两种评分方法预测ICU急性脑卒中患者死亡率准确性分析

The analysis of two scoring methods for acute stroke patients ICU mortality prediction

[摘要]目的比较急性生理与慢性健康状况评分Ⅱ（APACHEⅡ）与简化急性生理评分（SAPSⅡ）预测ICU急性缺血或出血性脑卒中患者死亡率的准确性。方法通过与格拉斯哥昏迷量表评分（GCS）、国立卫生研究院卒中量表评分（NIHSS）、欧洲卒中量表评分（ESS）及改良爱丁堡一斯堪的纳维亚评分（MESSS）比较，证实APACHEⅡ和SAPSⅡ可用于评价ICU急性缺血性或出血性脑卒中患者。研究对象为2013—01～2015—06在我院ICU住院的249例急性缺血性或出血性脑卒中患者。采用校正曲线、Hosmer-Lemeshow拟合优度检验和受试者工作特征曲线（ROC）比较APACHEⅡ和SAPSⅡ预测死亡率的准确性，并与GCS评分、NIHSS评分、ESS评分、MESSS评分的预测结果进行比较。结果患者实际死亡率为26．5％，APACHEⅡ和SAPSⅡ预测死亡率分别为34．01％和34．23％。平均GCS、NIHSS、ESS与MESSS评分分别为9．32、21．52、52．20与17．53。校准曲线完美地接近预测线。ROC曲线显示，APACHEⅡ评分预测缺血性脑卒中患者的死亡率（AUC=0．805）更准确，SAPSⅡ评分预测出血性脑卒中患者死亡率（AUC=0．834）更准确。GCS、NIHSS、ESS与MESSS评分预测缺血或出血性脑卒中患者死亡率准确性均低于APACHEⅡ和SAPSⅡ评分。结论APACHEⅡ和SAPSⅡ都可预测急性脑卒中患者死亡率。且APACHEⅡ预测缺血性脑卒中患者准确率更高，SAPSⅡ评分预测出血性脑卒中患者死亡率准确性更高。

Objective To compare the accuracy of acute physiology and chronic health evaluation Ⅱ （APACHE Ⅱ ） and simplified acute physiology score Ⅱ（SAPS Ⅱ） in predicting hemorrhagic or ischemic stroke in ICU. Methods We studied the applicability of the APACHE Ⅱ and SAPS Ⅱ in patients admitted to the ICU with acute stroke and compared the results with the Glasgow coma scale （GCS）, national institutes of health stroke scale （NIHSS）, the European stroke scale（ESS） and modified Edinburgh - Scandinavia stroke scale score （MESSS）. Ischemic or hemorrhagic stroke patients admitted to the ICU between 2013 January and 2015 June were included in the study. Overall 249 patients were included in this study. APACHE I1 and SAPS Ⅱ predicted mortalities were compared using a calibration curve, the Hosmer - Lemeshow goodness - of - fit test, and the receiver operating characteristic （ROC） curve, and the results were compared with the GCS, NIHSS, ESS and MESSS. Results The observed mortality was 26.5 %, whereas APACHE Ⅱ and SAPS Ⅱ- predicted mortalities were 34.01% and 34.23 % , respectively. The mean GCS, NIHSS, ESS and MESSS scores were 9.32,21.52, 52.20 and 17.53, respectively. The calibration curve was close to the line of perfect prediction. The ROC curve showed a slightly better prediction of mortality for APACHE Ⅱ in hemorrhagic stroke patients（AUC =0.805） and SAPS Ⅱ in ischemic stroke patients （AUC = 0. 834）. The GCS, NIHSS, ESS and MESSS were inferior in predicting mortality in both patient groups. Conclusion The accuracy of APACHE Ⅱ in hemorrhagic stroke patients and SAPS Ⅱ in ischemic stroke patients was superior.