肝硬化并发脓毒症患者SOFA评分和MELD-Na+评分变化及其临床意义探讨

doi:10.3969/j.issn.1672-5069.2026.02.028

摘要/Abstract

摘要： 目的探讨序贯器官衰竭估计(SOFA)评分联合终末期肝病模型钠(MELD-Na⁺)评分预测肝硬化并发脓毒症患者短期预后的效能。方法 2022年1月～2024年6月我院收治的肝硬化并发脓毒症患者236例,常规临床检测,计算SOFA评分和MELD-Na⁺评分。应用多因素Logistic回归分析肝硬化并发脓毒症患者短期预后的影响因素,应用受试者工作特征(ROC)曲线评估预测效能。结果随访28 d,本组肝硬化患者死亡94例(39.8%);死亡组消化道出血和肝性脑病发生率、血清TBIL、Cr、INR、SOFA评分和MELD-Na⁺评分分别为43.6%、33.0%、(82.7±40.9)μmol/L、(122.4±40.4)μmol/L、(2.1±0.5)、(9.7±3.2)分和(32.1±7.8)分,均显著高于生存组【分别为26.1%、16.2%、(71.5±30.2)μmol/L、(95.6±38.8)μmol/L、(1.8±0.4)、(6.5±2.6)分和(24.0±5.8)分,P<0.05】,而PaO₂/FiO₂、MAP、GCS和Na⁺分别为(259.8±45.6) mmHg、(70.2±15.5) mmHg、(12.3±2.4)分和(128.5±26.2 )mmol/L,均显著低于生存组【分别为(274.5±50.2) mmHg、(83.5±11.8) mmHg、(13.3±2.1)分和(136.8±24.5)mmol/L,P<0.05】;多因素分析显示SOFA评分和MELD-Na⁺评分升高是肝硬化并发脓毒症患者短期预后不良的危险因素(P<0.05);应用SOFA评分和MELD-Na⁺评分联合预测肝硬化并发脓毒症患者预后不良的效能显著优于单项指标预测。结论 SOFA评分联合MELD-Na⁺评分可作为预测肝硬化并发脓毒症患者短期预后的潜在指标,为临床早期干预提供依据。

关键词: 肝硬化, 脓毒症, 序贯器官衰竭估计评分, 终末期肝病模型钠评分, 预后, 诊断

Abstract: Objective This study aimed to investigate sequential organ failure assessment (SOFA) and model for end-stage liver disease-sodium (MELD-Na⁺) in predicting prognosis of patients with liver cirrhosis (LC) complicated by sepsis. Methods A total of 236 patients with sepsis with underlying LC were admitted to our hospital between January 2022 and June 2024, and routine clinical materials were collected for calculating SOFA and MELD-Na⁺ scores. Multivariate Logistic regression analysis was applied to reveal impacting factors, and receiver operating characteristic (ROC) curve was drawn for assessing predicting efficacy. Results By end of 28 day observation, 94 patients (39.8%) died in our series; incidences of esophageal variceal bleeding and hepatic encephalopathy, serum bilirubin, Cr, INR, SOFA score and MELD-Na⁺ score at baseline in dead group were 43.6%, 33.0%, (82.7±40.9)μmol/L, (122.4±40.4)μmol/L, (2.1±0.5), (9.7±3.2) and (32.1±7.8), all much higher than [26.1%, 16.2%, (71.5±30.2)μmol/L, (95.6±38.8)μmol/L, (1.8±0.4), (6.5±2.6) and (24.0±5.8), respectively, P<0.05], while PaO₂/FiO₂, mean arterial pressure, Glasgow coma scale and serum Na⁺ level were (259.8±45.6) mmHg, (70.2±15.5) mmHg, (12.3±2.4) and (128.5±26.2 )mmol/L, all much lower than [(274.5±50.2) mmHg, (83.5±11.8) mmHg, (13.3±2.1) and (136.8±24.5)mmol/L, respectively, P<0.05] in survival group; Logistic analysis showed that SOFA and MELD-Na⁺ scores were both the independent risk factors for poor prognosis in this setting(P<0.05); combination of SOFA score and MELD-Na⁺ score had a satisfactory predicting performance in patients with LC and sepsis. Conclusion SOFA score in combination with MELD-Na⁺ score could be used as potential indicators for predicting the prognosis of patients with cirrhosis complicated with sepsis, which might provide a tool for early intervention.

Key words: Liver cirrhosis, Sepsis, Sequential organ failure assessment score, Model for end-stage liver disease-sodium, Prognosis, Diagnosis

刘立楠, 常宇飞, 王卉. 肝硬化并发脓毒症患者SOFA评分和MELD-Na⁺评分变化及其临床意义探讨[J]. 实用肝脏病杂志, 2026, 29(2): 273-276.

Liu Linan, Chang Yufei, Wang Hui. SOFA and MELD-Na scores in predicting prognosis of patients with liver cirrhosis complicated by sepsis[J]. Journal of Practical Hepatology, 2026, 29(2): 273-276.

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肝硬化并发脓毒症患者SOFA评分和MELD-Na⁺评分变化及其临床意义探讨

SOFA and MELD-Na scores in predicting prognosis of patients with liver cirrhosis complicated by sepsis

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