APACHEII评分引入MODS评分系统对急诊内科危重患者预后的预测价值

Study of acute physiology and chronic health evaluationII (APACHEII) after introduction of multiple organ dysfunction score (MODS) in evaluating prognosis of emergency internal illness

目的验证APACHEII评分对病情的评价及预后的预测价值,同时探讨引入MODS评分对评价系统的作用。方法对287例急诊内科危重病人进行APACHEII评分并计算病死危险度、MODS评分及其二者之和的总得分;应用接受者操作特征曲线下面积(AUROCC)比较三种评分的分辨能力。结果存活组与死亡组之间的APACHEII和MODS、总分值差异有统计学意义(P<0.01)。APACHEII对群体的预计病死危险度与实际病死率之间差异无统计学意义(P>0.05);无MODS组预计病死危险度高于实际病死率(P<0.05);MODS组预计病死危险度低于实际病死率(P<0.05)。三种评分的ROC曲线下面积比较,总分具有最大的ROC曲线下面积,其预测存活与死亡的分辨度最好。结论APACHEII评分可以比较好地预测急诊内科危重病人群体的预后;但是对MODS患者预测结果偏低,MODS评分的引入可提高预测存活与死亡的能力。

Objective: To assess the predictability of APACHEII scoring system on intensive patients in emergency department advancedly, and to demonstrate if the predictive value is better after introduction of MODS. Methods: Calculate APACHEII, MODS, and Total score for 287 consecutive emergency internal patients. The discriminative power of the three scores was evaluated by the area under the receiver operating characteristic curve (AUROCC). Results: A significant difference was found between survivors and non-survivors groups on the score of patients scored with APACHEII, MODS and Total score respectively (P<0.01). There was no significant difference between the actual mortality and predicted mortality evaluated with APACHEII (P>0.05) in total. But the predictive result is higher in non-MODS group and lower in MODS group (P<0.05). For Total score the area under the ROC curve was higer than APACHEII and MODS, The difference was statistically significant (P<0.05). Conclusions: APACHEII can satisfactorily predict emergency internal illness in total , but predictive consequence is lower in patients complicated with MODS. The highest discriminative power was revealed with introducing MODS score.