Validation of postinjury multiple organ failure scores.
Validation of postinjury multiple organ failure scores.
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DOI：
10.1097/shk.0b013e31818ba4c6
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发表时间：
2009-05
期刊：
影响因子：
--
通讯作者：
Banerjee A
中科院分区：
文献类型：
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作者：
Sauaia A;Moore EE;Johnson JL;Ciesla DJ;Biffl WL;Banerjee A
大多数多器官功能衰竭（MOF）评分是在十多年前开发的，但在验证方面做得很少，也没有了解每个人所识别的人群之间的差异。由于缺乏金标准，验证必须依赖于客观的临床和资源利用结果。因此，我们建议：1）验证两种广泛接受的MOF评分（Denver和马歇尔），检查其与损伤后人群不良结局的相关性; 2）比较每种评分确定的患者的风险因素、特征和结局。丹佛MOF评分对4种器官功能障碍（肺、肾、肝、心脏）进行分级（从0-3），并将MOF定义为评分> 3。此外，马歇尔评分还对中枢神经系统（CNS）和血液功能障碍进行分级（共6个器官，0 - 4级）。使用前瞻性收集的数据集，对1992-2004年收治的ISS >15的1389名连续创伤患者每日进行两种评分的MOF评分，并评估其结局（死亡;无呼吸机天数，VFD;机械通气时间，MV;和重症监护室住院时间，ICU-LOS）。主要分为三组：1）严重损伤组，其多器官功能衰竭危险因素发生率、死亡率和利用率均较高（Denver =马歇尔=多器官功能衰竭和Denver=多器官功能衰竭+马歇尔=无多器官功能衰竭）; 2）中度损伤组，多器官功能衰竭危险因素发生率中等，利用率中等，死亡率低（Denver=无多器官功能衰竭，马歇尔=多器官功能衰竭）; 3）轻度损伤组，其危险因素率、死亡率和利用率均较低（Denver =马歇尔=无多器官功能衰竭）。两种评分均表现良好，Denver MOF评分显示出更高的特异性。每个分数的基本概念可以组合起来产生改进的MOF分数。
Most multiple organ failure (MOF) scores were developed over a decade ago, but little has been done in terms of validation and to understand the differences between populations identified by each of them. Given the lack of a gold standard, validation must rely upon objective clinical and resource utilization outcomes. Thus, we propose to: 1)validate two widely accepted MOF scores (Denver's and Marshall's) examining their association with adverse outcomes in a postinjury population; and 2) compare risk factors, characteristics and outcomes of patients identified by each score. The Denver MOF score grades (from 0-3) 4 organ dysfunctions (lung, kidney, liver, heart) and defines MOF as score > 3. The Marshall score grades, in addition, central nervous system (CNS) and hematologic dysfunction (for a total of 6 organs on a 0 to 4 scale). Using a prospectively collected dataset, MOF scored daily by both scores for 1389 consecutive trauma patients with ISS >15, admitted from 1992-2004, and their outcomes evaluated (death; ventilator-free days, VFD; mechanical ventilation time, MV; and length of stay in the intensive care unit, ICU-LOS). Three major groups could be identified: 1)severe injury group for whom MOF risk factor rates, mortality and utilization were all high (Denver = Marshall= MOF and Denver= MOF + Marshall=No MOF); 2) moderate injury group with medium rate of MOF risk factors, medium utilization and low mortality (Denver= No MOF, Marshall= MOF); and 3) mild injury group for whom risk factor rates, mortality and utilization were all low (Denver = Marshall=No MOF). Both scores performed well, with the Denver MOF score showing greater specificity. The basic concepts of each score can probably be combined to produce an improved MOF score.