基于生理指标的住院患者病情严重程度评分构建与有效性研究

Constructing and effectiveness analysis on inpatients illness severity score based on physiology

目的:构建适用于国内医院信息系统的在院患者病情危重程度评分,并检验其有效性。方法:以某大型综合医院2015年7月1日?2015年12月31日住院的18岁以上患者为研究对象,提取其诊疗数据。参照基于实验室检查的急性生理功能评分第2版(LAPS2)研发思路,纳入14项生理指标,构建了适于国内医院信息系统实际情况的病情危重评分。分析危重评分与患者在院死亡率、平均住院日的简单关系;构建Logistic模型,考察危重评分与在院死亡之间的关系;构建最小二乘法模型(OLS),考察危重评分与平均住院日之间的关系。结果:所构建的住院患者病情严重程度评分是范围在0?160的连续型变量。分值越高,患者数量越少,而患者在院死亡率迅速提高。Logistic回归结果显示,评分越高,在院死亡可能性越大。随着评分的增加,全部患者和以治愈好转为转归患者的平均住院日呈现递增趋势;而以死亡为转归的患者平均住院日呈现先上升后下降的倒U型趋势。OLS回归结果与此一致。结论:基于生理指标构建的住院患者病情危重程度评分是有效的。

Objective： To construct a score for inpatients illness severity applied to hospital information system in China and to test its effectiveness. Methods： Patients over the age of 18 in a large general hospital who were hospitalized from July 1,2015 to December 31,2015 were selected as the object of study, and extracted their medical record data. According to the Laboratory Acute Physiology Score, version 2 （LAPS2）, 14 physiological indicators were included and built an illness severity score that applied to Chinese hospital information system. The relationship between the score and hospital mortality and average length of stay （LOS） were analyzed and a Logistic model was established to explore the relationship between the score and death, and an Ordinary Least Square （OLS） model was established to explore the relationship between the score and average LOS. Results： The severity score of the inpatients was a continuous variable ranged from 0 to160. With the score increasing, the number of patients decreased, and hospital mortality increased. Logistic regression results showed that the higher the score, the greater the likelihood of death in hospital. With the increase in scores, the average LOS in all patients and patients who were cured was increasing, while the average LOS of patients who died declined. OLS regression results are consistent. Conclusion： The severity score of inpatients based on physiological indexes is effective.