三种评分预测严重烧伤患者死亡风险的对比研究

谢志勤; 郭光华; 杨珍; 易含笑; 王水连; 唐鑫荣; 刘德广; 曾彦德

doi:10.3760/cma.j.cn501120-20201113-00473

三种评分预测严重烧伤患者死亡风险的对比研究

doi: 10.3760/cma.j.cn501120-20201113-00473

1.
南昌大学第一附属医院护理部，南昌　　330006
2.
南昌大学护理学院，南昌　　330006
3.
南昌大学第一附属医院烧伤科，南昌　　330006

基金项目:

江西省科技厅应用培育计划 20181BBG78028

江西省科技厅重点研发项目 20192BBGL70016

详细信息

通讯作者:
杨珍，Email：64243156@qq.com

计量
- 文章访问数: 264
- HTML全文浏览量: 44
- PDF下载量: 44
- 被引次数: 0
出版历程
- 收稿日期: 2020-11-13

Comparative study of three scores in predicting the death risk of severe burn patients

1.
Department of Nursing, the First Affiliated Hospital of Nanchang University, Nanchang 330006, China
2.
College of Nursing, Nanchang University, Nanchang 330006, China
3.
Department of Burns, the First Affiliated Hospital of Nanchang University, Nanchang 330006, China

Funds:

Applied Cultivation Program of Jiangxi Science and Technology Department 20181BBG78028

Key Research and Development Program of Jiangxi Science and Technology Department 20192BBGL70016

More Information

Corresponding author: Yang Zhen, Email: 64243156@qq.com

摘要

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。
- 烧伤 /
- 预后 /
- 预测
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.
- Burns /
- Prognosis /
- Forecasting
谢志勤、王水连：论文撰写；郭光华、杨珍、易含笑：研究指导、经费支持、论文修改；唐鑫荣、刘德广、曾彦德：数据整理、统计分析

所有作者均声明不存在利益冲突

HTML全文

1 改良Baux评分、比利时烧伤预后评分与Ryan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

下载: 全尺寸图片幻灯片

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（%）］
组别	例数	男	女	年龄［岁，M（Q₁，Q₃）］	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

下载: 导出CSV

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
改良Baux 评分（分）	例数	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

下载: 导出CSV

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
改良Baux 评分（分）	例数	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

下载: 导出CSV

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
Ryan评分（分）	例数	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

下载: 导出CSV

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

下载: 导出CSV

参考文献(28)

