查尔森合并症指数评分系统评价基础疾病对危重患者预后的影响

The use of Charlson weighted index of comorbidities scoring system to evaluate the impact of original diseases for prognosis in intensive care unit patients

目的探讨查尔森合并症指数（WIC）评分系统评价基础疾病对于重症监护病房（ICU）危重患者28d死亡风险的影响。方法单中心、回顾性分析上海长征医院2009年1月至2011年10月ICU406例危重病患者的临床信息，按照28d治疗转归分为死亡组（104例）和存活组（302例）；记录一般临床资料；计算入院时WIC评分和入院24h急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分。采用logistic回归分析影响患者预后的因素。结果与存活组比较，死亡组患者年龄、WIC评分、APACHEⅡ评分、严重脓毒症的比例及主要致病因素如肺部感染的比例均较高，多发伤的比例较低。单因素分析显示，年龄、WIC评分、APACHEⅡ评分、肺部感染、多发伤、严重脓毒症与患者28d预后相关。多因素logistic回归分析提示，WIC评分[优势比（OR）=1．538，95％可信区间（95％CI）为1．265～1．869，P=0．000]、APACHEⅡ评分（OR=1．193，95％凹为1．137～1．252，P=0．000）、肺部感染（OR=0．546，95％CI为0．304～0．982，P=0．043）、严重脓毒症（OR=0．178，95％CI为0．098～0．323，P=0．000）与患者28d预后独立相关。WIC评分、APACHEⅡ评分及二者合并后预测预后的受试者工作特征曲线（ROC曲线）下面积[AUC（95％CI）]依次为0．657（0．592～0．722）、0．790（0．739～0．841）、0．821（0．772—0．869）。结论WIC评分系统可以较好地评价ICU危重患者的28d预后。

Objective To investigate the efficiency of original diseases by the Charlson weighted index of comorbidities （WIC） in predicting 28-day mortality in patients with critical illnesses in intensive care unit （ICU）. Methods A single-center retrospective analysis of clinical data of 406 patients admitted between January 2009 and October 2011 to Shanghai Changzheng Hospital was conducted. The patients were divided into non-survivor group （n=104） and survivor group （n=302） according to 2g-day outcome. The data were recorded, and the WIC and the acute physiology and chronic health evaluationⅡ （APACHE Ⅱ ） score were calculated. Logistic regression analysis was used to determine the independent predictors for 28-day mortality. Results Compared with survivors, the average age, WIC and APACHE Ⅱ scores, severe sepsis, pneumonia, and multiple injuries were higher in non-survivors. The univariate analysis showed that age, the WIC score, APACHE Ⅱ score, pneumonia, multiple injuries and severe sepsis were related with patients＇ 28-day prognosis. The multivariate logistic regression revealed that 28-day prognosis depended significantly on WIC score [odds ratio （OR）： 1.538, 95% confidence interval （95%CI） 1.265 - 1.869, P=0.000], APACHE Ⅱ score （OR=1.193, 95%CI 1.137- 1.252, P=0.000）, pneumonia （OR：0.546, 95%CI 0.30± 0.982, P=0.043）, and severe sepsis （OR=0.178, 95%CI 0.098- 0.323, P=0.000）. The area under the receiver operating characteristics curve （ROC curve） in predicting mortality was 0.657 （0.592 - 0.722） for the WIC score, 0.790 （0.739 - 0.841 ） for APACHE Ⅱ score and 0.821 （0.772 - 0.869） for their combination. Conclusion The WIC scoring system can be a good evaluation method for 28-day prognosis in ICU patients.