z=3.679, P < 0.001) and LODS score (Z=3.698, P < 0.001) but was comparable with that of OASIS score (Z=1.102, P=0.271); the AUC of OASIS score was significantly higher than that of LODS score (Z=2.172, P=0.030) and comparable with that of SOFA score (Z=1.709, P=0.088). For predicting ICU mortality in patients without septic shock, the AUC of SAPS-Ⅱ score was 0.769 (0.743-0.793), the highest among the 4 scoring systems; in patients with septic shock, the AUCs SAPS-Ⅱ score and OASIS score, 0.768 (0.745-0.791) and 0.762 (0.738-0.785), respectively, were significantly higher than those of the other two scoring systems. Binomial logistic regression showed the corrected SOFA, SAPS-Ⅱ, and OASIS scores, but not LODS scores, were significantly correlated with ICU mortality in patients with sepsis, and their ORs were 1.08 (95% CI: 1.03-1.14, P=0.001), 1.04 (95% CI: 1.02-1.05, P < 0.001), 1.04 (95% CI: 1.01-1.06, P=0.001), 0.96 (95% CI: 0.89-1.04, P=0.350), respectively.
Conclusions: The scores of SOFA, SAPS-Ⅱ, OASIS, and LODS can predict ICU mortality in patients with sepsis, but SAPS-Ⅱ and OASIS scores have better predictive value than SOFA and LODS scores.
目的: 评价序贯器官衰竭评分(SOFA)、简化急性生理评分(SAPS-Ⅱ)、牛津急性疾病严重程度评分(OASIS)、Logistic器官功能障碍系统(LODS)评分系统预测ICU脓毒症患者死亡风险的价值。
方法: 通过MIMIC-Ⅲ数据库提取2001年至2012年共计2470例脓毒症患者的临床资料，收集入ICU首日内SOFA评分、SAPS-Ⅱ评分、OASIS评分以及LODS评分。根据患者ICU存活情况分为存活组和死亡组，分析比较两组间不同评分系统的差异性，计算4种评分系统ROC曲线下面积进行差异性分析，对脓毒症患者ICU死亡情况进行二项Logistic回归分析，以综合比较4种评分系统对脓毒症患者ICU死亡的预测价值。
结果: 2470例脓毒症患者中ICU内存活1966例(79.6%)，死亡504例(20.4%)。其中死亡组年龄、机械通气使用率、初始乳酸、肌酐、尿素氮、SOFA、SAPS-Ⅱ、OASIS和LODS评分明显高于存活组(P < 0.05)，体质量及血小板明显低于存活组(P < 0.05)。SOFA评分、SAPS-Ⅱ评分、OASIS评分以及LODS评分的ROC曲线下AUC值分别为0.729(P < 0.001)，0.768(P < 0.001)，0.757(P < 0.001), 0.739(P < 0.001)。其中SAPS-Ⅱ评AUC值明显高于SOFA评分和LODS评分(Z=3.679，P < 0.001；Z=3.698，P < 0.001)，SAPS-Ⅱ与OASIS评分无明显差异(Z=1.102，P=0.271)；OASIS评分明显高于LODS评分(Z=2.172，P=0.030)，但与SOFA评分无明显差异(Z=1.709，P=0.088)。按照是否合并脓毒性休克将患者分为两组，在单纯脓毒症组中，SAPS-Ⅱ评分预测患者死亡的AUC值明显高于其他3种评分，为0.769(0.743-0.793)，在合并脓毒性休克组中，SAPS-Ⅱ与OASIS评分预测患者死亡的AUC值明显高于其他两种评分，分别为0.768 (0.745-0.791)、0.762 (0.738-0.785)。二项Logistic回归多因素分析后发现SOFA、SAPS-Ⅱ、OASIS评分系统均与脓毒症患者死亡相关(OR：1.08，95% CI：1.03-1.14，P=0.001；OR：1.04，95% CI：1.02-1.05，P < 0.001；OR：1.04，95% CI：1.01-1.06，P=0.001)，但LODS评分与脓毒症患者发生ICU死亡无明显关系(OR：0.96，95%CI：0.89-1.04，P=0.350)。
结论: SOFA、SAPS-Ⅱ和OASIS评分均能预测脓毒症患者ICU死亡风险，但SAPS-Ⅱ评分和OASIS评分预测价值优于SOFA评分及LODS评分。
Keywords: Logistic Organ Dysfunction System; Oxford Acute Severity of Illness Score; Sequential Organ Failure Assessment; Simplified Acute Physiology Score Ⅱ; sepsis.