序贯器官衰竭评分判断肝衰竭患者预后价值

摘要

目的通过序贯器官衰竭评分（SOFA）探讨肝衰竭并发多器官功能障碍综合征（MODS）患者预后的价值。方法对118例符合MODS诊断标准的肝衰竭患者进行SOFA评分，比较存活与死亡者临床特征的差异，评判其对肝衰竭合并MODS死亡的判断能力。结果死亡组与生存组患者呼吸系统SOFA得分分别为0.78±0.91和0.13±0.34（P<0.01），循环系统为0.55±0.85和0.0±0.0（P<0.05），肾脏得分1.43±1.12和0.38±0.81（P<0.01）；死亡组与生存组患者SOFA总得分分别为10.93±2.21和8.31±1.20（P<0.05），受试者工作特征（ROC）曲线下面积为0.857（标准误0.040，渐进显著性水平P＜0.01），渐进95%可信区间为0.778～0.936。当截断点为8分、9分和10分时，阳性预测值分别为89.2%、92.9%和96.0%，阴性预测值分别为57.1%、45.0%和30.2%。结论 MODS患者呼吸、循环和肾脏功能障碍是肝衰竭死亡的独立危险因素，SOFA评分对肝衰竭的预后具有良好的判断能力。%Objective To classify the efficacy of sequential organ failure assessment score(SOFA)in prediction of patients with multi-organ dysfunction syndrome (MODS). Methods SOFA score was calculated retrospectively in 118 patients with liver failure complicated by MODS. The clinical features of survival patients and dead patients were compared and the prediction value of SOFA score on patient survival was analyzed. Results In the dead patients,SOFA score was 0.78±0.91 for the respiratory system,0.55±0.85 for the circulation system,and 1.43±1.12 for the renal system,however,these scores were significantly higher than that in the survival patients for each corresponding system (0.13±0.34,P<0.01 for the lung;0.0±0.0,P<0.05 for the heart;0.38±0.81, P<0.01 for the renal);For the dead patients,the SOFA total score was 10.93±2.21,which was significantly higher than that for the survival patients (8.31±1.20,P<0.05);The area under receiver operating characteristic curve of SOFA score was 0.875 (standard error was 0.040,asymptotic significance,P<0.01),the 95 percent confidence interval was 0.778 to 0.936;When the cut-off value was 8,9 and 10 scores,the positive predictive value was 89.2%, 92.9% and 96.0%,respectively,and the negative predictive value was 57.1%,45.0% and 30.2%,respectively. Conclusion SOFA score was valuable in prediction of prognosis in patients with liver failure. Respiratory, circulation and renal dysfunction were independent risk factors for death in patients with MOSD.