ICU危重患者APACHEⅡ评分变化率和临床预后的关系

摘要

目的:分析ICU危重症患者APACHEⅡ评分变化率(简称APACHEⅡ变化率)和临床预后的关系.方法:选取ICU危重症患者94例并跟踪28d,根据28d生存情况分为生存组(66例)和死亡组(28例),收集第1天APACHEⅡ评分(APACHEⅡ1)、第2天APACHEⅡ评分(APACHEⅡ2)资料,计算APACHEⅡ变化率;比较2组患者APACHEⅡ1、APACHEⅡ2和APACHEⅡ变化率;采用ROC曲线比较APACHEⅡ1和APACHEⅡ变化率预测临床预后的差异.结果:死亡组患者APACHEⅡ1、APACHEⅡ2高于生存组,而APACHEⅡ变化率低于生存组(P<0.05);APACHEⅡ变化率与预后呈负相关性(P<0.05);ROC曲线结果显示APACHEⅡ变化率预测总体预后的曲线下面积(AUC)为0.880,高于APACHEⅡ1的曲线下面积0.775(P<0.05).APACHEⅡ变化率的最佳界值为0.21(敏感性60.7％,特异性95.5％).结论:APACHEⅡ变化率对ICU危重症患者临床预后的评估意义高于单纯APACHEⅡ评分.%Objective:To analyze the relationship between the variability of APACHEⅡ and clinical prognosis of severe patients from ICU.Method:Ninety-four severe patients from ICU were recruited and followed up for 28 days.All the patients were divided into survival group (66 cases) and death group (28 cases) according to the 28-day survival situation.The first day APACHEⅡ score (APACHEⅡ1) and second day APACHE Ⅱ score (APACHEⅡ2) were collected.The variability of APACHEⅡ was calculated.The difference in APACHEⅡ1, APACHEⅡ2 and the variability of APACHEⅡ between two groups were compared.ROC curve method was carried out to compare the difference in APACHEⅡ1 and variability of APACHEⅡ in the assessment of clinical prognosis.Results:The APACHEⅡ1 and APACHEⅡ2 in death group were higher than those in survival group, and the variability of APACHEⅡ was lower in death group than in survival group with the differences being statistically significant (P<0.05).There was a negative correlation between variability of APACHEⅡ and prognosis (P<0.05).ROC curve showed that the area under the curve (AUC) of the variability of APACHEⅡ predicting the assessment of overall prognosis was 0.880, greater than that of APACHEⅡ1 (0.775), with statistically significant differences (P<0.05).The cut-off of the variability of APACHEⅡ was 0.21 (sensitivity=60.7％, and specificity=95.5％).Conclusion:The variability of APACHEⅡ was superior to APACHEⅡ1 alone in predicting the clinical prognosis of ICU severe patients.