Multicenter study of the multiple organ dysfunction syndrome in intensive care units:: the usefulness of Sequential Organ Failure Assessment scores in decision making
Multicenter study of the multiple organ dysfunction syndrome in intensive care units:: the usefulness of Sequential Organ Failure Assessment scores in decision making
复制标题
DOI：
10.1007/s00134-005-2640-2
复制
发表时间：
2005-07-01
影响因子：
38.9
通讯作者：
Martín, MC
中科院分区：
文献类型：
--
作者：
Cabré, L;Mancebo, J;Martín, MC
目的：本研究调查了重症监护病房多器官功能障碍综合征（MODS）的发病率和死亡率，评估了这些患者生命支持的局限性，并确定了序贯器官衰竭评估（SOFA）的日常测量是否有助于决策。设计和设置：在79个重症监护病房的前瞻性，观察性研究。患者和参与者：在2个月期间收治的7，615名患者中，我们发现1，340名患者患有MODS。测量和结果：我们记录了MODS期间的死亡率、重症监护室和医院的住院时间以及SOFA总分的最大值和最小值。并对MODS患者生命支持的局限性进行了评价。采用逐步Logistic回归分析确定死亡率的预测因素。MODS患者的院内死亡率为44.6%，其中70.6%的患者因生命支持受限而死亡。最大化特异性的预测模型包括以下变量：最大SOFA评分、最小SOFA评分、连续5天的SOFA趋势和年龄超过60岁。模型诊断率为：特异性100%，灵敏度7.2%，阳性预测值100%，阴性预测值57.3%;受试者工作特征曲线下面积为0.807。结论：该模型显示，在我们的MODS人群中，年龄超过60岁且SOFA评分高于9至少5天的患者不太可能存活。
Objective: This study examined the incidence and mortality of multiple organ dysfunction syndrome (MODS) in intensive care units, evaluated the limitation of life support in these patients, and determined whether daily measurement of the Sequential Organ Failure Assessment (SOFA) is useful for decision making. Design and setting: Prospective, observational study in 79 intensive care units. Patients and participants: Of the 7,615 patients admitted during a 2-month period we found 1,340 patients to have MODS. Measurements and results: We recorded mortality and length of stay in the intensive care unit and the hospital and the maximum and minimum total SOFA scores during MODS. Limitation of life support in MODS patients was also evaluated. Stepwise logistic regression was used to determine the factors predicting mortality. The in-hospital mortality rate in patients with MODS was 44.6%, and some type of limitation of life support was applied in 70.6% of the patients who died. The predictive model maximizing specificity included the following variables: maximum SOFA score, minimum SOFA score, trend of the SOFA for 5 consecutive days, and age over 60 years. The model diagnostic yield was: specificity 100%, sensitivity 7.2%, positive predictive value 100%, and negative predictive value 57.3%; the area under the receiver operating characteristic curve was 0.807. Conclusions: This model showed that in our population with MODS those older than 60 years and with SOFA score higher than 9 for at least 5 days were unlikely to survive.