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焦小英.4种危重症评分对脓毒症合并急性肾损伤预后的评估价值[J].内科急危重症杂志,2026,32(1):39-42
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| DOI：10.11768/nkjwzzzz20260109 |
| 中文关键词: 危重症评分 脓毒症合并急性肾损伤 预后 |
| 英文关键词: |
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| 摘要点击次数: 76 |
| 全文下载次数: 72 |
| 中文摘要: |
| 摘要 目的：探讨4种危重症评分对脓毒症合并急性肾损伤（AKI）患者预后的评估价值。方法：选择脓毒症合并AKI患者102例，根据AKI分期标准分为Ⅰ期36例、Ⅱ期39例和Ⅲ期27例，依据入院28d预后分为存活组60例及死亡组42例。患者入住急诊重症监护室（EICU）当天进行急性生理与慢性健康状况评估（APACHEⅡ）评分和序贯器官衰竭评估（SOFA）评分、改良早期预警系统（MEWS）评分、急诊脓毒症死亡风险（MEDS）评分，采用Logistic回归分析患者死亡的影响因素，采用受试者工作特征（ROC）曲线分析4种评分对死亡的预测价值。结果：不同AKI分期患者的APACHEⅡ、SOFA、MEWS及MEDS评分比较，差异有统计学意义（P均<0.05）。死亡组4种评分明显高于存活组（P均<0.05）。Logistic回归分析显示，APACHEⅡ、SOFA、MEWS及MEDS评分是脓毒症合并AKI患者死亡的独立危险因素（P均<0.05）；ROC曲线下面积（AUC）分别为0.779、0.810、0.831和0.907，且MEDS评分的AUC明显高于APACHEⅡ评分（Z=2.371，P=0.018）。结论：APACHEⅡ、SOFA、MEWS及MEDS评分均能较好预测脓毒症合并AKI患者的预后，且MEDS评分明显优于APACHEⅡ评分。 |
| 英文摘要: |
| Abstract Objective: To investigate the prognostic value of four critical illness scores in patients with sepsis complicated with acute kidney injury (AKI). Methods: 102 patients with sepsis complicated with AKI were selected and divided into 36 cases instage Ⅰ, 39 cases in stage Ⅱ , and 27 cases in stage Ⅲ according to the AKI staging criteria. According to the prognosis 28 days after admission, the patients were divided into 60 cases inthe survival group and 42 cases in the death group. Acute Physiology and Chronic Health Evaluation Ⅱ (APACHEⅡ) score, Sequential Organ Failure Assessment (SOFA) score, Modified Early Warning Score (MEWS), and Mortality in Emergency Department Sepsis (MEDS) were performed on the day of admission to the emergency intensive care unit (EICU). Logistic regression was used to analyzethe factors influencing patient death, and the receiver operating characteristic (ROC) curve was employed to assess the predictive value of the four scores for death. Results: The comparison of APACHEⅡ, SOFA, MEWS and MEDS scores among patients with different AKI stages showed statistically significant differences(all P<0.05). The four scores of the death group were significantly higher than those of the survival group (all P<0.05). Logistic regression analysis showed that APACHEⅡ, SOFA, MEWS and MEDS scores were independent risk factors for death in patients with sepsis complicated with AKI (all P< 0.05). The area under the ROC curve (AUC) was 0.779, 0.810, 0.831 and 0.907, respectively, and the AUC of the MEDS score was significantly higher than that of the APACHEⅡ score (Z=2.371, P= 0.018). Conclusion: APACHEⅡ, SOFA, MEWS and MEDS scores can all predict the prognosis of patients with sepsis complicated with AKI relatively well, and the MEDS score is significantly better than the APACHEⅡ score. |
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