Use of the sequential organ failure assessment score as a severity score
Use of the sequential organ failure assessment score as a severity score
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DOI：
10.1007/s00134-004-2528-6
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发表时间：
2005-02-01
影响因子：
38.9
通讯作者：
Vincent, JL
中科院分区：
文献类型：
--
作者：
Amaral, ACKB;Andrade, FM;Vincent, JL
目的：评估 SOFA 评分是否可用于开发预测不同国家重症监护病房 (ICU) 死亡率的模型。设计和设置：分析预期收集的数据库。研究人员对入住 ICU 时间超过 2 天的患者进行了研究，以开发基于器官功能障碍测量的死亡率预测模型。患者：来自六个国家的 748 名患者。测量：构建了两个逻辑回归模型，一个基于 SOFA 最大值（SOFA Max 模型），另一个基于多元回归确定的变量（SOFA Max 感染模型）。两个模型的 H 和 C 统计数据的 p 值均高于 0.05，但 D 统计数据显示，在针对感染的存在进行分层时，SOFA Max 模型的性能较差。使用SOFA Max感染模型进行后续分析。曲线下面积为0.853。除一个国家的 ICU 总人口死亡率（28.3% vs. 19.1%）和非感染患者死亡率（21.4% vs. 12.6%）均高于预测死亡率外，观察到的死亡率和预测死亡率没有统计学上的显着差异。结论：根据年龄和感染情况调整后的 SOFA Max 可以预测该人群的死亡率，但在一个国家，ICU 死亡率高于预期。我们的数据不允许我们确定这些差异背后的原因，应鼓励进一步研究以发现国家之间死亡率的差异并阐明这些差异的基础。
Objective: To evaluate whether the SOFA score can be used to develop a model to predict intensive care unit (ICU) mortality in different countries. Design and Settings: Analysis of a prospectively collected database. Patients with ICU stay longer than 2 days were studied to develop a mortality prediction model based on measurements of organ dysfunction. Patients: 748 patients from six countries. Measurements: Two logistic regression models were constructed, one based on the SOFA maximum (SOFA Max model) and the other on variables identified by multivariate regression (SOFA Max-infection model). The H and C statistics had a p value above 0.05 for both models, but the D statistics showed a poor performance on the SOFA Max model when stratified for the presence of infection. Subsequent analysis was performed with SOFA Max-infection model. The area under the curve was 0.853. There were no statistically significant differences in observed and predicted mortalities except for one country which had a higher than predicted ICU mortality both in the overall population (28.3 vs. 19.1%) and in the noninfected patients (21.4 vs. 12.6%). Conclusions: The SOFA Max adjusted for age and the presence of infection can predict mortality in this population, but in one country the ICU mortality was higher than expected. Our data do not allow us to determine the reasons behind these differences, and further studies to detect differences in mortality between countries and to elucidate the basis for these differences should be encouraged.