Comparative study of three scores in predicting the death risk of severe burn patients
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摘要:
目的 探讨改良Baux评分、比利时烧伤预后评分、Ryan评分对严重烧伤患者死亡风险的预测价值，并进行对比研究。 方法 采用回顾性病例系列研究方法。2018年2月—2019年11月，南昌大学第一附属医院烧伤科收治260例符合入选标准的严重烧伤患者，其中男158例、女102例，年龄36（3，53）岁。根据最终结局，将患者分为存活组（229例）和死亡组（31例），比较2组患者入院时性别、年龄、烧伤原因、烧伤部位、烧伤总面积、烧伤深度、合并吸入性损伤情况、合并基础疾病情况，以及根据前述部分资料计算的改良Baux评分、比利时烧伤预后评分、Ryan评分，对数据进行χ2检验或Mann-Whitney U检验。采用Kendall tau-b系数法对260例严重烧伤患者前述3种评分结果进行一致性分析。分别绘制前述3种评分预测260例严重烧伤患者死亡风险的受试者操作特征曲线（ROC），计算曲线下面积（AUC）及最佳阈值与最佳阈值下的敏感度、特异度。采用Delong检验对前述3种评分AUC的质量进行比较。 结果 2组患者性别、烧伤部位、烧伤深度均相近（P>0.05）；死亡组患者年龄、烧伤总面积、火焰烧伤比例、合并吸入性损伤比例、合并基础疾病比例均明显大于存活组（Z值分别为5.53、7.18，χ2值分别为16.23、15.89、17.78，P<0.01）；死亡组患者改良Baux评分、比利时烧伤预后评分、Ryan评分分别为142（115，155）、7（5，7）、2（2，3）分，均明显高于存活组的64（27，87）、1（0，3）、0（0，1）分（Z值分别为7.91、7.64、7.61，P<0.01）。在260例严重烧伤患者中，改良Baux评分与Ryan评分、改良Baux评分与比利时烧伤预后评分、Ryan评分与比利时烧伤预后评分结果均具有显著一致性（Kendall tau-b系数分别为0.75、0.71、0.86，P<0.01）。改良Baux评分、比利时烧伤预后评分、Ryan评分对260例严重烧伤患者死亡风险预测的ROC的AUC分别为0.92、0.89、0.85（95%置信区间分别为0.86~0.98、0.83~0.95、0.78~0.93，P<0.01），最佳阈值分别为106.5、4.5、1.5分，最佳阈值下的敏感度分别为88.5%、76.9%、73.1%，最佳阈值下的特异度分别为88.5%、87.2%、86.3%。改良Baux评分与比利时烧伤预后评分的AUC质量相近（z=1.25，P>0.05），均明显优于Ryan评分（z值分别为2.35、2.11，P<0.05）。 结论 改良Baux评分、比利时烧伤预后评分、Ryan评分对严重烧伤患者死亡风险均有较好的预测能力，从临床实践考虑，改良Baux评分更适合作为严重烧伤患者的预后预测工具。 Abstract:Objective To explore the predictive values of the modified Baux score, Belgian Outcome in Burn Injury score, and Ryan score on the death risk of severe burn patients. Methods A retrospective case series study was conducted. From February 2018 to November 2019, 260 severe burn patients who met the inclusion criteria were admitted to the Department of Burns of the First Affiliated Hospital of Nanchang University, including 158 males and 102 females, aged 36 (3, 53) years. According to the final outcome, the patients were divided into survival group (n=229) and death group (n=31). Data of patients were compared and statistically analyzed with chi-square test or Mann-Whitney U test between the two groups, including the gender, age, cause of burn, site of burn, total burn area, depth of burn, combined inhalation injury, and combined underlying diseases on admission, and the modified Baux score, Belgian Outcome in Burn Injury score, and Ryan score calculated based on part of the aforementioned data. The Kendall tau-b coefficient method was used to analyze the consistency of the above-mentioned three scores in 260 severe burn patients. The receiver operating characteristic (ROC) curves of the above-mentioned three scores predicting the death risk of 260 severe burn patients were drawn, and the area under the curve (AUC), the optimal threshold, and the sensitivity and specificity under the optimal threshold were calculated. The quality of AUC of the above-mentioned three scores was compared by Delong test. Results The gender, site of burn, and depth of burn of patients between the two groups were all similar (P>0.05). The age, total burn area, proportion of flame burn, proportion of combined inhalation injury, and proportion of combined underlying diseases of patients in death group were significantly higher than those in survival group (with Z values of 5.53 and 