APACHEⅡ、SAPSⅡ和ATN-ISI评分系统对急性肾功能衰竭患者病情评估价值比较

Comparison of APACHEⅡ,SAPSⅡ and ATN-ISI scoring systems in evaluating severity and predicting prognosis of patients with acute renal failure

目的:评价APACHEⅡ、SAPSⅡ和ATN-ISI 3种评分系统用于急性肾功能衰竭患者病情评估及预后的价值。方法:回顾性分析166例急性肾功能衰竭患者的临床资料,分别应用APACHEⅡ、SAPSⅡ、ATN-ISI评分系统对患者病死率进行预测,并比较3种评分方法的分辨度,评价其预测效力。结果:166例患者中死亡49例(29.52%),存活117例(70.48%)。死亡组APACHEⅡ、SAPSⅡ和ATN-ISI评分均明显高于存活组(P<0.01);APACHEⅡ对患者死亡危险度预测明显高于SAPSⅡ(P<0.01);不同分数段患者病死率比较差异均有统计学意义(P<0.01),分值越高,病死率越高。APACHEⅡ、SAPSⅡ预计死亡危险度分别为39.38%,32.37%,均高于实际病死率(29.52%),SAPSⅡ预计值更接近实际病死率。APACHEⅡ、SAPSⅡ和ANT-ISI的AUC分别为0.721±0.042、0.852±0.034和0.885±0.026,3种评分方法的分辨度比较差异无统计学意义(P>0.05)。结论:APACHEⅡ、SAPSⅡ和ATN-ISI评分系统对患者病死率均有较好的预测,3种评分方法的分辨度对急性肾功能衰竭预测效力相同。

Objective To evaluate the value of acute physiology and chronic healthy condition score Ⅱ（APACHEⅡ）,simplified acute physiology scoreⅡ（SAPSⅡ）,and acute tubular necrosis-individual severity index（ATN-ISI） scoring systems to analyzing the severity and the prognosis of acute renal failure.Methods A total of 166 patients with acute renal failure were analyzed retrospectively and scored respectively to predict the fatality rate with APACHEⅡ,ATN-ISI and SAPSⅡ.The discrimination of three systems was compared and the predicting power was evaluated.Results In the 166 patients,49 died and 117 survived.The scores of APACHEⅡ,SAPSⅡ and ATN-ISI in the nonsurvivors were higher than those of the survivors（P0.01）.APACHEⅡ could better predict the fatality rate than SAPSⅡ in the nonsurvivors（P0.01）.The significant difference of fatality rate was found in patients with different scores（P0.01）.The fatality rate increased along with elevation of the scores.The fatality rate predicted by APACHEⅡ（39.38%） or SAPSⅡ（32.37%） was higher than the actual fatality rate（29.52%）.The fatality rate predicted by SAPSⅡ was close to actual fatality rate.The areas under ROC curve of APACHEⅡ,SAPSⅡ and ATN-ISI were 0.721±0.042,0.852±0.034 and 0.885±0.026,respectively,which showed no significant difference.Conclusion The scoring systems of APACHEⅡ,SAPSⅡ and ATN-ISI can well predict fatality rate in patients with acute renal failure.The predicting power in the discrimination of three scoring systems has no significant difference.