对于ICU终生决策的死亡率预测指标:delta-SOFA和SAPS 3 - 追溯评估
Maria Carmen Sala-Trull1, Pablo Monedero2, Francisco Guillen-Grima3,4
1Anaesthesia and Intensive Care, Clinica Universidad de Navarra, University of Navarra, Pamplona, Navarra, Spain csala@unav.es.
BMJ supportive & palliative care
|February 17, 2025
概括
通过将简化急性生理学得分3 (SAPS 3) 与顺序性器官衰竭评估 (SOFA) 得分的变化相结合,改善了重症监护室 (ICU) 的住院死亡率的预测. 这种方法,特别是在第五天使用delta-SOFA,有助于在长时间的ICU住院中做出复杂的终生决策.
科学领域:
- 关键护理医学 关键护理医学
- 预测模型的预测建模
- 健康 结果 研究 研究 结果
背景情况:
- 在ICU中生命终结的决定是复杂的,受患者状况,治疗有效性和资源可用性的影响.
- 准确预测住院死亡率对于指导这些决定至关重要.
研究的目的:
- 评估德尔塔-序列性器官衰竭评估 (SOFA) 在第二,第三和第五天对住院死亡率的分数的预测值.
- 评估delta-SOFA得分和简化急性生理学得分3 (SAPS3) 的综合预测能力.
主要方法:
- 对200名住院时间≥5天的ICU患者进行了回顾性队列研究 (2018-2020).
- 在录取和第二,第三和第五天收集SAPS 3和SOFA分数.
- 利用后勤回归和差异分析来识别死亡率预测因素并评估模型性能.
主要成果:
- 总体而言,住院死亡率为26%.
- 不幸存者表现出更高的SAPS 3分数和更糟糕的SOFA分数,特别是在第3天和第5天.
- 在第五天,SAPS 3和delta-SOFA的组合产生了0.71的AUROC,这表明预测准确度中等.
结论:
- 在第五天将delta-SOFA得分与SAPS 3结合起来,可以提高长期住院ICU期间住院死亡率的预测.
- 这些发现表明,早期治疗限制 (48小时内) 可能过早.
- 随着时间的推移,患者反应的演变支持对终身护理的更可行的共享决策.
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