APACHEⅡ和MPMⅡ对多器官功能不全综合征的比较分析

Evaluation and Comparision of APACHEⅡand MPMⅡin MODS

目的:评价和比较急性生理学及慢性健康状况评价Ⅱ(APACHEⅡ)和死亡概率模型Ⅱ(MPMⅡ)在多器官功能不全综合征(MODS)的应用情况。方法:对50例MODS病例分别进行APACHEⅡ和MPMⅡ评分并计算预测死亡率(PHM)。在各种评分法中,生存组与死亡组的PHM进行两个独立样本的非参数检验,APACHEⅡ和MPMⅡ的校准度采用Lemeshow-Hosmer拟和优度检验;分辨度采用接受者操作特征曲线下面积进行比较,P<0.05为显著统计学意义。结果:APACHEⅡ的PHM是0.392,MPMⅡ的PHM是0.386;在各种评分法中,生存组与死亡组的PHM有显著性差别(P<0.0001),APACHEⅡ和MPMⅡ的AUROCC分别是0.914、0.877;校准度经拟和优度检验提示APACHEⅡ(P=0.283)、MPMⅡ(P=0.015)。结论:APACHEⅡ和MPMⅡ都可以应用于MODS的病情评价及预后的预测。其中,APACHEⅡ的分辨度和校准度最高,说明该系统的准确性和效能最好。

Objective: To evaluate and compare the performance of version Ⅱ of the Acute Physiology and Chronic Health Evaluation system(APACHE Ⅱ) and version Ⅱ of the Mortality Probability Model(MPM Ⅱ) used for multiple organ dysfunction syndrome. Methods: Probability of hospital death(PHM) for patients were estimated by applying APACHE Ⅱ and MPM Ⅱ(MPM_0) respectively in 50 MODS patients. To compare PHM of survivors and non-survivors by Mann-Whitney U test. The Lemeshow-Hosmer goodness-of-fit and the area under the receiver operating characteristic curve(AUROCC) of the two models were assessed. Results: Two systems underestimated mortality. The PHM of survivors and that of non-survivors has significantly difference(P<0.0001). The AUROCC were 0.914 for APACHE Ⅱ、0.877 for MPM_0. The APACHE Ⅱ showed better calibration(P>0.05 for APACHE Ⅱ). The MPM_0 has poor calibration(P<0.05). Conclusions: APACHE Ⅱ and MPM Ⅱ were good for understanding the severity and prognosis of MODS. The discrimination and calibration of the APACHE Ⅱ was better than the other. The APACHE Ⅱ is the best model to estimate the severity and predict the outcome of MODS.