OASIS评分对ICU老年患者病情的评估和预后判断的价值

doi:10.3969/j.issn.1006-6233.2023.03.017

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摘要 目的: 探讨牛津急性疾病严重程度评分(OASIS)在重症监护室(ICU)老年患者预后预测中的应用。方法: 本研究选取我院2020年7月至2022年7月ICU治疗的101例老年重症患者,根据患者住院治疗28d的预后生存情况将患者分为存活组64例、死亡组37例,对比分析两组患者一般临床资料、合并疾病、相关实验室指标、OASIS评分、联合合并症评分(CCS)、查尔森合并症指数(CCI)、急性生理与慢性健康评分(APACHE Ⅱ),采用Logistic回归模型分析OASIS评分与患者不良预后结局的关系,采用ROC曲线分析上述四种评分方法在预测ICU老年不良预后结局中的价值。结果: 死亡组患者的年龄高于存活组,差异具有统计学意义(P<0.05);死亡组和存活组患者的BMI、性别、吸烟、饮酒、外科手术占比比较,差异无统计学意义(P>0.05);亡组患者的ALT、AST、WBC、Hb、NLR、BUN、Scr、血糖、PaO₂、PaCO₂高于存活组,死亡组患者的ALB、pH值低于存活组,差异具有统计学意义(P<0.05);死亡组和存活组患者的血钠水平比较,差异无统计学意义(P>0.05);死亡组患者的OASIS评分、CCS评分、CCI评分、APACHE Ⅱ评分高于存活组,差异具有统计学意义(P<0.05);Logistic回归模型显示:年龄增大、OASIS评分增高、CCS评分增高、CCI评分增高、APACHE Ⅱ评分增高、NLR增高、Scr增高、pH降低、PaO₂降低、PaCO₂增高、ALB降低是老年ICU患者死亡的独立危险因素(P<0.05);OASIS评分、CCS评分、CCI评分、APACHE Ⅱ评分预测老年ICU患者死亡的曲线下面积AUC值分别为0.870、0.764、0.747、0.745。结论: OASIS评分与ICU老年患者治疗无效死亡关系密切,并且对患者病情判断及预后预测中具有较高的临床价值。

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关键词 ：牛津急性疾病严重程度评分, 重症监护室, 老年, 预后

Abstract：Objective: To explore the use of the Oxford Acute Disease Severity score (OASIS) in the outcome prediction of elderly patients in the intensive care unit (ICU). Methods: In this study, 101 elderly critically ill patients treated in the ICU of our hospital from July 2020 to July 2022 were selected, and the patients were divided into 64 cases in the survival group and 37 cases in the death group according to their prognostic survival at 28 days of hospitalization, and the general clinical data, comorbid diseases, relevant laboratory indices, OASIS score, combined comorbidity score (CCS), Charlson Comorbidity Index (CCI), Acute Physiological and Chronic Health Score (APACHE Ⅱ), logistic regression model was used to analyze the relationship between OASIS score and poor prognostic outcome of patients, and ROC curve was used to analyze the value of the above four scoring methods in predicting unfavourable prognostic outcome of the elderly in ICU. Results: The age of patients in the death group was significantly higher than that in the survival group (P<0.05); there was no significant difference in BMI, sex, smoking, alcohol consumption and surgical operation between the death group and the survival group (P>0.05); the ALT, AST, WBC, Hb, NLR, BUN, Scr, blood sugar, PaO₂ and PaCO₂ of the dead group were higher than those of the survival group, while the ALB and pH values of the dead group were lower than those of the survival group, the difference was statistically significant (P<0.05); there was no significant difference in the blood sodium level between the death group and the survival group (P>0.05); the OASIS score, CCS score, CCI score and APACHE Ⅱ score of patients in the death group were higher than those in the survival group, and the difference was statistically significant (P<0.05); logistic regression model showed that age, OASIS score, CCS score, CCI score, APACHE II score, NLR, Scr, pH, PaO₂, PaCO₂ and ALB were independent risk factors for death of elderly ICU patients (P<0.05); the AUC values of the area under the curve of OASIS score, CCS score, CCI score and APACHE Ⅱ score predicting the death of elderly ICU patients were 0.870, 0.764, 0.747 and 0.745, respectively. Conclusion: OASIS score is closely related to the death of elderly patients in ICU after treatment, and has high clinical value in the judgment of patients' condition and prognosis.

Key words： Oxford acute illness severity score Intensive care unit Elderly Prognosis

基金资助:湖北省卫生健康委员会2019年度第一批联合基金立项项目,(编号:WJ2019H012)

通讯作者: 罗晶晶

引用本文:

王志为, 许文娟, 舒品源, 陈咏梅, 罗晶晶. OASIS评分对ICU老年患者病情的评估和预后判断的价值[J]. 河北医学, 2023, 29(3): 436-441.
WANG Zhiwei, XU Wenjuan, SHU Pinyuan, et al. The Value of OASIS Score in the Evaluation and Prognosis of Elderly Patients in ICU. HeBei Med, 2023, 29(3): 436-441.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2023.03.017 或 http://www.hbyxzzs.cn/CN/Y2023/V29/I3/436

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