摘要
目的对比分析APACHEⅡ、APACHEⅢ评分及PSI评分评估老年重症肺炎患者预后的临床价值。方法研究纳入2014-05-2015-09入住天津市第一中心医院的老年重症肺炎患者102例，根据28d生存情况分为生存组与死亡组，分析比较两组患者APACHEⅡ、APACHEⅢ评分及PSI评分差异，通过ROC曲线下的面积评估各评分系统的预测能力。结果APACHEi、PSI评分与APACHEⅡ评分呈显著正相关（r值分别为0．579、0．218，P〈0．01）；APACHEⅡ、APACHEm评分及PSI评分ROC曲线下面积分别为0．930（P=0．000，95％C10．861—1．000）、0．795（P=0．001，95％C10．661-0．929）及0．677（P=0．047，95％C10．515～0．839）。结论在三种评分系统中，APACHEⅡ、APACHEm评分系统预测老年重症肺炎预后的准确性高，且APACHEⅡ评分优于APACHEⅢ评分，PSI评分预测预后的临床价值有限，评估老年重症肺炎预后首选APACHEⅡ评分。
Objective The aim of this study was to compare the effects of Acute Physiology and Chronic Health Evaluation Ⅱ score （ APACHE Ⅲ score）, Acute Physiology and Chronic Health Evaluationlll score （APACHE Ⅲ score） and pneumonia severity index （PSI score） for the prediction of 28- day mortality in the elderly patients with severe pneumonia. Methods A total of 102 critical patients during May 2014 and September 2015, undertook APACHE Ⅱ, score APACHEⅢ score and PSI score. Correlations between the scores from the three methods and prognoses were compared according to the survival and death conditions during a 28 - day observation period; the accuracy of evaluating the prognoses with three scoring systems was compared by areas under the ROC curve. Results APACHE Ⅱ /Ⅲ score had good discrimination for predicting 28 - day mortality in elderly patients with severe pneumonia, and with AUC 0. 930 （P = 0. 000, 95% CI 0. 861 ~ 1. 000）, 0. 795 （P = 0. 001, 95% CI 0. 661 ~ 0. 929）. However, the PSI score did not have discrimination power for predicting mortality, withAUC0.677（P=0.047,95%CI0.515~0.839）. Conclusion These data suggest that APACHE Ⅱ, as well as APACHE Ⅲ score, is effective for predicting 28 - day mortality in elderly patients with severe pneumonia, but that the PSI score does not have good discrimination and calibration for predicting mortality. APACHE Ⅱ score is excellent in the prediction of 28 - day mortality.
出处
《中国急救医学》
CAS
CSCD
北大核心
2015年第11期1013-1016,共4页
Chinese Journal of Critical Care Medicine
基金
基金项目：天津市卫生局科技攻关项目（13KG104）
