MODS修订评分对老年多器官功能障碍综合征患者的预后评估

doi:10.3877/cma.j.issn.1674-6902.2020.02.012

目的

比较多器官功能障碍综合征(MODS)评分修订系统与现用评分系统对老年多器官功能不全综合征(MODSE)患者的预后评估价值。

方法

回顾性分析解放军总医院2009年1月至2012年6月收治的387例符合MODSE标准患者入重症监护室后第一个24 h的急性生理及慢性健康状态评分(APACHE Ⅱ、APACHE Ⅲ)、简化急性生理评分(SAPS Ⅱ)、MODS评分、MODS联合年龄评分、MODS联合年龄评分加倍修订、MODS联合年龄评分指数修订系统，评估并检验各自预后评估效能。

结果

与女性组相比，男性组平均住ICU时间和死亡平均年龄显著降低，28天病死率和总体病死率高于女性组；随着年龄增大，器官衰竭数目、28天病死率和总体病死率逐渐增加，平均住ICU时间逐渐缩短；与生存组相比，死亡组年龄及各种评分均高，差异具有统计学意义；APACHE Ⅱ、APACHE Ⅲ、SAPS Ⅱ、MODS、MODS联合年龄评分、MODS联合年龄评分加倍修订、MODS联合年龄评分指数化修订系统受试者工作曲线下面积：0.810、0.791、0.712、0.801、0.834、0.787、0.793。其中MODS联合年龄评分敏感性最高，APACHE Ⅱ特异性最好，MODS联合年龄评分系统Youden指数和曲线下面积最大。

结论

MODS评分修订系统与现用评分系统均可较好的早期评估老年多器官功能不全综合征患者的预后；其中MODS联合年龄评分系统具有更优秀的预后评估效能。

关键词: 老年人, 多器官功能障碍综合征, 评分系统, 年龄评分, 预后

Objective

To compare the prognostic values of revised multiple organ dysfunction score (MODS) and the current scoring systems for elderly patients with multiple organ dysfunction syndrome (MODSE).

Methods

The first 24-hour data of 387 patients with MODSE after admission to the Intensive Care Unit in the General Hospital of Chinese People′s Liberation Army from January 2015 to December 2018 were analyzed retrospectively. Then the prognostic effectiveness of each scoring system, including acute physiological and chronic health status scores (APACHE Ⅱ, APACHE Ⅲ), simplified acute physiology score (SAPS Ⅱ), MODS score, MODS combined age score, MODS combined age double score, MODS combined age index revised score, were evaluated and tested.

Results

Compared with the female group, the average length of ICU stay and the average age of death were significantly lower, and the 28-day mortality and the overall mortality were higher in the male group (P<0.05). With the age increasing, the number of organ failure, the 28-day mortality and the overall mortality gradually increased, and the average length of stay in ICU gradually decreased. Compared with the survival group, the average age and the scores of the death group increased significantly. The areas under the ROC curve of these 7 scoring systems were 0.810, 0.791, 0.712, 0.801, 0.834, 0.787 and 0.793, respectively. Compared with the above scoring systems, APACHE Ⅱ had the best performance in specificity while MODS combined age score had the highest sensitivity and its Youden index and the area under the ROC curve were the largest.

Conclusion

Revised MODS and the existing score systems can evaluate the prognosis of the patients with MODSE at the early stage. Among them, MODS combined with age score system has better prognostic evaluation efficiency.

Key words: Elderly, Multiple organ dysfunction syndrome, Scoring system, Age score, Prognosis

表1 不同年龄组患者预后比较

分　组	衰竭器官数目	住ICU时间(d)	28 d病死率(%)	总体病死率(%)
65～74岁	3.31±1.27	24.91±24.48	45.05(41/91)	53.75(48/91)
75～84岁	3.61±1.18	23.88±23.94	48.03(73/152)	59.21(90/152)
85～90岁	3.65±1.10	18.89±17.57	50.00(56/112)	59.82(73/112)
≥91岁	3.72±1.17	16.56±14.78	53.12(17/32)	71.88(23/32)

表1 不同年龄组患者预后比较

分　组	衰竭器官数目	住ICU时间(d)	28 d病死率(%)	总体病死率(%)
65～74岁	3.31±1.27	24.91±24.48	45.05(41/91)	53.75(48/91)
75～84岁	3.61±1.18	23.88±23.94	48.03(73/152)	59.21(90/152)
85～90岁	3.65±1.10	18.89±17.57	50.00(56/112)	59.82(73/112)
≥91岁	3.72±1.17	16.56±14.78	53.12(17/32)	71.88(23/32)

表2 28天生存组和死亡组预后评分比较

分　组		年龄	APACHE Ⅱ	APACHE Ⅲ	SAPS Ⅱ	MODS	MODS1	MODS2	MODS3
28天生存		75.57±9.24	19.17±6.63	70.18±23.07	45.82±16.89	6.57±2.58	7.51±3.01	10.17±4.24	8.63±3.89
28天死亡		84.05±8.77	27.92±7.90	100.43±28.41	59.16±18.60	11.33±4.35	13.08±4.96	14.82±4.61	13.32±4.52
	P值	0.015	0.010	0.009	0.013	0.000	0.000	0.027	0.000

表2 28天生存组和死亡组预后评分比较

分　组		年龄	APACHE Ⅱ	APACHE Ⅲ	SAPS Ⅱ	MODS	MODS1	MODS2	MODS3
28天生存		75.57±9.24	19.17±6.63	70.18±23.07	45.82±16.89	6.57±2.58	7.51±3.01	10.17±4.24	8.63±3.89
28天死亡		84.05±8.77	27.92±7.90	100.43±28.41	59.16±18.60	11.33±4.35	13.08±4.96	14.82±4.61	13.32±4.52
	P值	0.015	0.010	0.009	0.013	0.000	0.000	0.027	0.000

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MODS score on prognostic evaluation of elderly patients with multiple organ dysfunction syndrome

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MODS score on prognostic evaluation of elderly patients with multiple organ dysfunction syndrome