摘要目的:探讨序贯器官衰竭评估（SOFA）评分及其动态变化（ΔSOFA）在血液重症监护病房（HCU）中预测死亡率的价值。方法:回顾性收集2024年5月至2024年6月中国医学科学院血液病医院重症医学诊疗中心收治的79例血液病危重症患者的临床数据，计算患者自住院于HCU前2 d至后2 d的SOFA评分及ΔSOFA。应用受试者工作特征曲线（ROC）研究SOFA评分及ΔSOFA在死亡率预测中的价值。结果:79例患者的HCU死亡率为54.4%。死亡组全体患者、白血病患者和造血干细胞移植（HSCT）患者住院第1~3天SOFA（D_1、D_2、D_3）评分和第1天ΔSOFA（ΔD_1）均较非死亡组明显增高（ P值均<0.05）。ROC曲线分析显示，D_1、D_2、D_3评分和ΔD_1均可预测患者死亡率（ P<0.001），曲线下面积（AUC）分别为0.786、0.866、0.901、0.843，灵敏度分别为74.36%、57.89%、62.85%、86.84%，特异度分别为70.00%、100%、100%、67.65%。HSCT组中，D_-1、D_1、D_2、D_3评分和ΔD_1均可预测HCU死亡率，AUC分别为0.833、0.794、0.871、0.846、0.795；灵敏度分别为100%、85.71%、71.43%、57.14%、57.14%；特异度分别为73.33%、70.59%、91.33%、100%、100%。白血病组中，D_1、D_2、D_3评分和ΔD_1可预测HCU死亡率，AUC分别为0.760、0.829、0.846、0.756；灵敏度分别为71.43%、78.57%、53.85%、71.43%；特异度分别为76.19%、78.95%、100%、63.16%。对于全体患者，D_3评分特异度最高，ΔD_1灵敏度最高。对于HSCT组和白血病组患者，D_1和D_3评分的灵敏度及特异度均高于ΔD_1。 结论:对于住院于HCU的血液危重症、白血病和HSCT患者，D_1、D_2、D_3评分和ΔD_1与HCU死亡率明显相关。

abstractsObjective:To investigate the value of Sequential Organ Failure (SOFA) score and its dynamics (ΔSOFA) in predicting mortality in hematology care unit (HCU) .Methods:A retrospective clinical study was conducted on 79 critically ill hematologic patients admitted to the Center for Critical Care Medicine, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences, between May and June 2024. SOFA scores and ΔSOFA were calculated within 2 days before and after HCU admission. The predictive value of SOFA and ΔSOFA in mortality was assessed using receiver operating characteristic (ROC) curve analysis.Results:Among the 79 patients, the HCU mortality rate was 54.4%. The SOFA scores on days 1–3 (D1, D2, and D3) and ΔSOFA on day 1 (ΔD_1) of all patients, leukemia patients and hematopoietic stem cell transplantation (HSCT) patients were significantly higher in the death group compared with the non-death group (all P<0.05). ROC curve analysis revealed that the D_1, D_2, D_3 scores, and ΔD_1 significantly predicted mortality ( P<0.001), with areas under the curve (AUCs) of 0.786, 0.866, 0.901, and 0.843, respectively. The sensitivity values were 74.36%, 57.89%, 62.85%, and 86.84%, while specificity values were 70%, 100%, 100%, and 67.65%, respectively. In the HSCT group, the D_-1, D_1, D_2, D_ 3, scores and ΔD_1 were predictive of HCU mortality, with AUCs of 0.833, 0.794, 0.871, 0.846, and 0.795, respectively. Sensitivity values for these scores were 100%, 85.71%, 71.43%, 57.14%, and 57.14%, while specificity values were 73.33%, 70.59%, 91.33%, 100%, and 100%, respectively. In the leukemia group, the D_1, D_2, D_3 scores, and ΔD_1 were predictive of HCU mortality, with AUCs of 0.760, 0.829, 0.846, and 0.756, respectively. Sensitivity values were 71.43%, 78.57%, 53.85%, and 71.43%, while specificity values were 76.19%, 78.95%, 100%, and 63.16%, respectively. For all patients, the D_3 score exhibited the highest specificity, while the ΔD_1 demonstrated the highest sensitivity. For patients in both the HSCT and leukemia groups, the sensitivity and specificity values of the D_1 and D_3 scores exceeded those of the ΔD_1. Conclusion:For patients with hematologic critical illness, including leukemia and those undergoing HSCT hospitalized in the HCU, D_1, D_2, D_ 3 scores and ΔD_1 are significantly associated with HCU mortality.