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目的:探讨不同时间点序贯器官衰竭评分（SOFA）对重症肺炎急性呼吸窘迫综合征（ARDS）患者预后的评估价值。方法:采用回顾性队列研究方法。收集2015年1月至2019年12月宁夏医科大学总医院急诊重症监护病房（ICU）收治的重症肺炎ARDS患者的临床资料，包括入院1、2、3、7 d的SOFA评分，以及患者性别、年龄等一般临床资料，通过诊断试验分析不同时间点SOFA评分对重症肺炎ARDS患者及不同年龄段患者预后评估的价值。结果:纳入88例患者，最终存活42例，死亡46例，病死率为52.27%。死亡组年龄明显大于存活组（岁：60.67±14.66比51.91±15.97），各时间点SOFA评分均明显高于存活组（分：入院后1、2、3、7 d别为9.83±3.50比7.54±2.67、9.98±3.75比7.48±2.92、10.84±4.14比7.23±2.94、11.71±4.03比6.51±3.22，均n P<0.01）。受试者工作特征曲线（ROC曲线）分析显示，入院1、2、3、7 d SOFA评分对重症肺炎ARDS患者的预后均有一定预测价值（均n P<0.01），且入院时间越长，SOFA评分对重症肺炎ARDS患者的ROC曲线下面积（AUC）越大，入院7 d SOFA评分预测重症肺炎ARDS患者的敏感度最高，为92.86%，而入院3 d时特异度最高，为88.10%。除入院7 d AUC明显大于2 d外（0.85比0.72，n P<0.05），其余各时间点ACU比较差异均无统计学意义。以年龄进行分层后，<60岁患者不同时间点SOFA评分对预后预测的敏感度、特异度、准确率及AUC均逐渐提高，预测价值较好；但仅入院3 d SOFA评分预测患者预后的AUC明显高于入院1 d （0.80比0.77，n P<0.05），其他各时间点AUC比较差异均无统计学意义。而在≥60岁的患者中，入院1 d及2 d SOFA评分评价患者预后的AUC偏小（分别为0.67、0.68），预测效果较差；各时间点SOFA评分评价患者预后的AUC差异均无统计学意义。不同年龄重症肺炎ARDS患者各时间点SOFA评分的变化趋势显示，无论是否按照年龄进行分层，死亡组重症肺炎ARDS患者SOFA评分呈上升趋势，而存活组患者SOFA评分呈下降趋势，于入院7 d达到峰值或谷值，且死亡组明显高于存活组（分：年龄<60岁为12.50比6.69，年龄≥60岁为11.58比6.21）。n 结论:SOFA评分对重症肺炎ARDS患者预后有一定评估价值；早期SOFA评分对老年重症肺炎ARDS患者预后评价效果较差。“,”Objective:To explore the evaluation value of sequential organ failure assessment (SOFA) score at different time points in the prognosis of patients with severe pneumonia combined with acute respiratory distress syndrome (ARDS).Methods:A retrospective cohort study method was conducted, including patients with severe pneumonia and ARDS admitted to the emergency intensive care unit (ICU) of General Hospital of Ningxia Medical University from January 2015 to December 2019. General clinical data such as gender, age, and the SOFA scores at 1, 2, 3, and 7 days after admission were recorded. According to the diagnostic test, the prognostic evaluation value of SOFA score in patients with severe pneumonia combined with ARDS at different time points and different ages was analyzed.Results:A total of 88 cases were included in this study, eventually, 42 cases were survived and 46 cases died, the mortality was 52.27%. The age of the death group was significantly older than the survival group (years old: 60.67±14.66 vs. 51.91±15.97), the SOFA score at each time point were significantly higher than those in the survival group (9.83±3.50 vs. 7.54±2.67, 9.98±3.75 vs. 7.48±2.92, 10.84±4.14 vs. 7.23±2.94, 11.71±4.03 vs. 6.51±3.22, respectively at 1, 2, 3, 7 days after admission, all n P < 0.01). The receiver operator characteristic curve (ROC curve) showed that the SOFA score at 1, 2, 3, and 7 days after admission had a certain predictive value for the prognosis of patients with severe pneumonia combined with ARDS (all n P < 0.01), and with the prolong of ICU stay, the area under ROC curve (AUC) of SOFA score had gradually increased. On the 7th day after admission, the SOFA score had the highest sensitivity in predicting severe pneumonia combined with ARDS patients, which was 92.86%, and the specificity was the highest on the 3rd day after admission, which was 88.10%. The AUC in day 7 was significantly higher than day 2 (0.85 vs. 0.72) , there was no statistically significant difference of AUC at other time points. After stratifying by age, the diagnostic of sensitivity, specificity, accuracy, and AUC of SOFA score for the prognosis had gradually increased, and the predictive value was better. However, only on day 3 after admission, the AUC of SOFA score was significantly higher than day 1 (0.80 vs. 0.77, n P < 0.05), and there was no significant difference in AUC at other time points. In patients older than 60 years old, the AUC of the SOFA score predicting the prognosis of patients was relatively small on day 1 and day 2 (0.67, 0.68, respectively), the ability was poor. There was no statistically significant difference in the AUC of SOFA scores at each time point in evaluating the prognosis of patients. The trends over time of patients at different ages and time points showed that regardless of age, the SOFA scores of the patients in the death group showed an upward trend, while showed a downward trend in the survival group, the difference reached the largest on the 7th day after admission, and the death group was significantly higher than the survival group (age < 60 years old: 12.50 vs. 6.69; age≥60 years old: 11.58 vs. 6.21).n Conclusion:The initial SOFA score has a certain value in the evaluation of prognosis of severe pneumonia patients combined with ARDS, but the effect is poor for elderly patients.