摘要
目的比较和评价急性生理学与慢性健康状况评分系统Ⅱ（APAcHEⅡ）、简明急性生理功能评分系统Ⅱ（SAPSⅡ）及Logistic器官功能障碍系统（LODS）3种评分系统对危重病患者院内病死率的预测能力。方法应用3种评分系统计算出病死概率并与实际病死率比较。通过受试者工作特征曲线（ROC）下的面积及分类表，判定3种评分系统的拟合优度；而各评分系统对分层精确度的预测则用校准曲线及Lemeshow—Hosmer妒统计来评估。结果APACHEⅡ评分系统的预测病死率与实际病死率基本相符，而其他两种评分系统的预测病死率偏低。APACHEⅡ、SAPSⅡ及LODS各评分系统的ROC曲线下面积分别为0．881、0．904和0．875；95％可信区间分别为0．858～0．904，0．884～0．924和0．851～0．898；而在诊断界点为50％时，APACHEⅡ、SAPSⅡ及LODS各评分系统的整体正确分类率分别为81．60％、82．Og％和79．26％。APACHEⅡ（X^2=9．69）及SAPSⅡ（X^2=13．50）评分系统对分层精确度的预测较好，LODS评分系统则较差（X^2=87．22）。结论3种评分系统预测危重病患者预后的鉴别能力均较好且接近一致，APACHEⅡ及SAPSⅡ评分系统的分层预测精确度明显好于LODS。
Objective To compare and evaluate the prognostic value of three prognostic systems namely acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ ）, simplified acute physiology score （SAPS Ⅱ ）, and Logistic organ dysfunction system （LODS）, to predict mortality rate in intensive care unit （ICU）. Methods APACHE Ⅱ , SAPS Ⅱ and LODS were used to assess probabilities of hospital mortality rate and to compare with actual outcome. The overall goodness-of-fit of three prognostic systems were assessed by using the areas under the receiver operating characteristic （ROC） curves and classification tables. Calibration curves and Lemeshow -Hosmer chi square statistics were used to test accuracy of prediction. Results Hospital mortality rate was basically equivalent to that predicted by APACHE Ⅱ hut higher than those predicted by SAPS Ⅱ and LODS. The areas under the ROC curves were 0. 881 for APACHE Ⅱ , 0. 904 for SAPS Ⅱ and 0. 875 for LODS, and 95% confidence interval （CI） were 0. 858 - 0. 904, 0. 884 - 0. 924 and 0. 851 - 0. 898, respectively. The overall correct classification rates, applying the decision criterion of 50%, were 81.60% for APACHE Ⅱ , 82.09% for SAPS Ⅱ and 79.26% for LODS. Calibration of APACHE Ⅱ （X^2=9.69） and SAPS Ⅱ （X^2= 13.50） were superior to that of LODS （X^2= 87. 22）. Conclusion The prognostic value of discrimination for APACHE Ⅱ , SAPS Ⅱ and LODS is good and basically equivalent, hut calibration of acuity of APACHE Ⅱ and SAPS Ⅱ is much better than that of LODS.
出处
《中国危重病急救医学》
CAS
CSCD
北大核心
2006年第12期743-747,共5页
Chinese Critical Care Medicine
基金
广西留学回国人员科学基金项目(桂科回0342026)
关键词
危重病
疾病严重程度评分
病死率
预后
预测
critical illness
severity of illness score
mortality rate
outcome
prognostication
