扩展心血管SOFA评分组件的开发,反映心脏功能障碍,改善败血症生存预测:败血症和升高的热素 (SET) 研究中的探索性分析
S Lörstad1, Y Wang2, S Tehrani1
1Division of Internal Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden.
Journal of intensive care medicine
|October 1, 2024
概括
修改的心血管顺序器官衰竭评估 (SOFA) 评分,CE-SOFA,更好地识别了败血症患者的心脏功能障碍. 这种改进的败血症得分与原来的SOFA得分相比,提高了30天死亡率的预测.
科学领域:
- 关键护理医学 关键护理医学
- 心脏病学 心脏病学
- 败血症中的生物标志物
背景情况:
- 序列器官衰竭评估 (SOFA) 评分的当前心血管组件不充分反映了败血症的临床实践,并且未能确定心脏功能障碍.
- 需要改进的评分系统,以更好地预测心脏参与的败血症患者的死亡率.
研究的目的:
- 开发和验证一种改性心血管SOFA组件 (CE-SOFA),可以准确评估心脏功能障碍.
- 为了提高SOFA得分对败血症30天死亡率的预后歧视.
主要方法:
- 一组败血症患者被分为训练 (n=250) 和测试 (n=253) 组.
- 高灵敏性心脏托洛T (hs-cTnT),N终端亲B型尿素 (NT-proBNP),心率 (HR) 和心房动 (AF) 被纳入修改的SOFA分数 (CE-SOFA).
- 使用后勤回归,AUC,NRI以及DeLong和Hoshmer-Lemeshow测试来评估预后歧视.
主要成果:
- 与标准SOFA分数相比,CE-SOFA模型在培训 (AUC 0.67-0.75对0.62) 和测试队列 (AUC 0.72对0.68) 中都显示出改善的30天死亡率歧视.
- 在CE-SOFA中,通过NRI指数 (P=.009) 在测试队列中显著改善了歧视.
- 该模型在测试队列中表现出良好的校准.
结论:
- 开发的CE-SOFA模型有效地反映了败血症患者的心脏功能障碍.
- 与传统的SOFA得分相比,CE-SOFA显著改善了对败血症30天死亡率的预测.
- 建议进行外部验证,以进一步支持采用此修订的心血管组件作为潜在的SOFA 2.0.0版本.
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