SOFA 2.0评分对中暑患者住院死亡率的预测性能：一项多中心、数据驱动的亚表型研究
Predictive performance of the SOFA 2.0 score for in-hospital mortality in patients with heat stroke: a multicenter, data-driven subphenotype study.
摘要(中文译文)
热射病可快速进展，一旦发生多器官功能障碍，院内死亡风险随之升高。因此，早期风险分层在临床上具有重要意义，然而，热射病中常用严重程度评分之间的比较证据仍然有限。我们开展了一项多中心回顾性队列研究，纳入2013年至2023年间在中国两家三级医院首次诊断为热射病并住院的患者。使用入院24小时内首次可获得的数据计算重新校准的SOFA 2.0评分（SOFA2）、原始SOFA、改良早期预警评分、国家早期预警评分和热射病严重程度评分。主要结局为院内死亡，将存活出院作为竞争事件处理。采用累积发病率函数和Fine-Gray模型评估风险梯度，并基于早期临床和实验室特征进行无监督聚类以识别临床亚型。在292例患者中（平均年龄29.8 ± 14.9岁），24例（8.2%）在住院期间死亡。院内死亡的累积发病率随SOFA2四分位数呈阶梯式升高（Gray检验，< 0.001），而原始SOFA四分位数之间的区分度则不那么明显。较高的SOFA2评分与死亡风险增加相关，样条分析提示风险总体呈单调增加。共识别出两种主要临床亚型；在数据驱动聚类所识别的高风险亚型中，SOFA2显示出数值上一致的区分度和稳定的净获益趋势；然而，这些亚型特异性发现应谨慎解读。SOFA2或可早期、连续地反映热射病患者的院内死亡风险，但仍需外部验证。
Abstract
Heat stroke can progress rapidly, and the risk of in-hospital mortality increases once multiple organ dysfunction develops. Early risk stratification is therefore clinically important, yet comparative evidence across commonly used severity scores in heat stroke remains limited. We conducted a multicenter retrospective cohort study of patients admitted with a first diagnosis of heat stroke to two tertiary hospitals in China between 2013 and 2023. The recalibrated SOFA 2.0 score (SOFA2), original SOFA, Modified Early Warning Score, National Early Warning Score, and Heat Stroke Severity Score were calculated using the first available data within 24 h of admission. In-hospital death was the primary outcome, with discharge alive treated as a competing event. Cumulative incidence functions and Fine-Gray models were used to assess risk gradients, and unsupervised clustering based on early clinical and laboratory features was applied to identify clinical subtypes. Among 292 patients (mean age 29.8 ± 14.9 years), 24 (8.2%) died during hospitalization. The cumulative incidence of in-hospital death increased stepwise across SOFA2 quartiles (Gray test, < 0.001), whereas separation across original SOFA quartiles was less distinct. Higher SOFA2 scores were associated with an increased risk of mortality risk, with spline analyses indicating a generally monotonic risk increase. Two major clinical subtypes were identified; in the higher-risk subtype identified by data-driven clustering, SOFA2 showed numerically consistent discrimination and stable net benefit trends; however, these subtype-specific findings should be interpreted cautiously. SOFA2 may provide an early, continuous representation of in-hospital mortality risk in patients with heat stroke, although external validation is required.
如何引用
AMA
Haoming Luo, Yirui Zhu, Tongtong Wang, Weihua Li, Haiyang Guo, Chen Ting, et al. Predictive performance of the SOFA 2.0 score for in-hospital mortality in patients with heat stroke: a multicenter, data-driven subphenotype study.. Frontiers in medicine. 2026; doi:10.3389/fmed.2026.1818390.
APA
Haoming Luo, Yirui Zhu, Tongtong Wang, Weihua Li, Haiyang Guo, Chen Ting, et al (2026). Predictive performance of the SOFA 2.0 score for in-hospital mortality in patients with heat stroke: a multicenter, data-driven subphenotype study.. Frontiers in medicine. https://doi.org/10.3389/fmed.2026.1818390
GB/T 7714
Haoming Luo, Yirui Zhu, Tongtong Wang, Weihua Li, Haiyang Guo, Chen Ting, et al. Predictive performance of the SOFA 2.0 score for in-hospital mortality in patients with heat stroke: a multicenter, data-driven subphenotype study.[J]. Frontiers in medicine, 2026 doi:10.3389/fmed.2026.1818390.
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