ProVent评分在ICU术后长期机械通气患者中的应用验证

Clinical validation of the ProVent Score in patients on prolonged mechanical ventilation after surgery in intensive care unit

目的验证ProVent评分在ICU长期机械通气患者中的临床应用价值。方法选择2007年1月至2016年6月入住北京5家三甲医院的124例ICU术后长期机械通气患者。收集年龄(分为50~64岁,≥65岁)、机械通气第21天时的血小板计数,是否使用血管活性药物和肾脏替代治疗(正在或48h内进行),并采用受试者工作特征曲线(receiver operating characteristic curve, ROC曲线)下面积评估ProVent评分对长期机械通气患者1年预后的预测价值。结果 124例患者纳入本研究,1年累积病死率为74。2%。用ProVent评分绘制1年病死率的ROC曲线,曲线下面积是0.69 (95%CI 0.58~0.80, P=0.001)。Kaplan-Meier生存分析方法制作不同分级患者的Kaplan-Meier生存曲线,用于分析1年生存率:ProVent评分≤1分的人群1年生存率高于≥2分的人群(Log-rank检验,P=0.018)。结论 ProVent评分可用于国内术后长期机械通气患者1年死亡风险的预测。当ProVent评分≥2分时,提示长期机械通气患者预后不良。

Objective To evaluate clinical application of the ProVent Score in patients requiring prolonged mechanical ventilation (PMV) after surgery in intensive care unit (ICU). Methods A total of 124 patients who required PMV after surgery in ICU in five tertiary-care hospitals in Beijing between January 2007 and June 2016 were enrolled into this multicenter, retrospective, cohort study. Data included age (50-64 years and ≥65 year), platelet count on the 21st day of mechanical ventilation, the use of vasoactive drugs and renal replacement therapy (currently or within 48 h) were collected. The predictive effect of the ProVent Score on 1-year mortality in patients requiring PMV in ICU after surgery was evaluated using receiver operating characteristic curve (ROC curve). Results In this study, 124 patients were enrolled, with a cumulative 1-year mortality of 74.2%(92/124). The ProVent Score can predict 1-year mortality in patients with PMV after surgery, with the area under curve (AUC) of 0.69 [95%CI 0.58-0.80, P=0.001]. Survival curves incorporating two classification of the ProVent Score (≤1 vs.≥2) showed statistically significant differences (Log-rank test: P=0.018). Conclusions The ProVent Score can be used to predict 1-year mortality in patients requiring PMV after surgery in ICU. Patients with the ProVent Score not less than 2 usually show poor prognosis.