|
|
|
|
|
| Comparison of Logistic organ dysfunction system and sequential organ failure assessment score in prognosis of septic shock |
| Huang Jin-ju, Chen Qin-chang, Lin Zhuan-di |
| Intensive Care Unit, Panyu Central Hospital, Guangzhou 511400, China |
|
|
|
|
Abstract Objective To compare the prognostic value of the logistic organ dysfunction system (LODS) and the sequential organ failure assessment (SOFA) scores for patients with septic shock. Methods Clinical data of patients with septic shock in the Medical Information Mart for Intensive Care (MIMIC) were retrospectively analyzed. The LODS and SOFA scores on intensive care unit (ICU) admission were calculated. 28-day mortality after ICU admission was the primary outcome and hospital mortality and ICU mortality were the secondary outcomes. Multivariate Cox regression analysis was performed to assess the association of the two scoring systems with 28-day mortality. The Kaplan-Meier method was used to depict the surviving curve of patients with different illness severity scores and the receiver operating characteristic (ROC) curves were used to compare the predictive value of the two scoring systems. Results A total of 1256 patients with septic shock were included with a 28-day mortality rate of 24.28% (305/1256). When compared with survivors, non-survivors had significantly higher median LODS and SOFA scores (LODS: 6 points vs. 7 points, Z=8.962, P＜0.001; SOFA scores: 7 points vs. 9 points, Z=6.776, P＜0.001). Multivariate Cox regression analysis showed that LODS and SOFA scores were both significantly associated with 28-day mortality after adjustment for potential confounders (hazard ratios were 1.17 and 1.11, respectively, P＜0.0001). Kaplan-Meier survival curve analysis indicted that 28-day mortality increased with the increase of LODS or SOFA scores (Log-rank test P＜0.0001). ROC curve analysis showed that areas under the ROC curves (AUC) of LODS for predicting 28-day mortality and hospital mortality were greater than that of the SOFA scores (AUC 0.669 vs. 0.628, P=0.0071 and 0.685 vs. 0.637, P=0.0020, respectively), but there was no significant difference in the AUC for predicting ICU mortality (AUC 0.723 vs. 0.705, P=0.3416). Conclusion LODS might have a better predictive value for the prognosis of patients with septic shock when compared with the SOFA scores.
|
|
|
| About author:: Huang Jin-ju, E-mail: 4698163@qq.com |
|
|
|
| ［1］Reinhart K, Daniels R, Kissoon N, et al. Recognizing Sepsis as a Global Health Priority - A WHO Resolution［J］. N Engl J Med, 2017, 377(5): 414-417.
［2］Fleischmann C, Scherag A, Adhikari NK, et al. Assessment of Global Incidence and Mortality of Hospital-treated Sepsis. Current Estimates and Limitations［J］. Am J Respir Crit Care Med, 2016, 193(3): 259-272.
［3］Liu V, Escobar GJ, Greene JD, et al. Hospital deaths in patients with sepsis from 2 independent cohorts［J］. JAMA, 2014, 312(1): 90-92.
［4］Machado FR, Cavalcanti AB, Bozza FA, et al. The epidemiology of sepsis in Brazilian intensive care units (the Sepsis PREvalence Assessment Database, SPREAD): an observational study［J］. Lancet Infect Dis, 2017, 17(11): 1180-1189.
［5］Rhee C, Dantes R, Epstein L, et al. Incidence and Trends of Sepsis in US Hospitals Using Clinical vs Claims Data, 2009-2014［J］. JAMA, 2017, 318(13): 1241-1249.
［6］Finfer S, Bellomo R, Lipman J, et al. Adult-population incidence of severe sepsis in Australian and New Zealand intensive care units［J］. Intensive Care Med, 2004, 30(4): 589-596.
［7］中华医学会重症医学分会. 中国严重脓毒症/脓毒性休克治疗指南(2014)［J］. 全科医学临床与教育， 2015， 04: 365-367.
［8］Angus DC, van der Poll T. Severe Sepsis and Septic Shock［J］. N Engl J Med, 2013, 369(9): 840-851.
［9］Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)［J］. JAMA, 2016, 315(8): 801-810.
［10］Vincent JL, Moreno R, Takala J, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine［J］. Intensive Care Med, 1996, 22(7): 707-710.
［11］Raith EP, Udy AA, Bailey M, et al. Prognostic Accuracy of the SOFA Score, SIRS Criteria, and qSOFA Score for In-Hospital Mortality Among Adults With Suspected Infection Admitted to the Intensive Care Unit［J］. JAMA, 2017, 317(3): 290-300.
［12］Le Gall JR, Klar J, Lemeshow S, et al. The Logistic Organ Dysfunction system. A new way to assess organ dysfunction in the intensive care unit. ICU Scoring Group［J］. JAMA, 1996, 276(10): 802-810.
［13］Khwannimit B. A comparison of three organ dysfunction scores: MODS, SOFA and LOD for predicting ICU mortality in critically ill patients［J］. J Med Assoc Thai, 2007, 90(6): 1074-1081.
［14］Seymour CW, Liu VX, Iwashyna TJ, et al. Assessment of Clinical Criteria for Sepsis: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)［J］. JAMA, 2016, 315(8): 762-774.
［15］Silva E, Blecher S, Garrido AG, et al. Is there any difference between SOFA and LODS scores to discriminate outcome in septic patients［J］. Critical Care, 2001, 5(Suppl 1):P228.
［16］Johnson AE, Pollard TJ, Shen L, et al. MIMIC-Ⅲ, a freely accessible critical care database［J］. Sci Data, 2016, 3: 160035.
［17］李开源，冯聪，贾立静，等. MIMIC数据库在急诊医学临床研究过程中运用的思考［J］. 中华危重病急救医学， 2018， 30(5): 494-496.
［18］Thompson NR, Fan Y, Dalton JE, et al. A new Elixhauser-based comorbidity summary measure to predict in-hospital mortality［J］. Med Care, 2015, 53(4): 374-379.
［19］DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach［J］. Biometrics, 1988, 44(3): 837-845.
［20］Khwannimit B. Serial evaluation of the MODS, SOFA and LOD scores to predict ICU mortality in mixed critically ill patients［J］. J Med Assoc Thai, 2008, 91(9): 1336-1342.
［21］陈钦桂，何婉媚，郑海崇，等. 简化急性生理评分Ⅱ与牛津急性疾病严重程度评分对重症监护病房患者短期预后的预测价值比较［J］. 中华重症医学电子杂志(网络版)， 2018， 4(2): 159-163. |
|
|
|
Address: 1 North 2nd Street,
Zhongguancun, 
