The Value Of Using Oxford Acute Severity Of Illness Score To Assess The Prognosis And Severity Of Elderly Intensive Care Patients

Objective:The critical care score system is an important means for clinical evaluation of the severity of severe patients,evaluation of the efficacy,guidance of treatment and prognosis,which has been widely used in clinical practice.The Oxford Acute Severity of Illness Score(OASIS)has been introduced into clinical practice in recent years.This article mainly analyzed the OASIS Score of elderly patients in ICU and their outcomes,discussed the value of OASIS score in evaluating the severity and prognosis of elderly patients in ICU,and explored the diagnostic cut-off point indicating the increased risk of death of patients.Methods:Retrospective analyzed of clinical data of 667 patients hospitalized in two general hospitals in Huangshan general hospital from January 2015 to December 2017.The age group was divided into the elderly group(aged>60)and the the young middle-aged group(18<aged:?59).Including 383(57.42%)in the elderly group and 284(42.58%)in the young and middle-aged group.Each patient's OASIS score was calculated separately and then statistically processed and analyzed.Results:A total of 667 patients were included in this study,including 443 males(63.42%)and 224 females(33.58%),aged from 18 to 97 years,with an average age of 61.46±17.64 years.There were 485 cases of survival and 182 cases of death,with a case fatality rate of 27.29%.OASIS score(3?63),average(29.21±8.80).There were 367 cases(55.02%)of internal medicine,231 cases(34.63%)of trauma,43 cases(6.45%)of emergency surgery,and 26 cases(3.90%)of elective surgery.There were 383 cases(57.42%)in the elderly group and 284 cases(42.58%)in the young and middle-aged group.The OASIS score and case fatality rate of the young and middle-aged groups and the elderly group were 27.32(±9.13)points vs 30.61(±8.29)points,22.89%vs 30.55%,respectively,with statistically signficant difference(P<0.05).The gender composition of patients(P=0.548)and ICU duration(P=0.100)of the two groups showed no statistically significant difference.The age and OASIS scores of the patients in the survival group and the death group were(72.49±8.40)years old vs(77.77±9:43)years old,(28.45±7.43)points vs.(35.51 ±8.08)points,respectively,with statistically signficant difference(P<0.001),the gender composition(P=0.799),the ICU admission time(P=0.144),and the differences were not statistically significant(P>0.01).The area under the ROC curve of the OASIS score of the young and middle-aged group was 0.817(95%confidence interval:0.759-0.876,P<0.001),and the Youden index was the highest at 0.473 when OASIS was 31.5.In the elderly group,the area under the ROC curve of the OASIS score was 0.737(95%confidence interval:0.683-0.790,P<0.001),and the Youden index was the highest at 0.365 when OASIS was 34.5.The area under the ROC curve of the young and middle-aged group was higher than that of the elderly group(Z=-1.982,P=0.048).As the OASIS score increases,the patient's mortality rate gradually increases.Bivariate correlation analysis showed that the Spearman over correlation coefficient was rp=0.979,(p<0.001),middle-aged groups was rp=0.950,(P<0.001),and the Spearman correlation coefficient of the elderly group was rp=0.986,(P<0.001).The ROC curve of the OASIS score in the elderly group,the ICU mortality rate of the patients with different scores of the OASIS score,and the risk diagnosis cutoff points of the classification tree model were 35 points,40 points,and 30 points,respectively.The area under the ROC curve at the diagnostic cut-off point of 30 points is 0.681(95%confidence interval:0.632-0.758),and the area under the ROC curve at the diagnostic cut-off point of 35 points is 0.683(95%confidence interval:0.633-0.759)The difference was not statistically significant(z=0.060,P=0.952).The area under the ROC curve at the diagnostic cut-off point of 40 points is 0.613(95%confidence interval:0.563-0.662),and there were statistically significant differences between the diagnostic cut-off point of 30 points and the diagnostic cut-off point of 35 points(z=2.467,P?0.013;z=2.847,P=0.004).Conclusions:1.The proportion and fatality rate of elderly patients in ICU are higher than that of middle-aged and young people.2.OASIS score has a good value in the assessment of the condition and prognosis of elderly patients in ICU.With the increase of OASIS rating score,the mortality of patients increases gradually.3.OASIS score of 35 points is the cut-off point for patients with increased risk of death.