17.78, respectively, χ2 values of 16.23, 15.89, and 17.78, respectively, P<0.01); the modified Baux score, Belgian Outcome in Burn Injury score, and Ryan score of patients in death group were 142 (115, 155), 7 (5, 7), 2 (2, 3), all significantly higher than 64 (27, 87), 1 (0, 3), 0 (0, 1) in survival group (with Z values of 7.91, 7.64, and 7.61, respectively, P<0.01). In 260 severe burn patients, the results between the modified Baux score and Ryan score, modified Baux score and Belgian Outcome in Burn Injury score, Ryan score and Belgian Outcome in Burn Injury score were significantly consistent (with Kendall tau-b coefficients of 0.75, 0.71, and 0.86, respectively, P<0.01). The AUCs of ROC curves of the modified Baux score, Belgian Outcome in Burn Injury score, and Ryan score for predicting the death risk of 260 severe burn patients were 0.92, 0.89, and 0.85, respectively (with 95% confidence intervals of 0.86-0.98, 0.83-0.95, and 0.78-0.93, respectively, P<0.01); the optimal thresholds were 106.5, 4.5, and 1.5 points, respectively; the sensitivity under the optimal threshold were 88.5%, 76.9%, and 73.1%, respectively, and the specificity under the optimal threshold were 88.5%, 87.2%, and 86.3%, respectively. The modified Baux score was similar to Belgian Outcome in Burn Injury score in the AUC quality (z=1.25, P>0.05), which were both significantly better than the AUC quality of Ryan score (with z values of 2.35 and 2.11, respectively, P<0.05). Conclusions The modified Baux score, Belgian Outcome in Burn Injury score, and Ryan score have good ability in predicting the death risk of severe burn patients. From the perspective of clinical practice, the modified Baux score is more suitable as a predictive tool for the prognosis of severe burn patients. -
Key words:
- Burns /
- Prognosis /
- Forecasting
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参考文献
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表1 2组严重烧伤患者一般资料比较
组别 例数 性别［例（%）］ 年龄［岁，M（Q1，Q3）］ 烧伤原因［例（%）］ 烧伤部位［例（%）］ 男 女 火焰 其他 1处 ≥2处 存活组 229 139（60.7） 90（39.3） 32（2，50） 137（59.8） 92（40.2） 46（20.1） 183（79.9） 死亡组 31 19（61.3） 12（38.7） 61（50，72） 30（96.8） 1（3.2） 3（9.7） 28（90.3） 统计量值 χ2<0.01 Z=5.53 χ2=16.23 χ2=1.94 P值 0.950 <0.001 <0.001 0.164 注：TBSA为体表总面积 
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表2 260例严重烧伤患者改良Baux评分与Ryan评分结果的一致性情况（例）
改良Baux 评分（分） 例数 Ryan评分 0分 1分 2分 3分 0~50 91 85 6 0 0 51~100 108 40 62 6 0 101~150 51 0 16 29 6 151~200 10 0 0 7 3 合计 260 125 84 32 9
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表3 260例严重烧伤患者改良Baux评分与比利时烧伤预后评分结果的一致性情况（例）
改良Baux 评分（分） 例数 比利时烧伤预后评分 0~2分 3~5分 6~8分 0~50 91 86 5 0 51~100 108 59 49 0 101~150 51 0 28 23 151~200 10 0 0 10 合计 260 145 75 33
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表4 260例严重烧伤患者Ryan评分与比利时烧伤预后评分结果的一致性情况（例）
Ryan评分（分） 例数 比利时烧伤预后评分 0~2分 3~5分 6~8分 0 125 124 1 0 1 84 21 63 0 2 32 0 18 24 3 9 0 0 9 合计 260 145 72 33
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表5 3种评分对260例严重烧伤患者死亡风险预测的受试者操作特征曲线下的曲线面积质量比较
评分 曲线下面积差值 标准误 95%置信区间 z值 P值 改良Baux评分与比利时烧伤预后评分 0.03 0.02 -0.02~0.08 1.25 0.210 改良Baux评分与Ryan评分 0.07 0.03 0.01~0.12 2.35 0.019 比利时烧伤预后评分与Ryan评分 0.04 0.02 <0.01~0.07 2.11 0.035
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