Design and utility of surgical risk score assessment for HIV-infected patients

doi:10.3877/cma.j.issn.1674-0793.2016.03.010

Abstract

Abstract:

Objective

To design an assessment system to systematically analyze the risk of de-veloping post-operative sepsis and death of HIV-infected patients.

Methods

Eight hundred and fifty-one HIV-infected patients who underwent various surgical procedures from Jan 2008 to Jun 2015 in Shanghai Public Health Clinical Center were collected to conduct the retrospective statistical analysis. According the sepsis result, they were divided into two groups. Level of CD4, grade of incision, grade of surgery, opportunistic infections and organ function were scored from 1 to 4 corresponding to the serious-ness. The average score were used to calculate the sensitivity and specific value of the assessment system.

Results

Two hundred and sixty-four patients developed post-operative sepsis. The morbidity rate was 31.0%. Eleven died from serious sepsis in 30 days after surgery. The mortality rate was 1.3%. The average score of sepsis group was 11.50 while it was 7.46 in non-sepsis group. The score of sepsis group was significantly higher. When the cut-off value was set at 9.5, the sensitivity and specificity was 90%.

Conclusion

This assessment system can predict the surgery risk of HIV-infected patients and help surgeons to take preventive steps.

Key words: HIV infections, Sepsis, Mortality, Risk assessment

Baochi Liu, Tienan Feng, Lei Li, Yanhui Si, Qiling Liu, Weiwei Zhang, Xin Liu. Design and utility of surgical risk score assessment for HIV-infected patients[J]. Chinese Archives of General Surgery(Electronic Edition), 2016, 10(03): 205-208.

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Figures/Tables 5

References 12

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项目	1分	2分	3分	4分
CD4 T淋巴细胞（个/μl）	>350	200～350	51～199	≤ 50
切口分类	清洁	清洁-污染	污染	感染
手术分级	Ⅰ	Ⅱ	Ⅲ	Ⅳ
机会感染	无	既往有	轻	重
器官功能	无异常	检查异常	轻	重

项目	1分	2分	3分	4分
CD4 T淋巴细胞（个/μl）	>350	200～350	51～199	≤ 50
切口分类	清洁	清洁-污染	污染	感染
手术分级	Ⅰ	Ⅱ	Ⅲ	Ⅳ
机会感染	无	既往有	轻	重
器官功能	无异常	检查异常	轻	重

指标		β值	SE值	P值	95% CI
CD4		?	?	?	?
?	1	1	0	0.03	?
?	2	0.66	0.48	0.17	0.75~0.98
?	3	1.4	0.5	0.01	1.52~10.75
?	4	1.47	0.72	0.04	1.07~17.68
切口分类		?	?	?	?
?	1	1	0	0	?
?	2	1.21	0.48	0.01	1.32~8.46
?	3	3.79	0.66	0	12.21~161.4
?	4	22.39	10 334.61	1	0
手术分级		?	?	?	?
?	1	1	0	0.02	?
?	2	1.09	0.46	0.02	1.22~7.31
?	3	1.33	0.5	0.01	1.41~10.13
?	4	3.69	2.17	0.09	0.57~2 806.5
机会感染		?	?	?	?
?	1	1	0	0	?
?	2	2.8	0.55	0	5.53~48.44
?	3	5.6	0.93	0	43.66~1 689.97
?	4	21.34	13 843.65	1	0
器官功能		?	?	?	?
?	1	1	0	0	?
?	2	2.14	0.44	0	3.59~20.06
?	3	3.98	1.34	0	3.86~745.47
?	4	22.98	40 192.97	1	0
常数		-6.87	0.74	0	?

指标		β值	SE值	P值	95% CI
CD4		?	?	?	?
?	1	1	0	0.03	?
?	2	0.66	0.48	0.17	0.75~0.98
?	3	1.4	0.5	0.01	1.52~10.75
?	4	1.47	0.72	0.04	1.07~17.68
切口分类		?	?	?	?
?	1	1	0	0	?
?	2	1.21	0.48	0.01	1.32~8.46
?	3	3.79	0.66	0	12.21~161.4
?	4	22.39	10 334.61	1	0
手术分级		?	?	?	?
?	1	1	0	0.02	?
?	2	1.09	0.46	0.02	1.22~7.31
?	3	1.33	0.5	0.01	1.41~10.13
?	4	3.69	2.17	0.09	0.57~2 806.5
机会感染		?	?	?	?
?	1	1	0	0	?
?	2	2.8	0.55	0	5.53~48.44
?	3	5.6	0.93	0	43.66~1 689.97
?	4	21.34	13 843.65	1	0
器官功能		?	?	?	?
?	1	1	0	0	?
?	2	2.14	0.44	0	3.59~20.06
?	3	3.98	1.34	0	3.86~745.47
?	4	22.98	40 192.97	1	0
常数		-6.87	0.74	0	?

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