ABSTRACT
Objective:To compare the predictive value of Oxford acute severity of illness score (OASIS) and simplified acute physiology score Ⅱ (SAPSⅡ) for in-hospital mortality in intensive care unit (ICU) patients with sepsis.Methods:A retrospective cohort study was conducted using the data in the Medical Information Mart for Intensive Care-Ⅳ0.4 (MIMIC-Ⅳ 0.4). Based on Sepsis-3 diagnostic criteria, the basic information of ICU adult sepsis patients with infection and sequential organ failure assessment (SOFA) score ≥ 2 within 24 hours of ICU admission admitted for the first time in the database was extracted, including gender, age, vasopressor drugs, sedative drugs, mechanical ventilation, renal replacement therapy, length of ICU stay, OASIS, SAPSⅡ scores, etc. The primary outcome was in-hospital mortality. A receiver operator characteristic curve (ROC curve) was drawn, and the area under the ROC curve (AUC) was calculated to compare the prognostic value of OASIS score and SAPSⅡ score.Results:A total of 11 098 adult ICU sepsis patients were enrolled in the final analysis, of which 2 320 died and 8 778 survived in hospital, with a mortality of 20.90%. Compared with the survivors, the non-survivors were older [years old: 71 (60, 81) vs. 67 (56, 78)], had longer length of ICU stay [days: 6.95 (3.39, 13.07) vs. 4.23 (2.19, 9.73)] and higher proportions of using vasopressor drugs, sedative drugs, mechanical ventilation and renal replacement therapy [vasopressor drugs: 50.65% (1 175/2 320) vs. 33.05% (2 901/8 778), sedative drugs: 58.53% (1 358/2 320) vs. 48.41% (4 249/8 778), mechanical ventilation: 89.57% (2 078/2 320) vs. 81.66% (7 168/8 778), renal replacement therapy: 11.98% (278/2 320) vs. 6.57% (577/8 778), all P < 0.01]. Moreover, the non-survivors had higher OASIS score [43 (36, 49) vs. 35 (29, 41), P < 0.01] and SAPSⅡ score [49 (40, 60) vs. 38 (31, 47), P < 0.01] as compared with the survivors. ROC curve analysis showed that the AUC of OASIS score and SAPSⅡ score for predicting in-hospital death of ICU patients with sepsis was 0.713 [95% confidence interval (95% CI) was 0.701-0.725] and 0.716 (95% CI was 0.704-0.728), respectively, and the Delong test showed no significant difference in AUC between the two scoring systems ( P > 0.05). Conclusions:OASIS score has a good predictive value for in-hospital mortality in sepsis patients, which is similar to SAPSⅡ score. OASIS score is simpler and has a broader clinical application prospect than SAPSⅡ score.
ABSTRACT
Background: Aim of this study is to examine the efficacy of Physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) and Portsmouth predictor modification (P-POSSUM) equations in predicting morbidity and mortality in patients undergoing emergency laparotomy, to study the morbidity and mortality patterns in patients undergoing emergency laparotomy at Malla Reddy Institute of Medical Sciences, Hyderabad. Methods: The study was conducted for a period of 2 years from February 2018 to February 2020. 100 Patients undergoing emergency laparotomy were studied in the Department of General surgery MRIMS, Hyderabad. POSSUM and P-POSSUM scores are used to predict mortality and morbidity. The ratio of observed to expected deaths (O:E ratio) was calculated for each analysis. Results: The study included total 100 patients, 83 men and 17 women. Observed mortality rate was compared to mortality rate with POSSUM, the O:E ratio was 0.62, and there was no significant difference between the observed and predicted values (χ²=10.79, 9 degree of freedom (df) p=0.148). Observed morbidity rates were compared to morbidity rates predicted by POSSUM, there was no significant difference between the observed and predicted values (χ²=9.89, 9 df, p=0.195) and the overall O:E ratio was 0.91. P-POSSUM predicted mortality equally well when the linear method of analysis was used, with an O:E ratio of 0.65 and no significant difference between the observed and predicted values (χ²= 5.33, 9 df, p= 0.617).Conclusion: POSSUM and P-POSSUM scoring is an accurate predictor of mortality and morbidity following emergency laparotomy and is a valid means of assessing adequacy of care provided to the patient.