[1]	TsurumiA,QueYA,YanS,et al.Do standard burn mortality formulae work on a population of severely burned children and adults?[J].Burns,2015,41(5):935-945.DOI: 10.1016/j.burns.2015.03.017.
[2]	SheridanRL.Burn care: results of technical and organizational progress[J].JAMA,2003,290(6):719-722.DOI: 10.1001/jama.290.6.719.
[3]	曾庆玲,王庆梅,陶利菊,等.特重度烧伤患者死亡风险列线图预测模型的建立及预测价值[J].中华烧伤杂志,2020,36(9):845-852.DOI: 10.3760/cma.j.cn501120-20190620-00280.
[4]	SaffleJR.Predicting outcomes of burns[J].N Engl J Med,1998,338(6):387-388.DOI: 10.1056/NEJM199802053380610.
[5]	LipHTC,IdrisMAM,ImranFH,et al.Predictors of mortality and validation of burn mortality prognostic scores in a Malaysian burns intensive care unit[J].BMC Emerg Med,2019,19(1):66.DOI: 10.1186/s12873-019-0284-8.
[6]	OslerT,GlanceLG,HosmerDW.Simplified estimates of the probability of death after burn injuries: extending and updating the baux score[J].J Trauma,2010,68(3):690-697.DOI: 10.1097/TA.0b013e3181c453b3.
[7]	RyanCM,SchoenfeldDA,ThorpeWP,et al.Objective estimates of the probability of death from burn injuries[J].N Engl J Med,1998,338(6):362-366.DOI: 10.1056/NEJM199802053380604.
[8]	SalehiSH, As'adiK, Abbaszadeh-KasbiA, et al. Comparison of six outcome prediction models in an adult burn population in a developing country[J]. Ann Burns Fire Disasters, 2017, 30(1): 13-17.
[9]	PrasadA,ThodeHCJr,SingerAJ.Predictive value of quick SOFA and revised Baux scores in burn patients[J].Burns,2020,46(2):347-351.DOI: 10.1016/j.burns.2019.03.006.
[10]	樊钧豪,孙义方,伍国胜,等.基于改良全身炎症反应综合征评分建立的联合预测模型对大面积烧伤患者入院早期死亡风险的预测价值[J].中华烧伤杂志,2020,36(1):42-47.DOI: 10.3760/cma.j.issn.1009-2587.2020.01.008.
[11]	TsaiSY,LioCF,YaoWC,et al.Cost-drivers of medical expenses in burn care management[J].Burns,2020,46(4):817-824.DOI: 10.1016/j.burns.2020.01.004.
[12]	Belgian Outcome in Burn Injury Study Group.Development and validation of a model for prediction of mortality in patients with acute burn injury[J].Br J Surg,2009,96(1):111-117.DOI: 10.1002/bjs.6329.
[13]	BrusselaersN,AgbenorkuP,Hoyte-WilliamsPE.Assessment of mortality prediction models in a Ghanaian burn population[J].Burns,2013,39(5):997-1003.DOI: 10.1016/j.burns.2012.10.023.
[14]	ChristofidesC,MooreR,NelM.Baux score as a predictor of mortality at the CHBAH Adult Burns Unit[J].J Surg Res,2020,251:53-62.DOI: 10.1016/j.jss.2020.01.018.
[15]	罗茉莉,郑建锋.实践教学中如何快速准确计算烧伤面积[J].当代护士(上旬刊),2019,26(4):158-159.DOI: 10.3969/j.issn.1006-6411.2019.04.078.
[16]	李乐之,路潜.外科护理学[M].6版.北京:人民卫生出版社,2017.
[17]	LamNN,DucNM,HungNT.Influence of pre-existing medical condition and predicting value of modified Elixhauser comorbidity index on outcome of burn patients[J].Burns,2020,46(2):333-339.DOI: 10.1016/j.burns.2019.08.004.
[18]	XuY,JinX,ShaoX,et al.Valuable prognostic indicators for severe burn sepsis with inhalation lesion: age, platelet count, and procalcitonin[J/OL].Burns Trauma,2018,6:29[2020-11-13]. https://pubmed.ncbi.nlm.nih.gov/30397617/. DOI: 10.1186/s41038-018-0132-1.
[19]	NygaardRM,EndorfFW.Nonmedical factors influencing early deaths in burns: a study of the National Burn Repository[J].J Burn Care Res,2020,41(1):3-7.DOI: 10.1093/jbcr/irz139.
[20]	朱丹,曹钰,何亚荣,等.4种评分对成人重度热力烧伤患者的死亡风险预测价值[J].西部医学,2015,27(12):1788-1791.DOI: 10.3969/j.issn.1672-3511.2015.12.008.
[21]	ChenCC,ChenLC,WenBS,et al.Objective estimates of the probability of death in acute burn injury: a proposed Taiwan burn score[J].J Trauma Acute Care Surg,2012,73(6):1583-1589.DOI: 10.1097/TA.0b013e318265ff5a.
[22]	RontoyanniVG, MalagarisI, HerndonDN, et al. Skeletal muscle mitochondrial function is determined by burn severity, sex, and sepsis, and is associated with glucose metabolism and functional capacity in burned children[J]. Shock,2018,50(2):141-148. DOI: 10.1097/SHK.0000000000001074.
[23]	JeschkeMG, PintoR, CostfordSR, et al. Threshold age and burn size associated with poor outcomes in the elderly after burn injury[J]. Burns,2016,42(2):276-281. DOI: 10.1016/j.burns.2015.12.008.
[24]	FitriA, SaputraD, PutraAE. Perbandingan R-Baux score dengan BOBI score sebagai prediktor mortalitas pasien luka bakar di RSUP Dr. M. Djamil Padang[J]. Majalah Kedokteran Bandung, 2018,50(2):79-85. DOI: 10.15395/mkb.v50n2.1326.
[25]	WilliamsDJ,WalkerJD.A nomogram for calculation of the Revised Baux Score[J].Burns,2015,41(1):85-90.DOI: 10.1016/j.burns.2014.05.001.
[26]	YoshimuraY,SaitohD,YamadaK,et al.Comparison of prognostic models for burn patients: a retrospective nationwide registry study[J].Burns,2020,46(8):1746-1755.DOI: 10.1016/j.burns.2020.10.008.
[27]	SaadatGH,ToorR,MazharF,et al.Severe burn injury: body mass index and the Baux score[J].Burns,2021,47(1):72-77.DOI: 10.1016/j.burns.2020.10.017.
[28]	HalgasB,BayC,FosterK.A comparison of injury scoring systems in predicting burn mortality[J].Ann Burns Fire Disasters,2018,31(2):89-93.