Background Comorbidity is one of the most important determinants ot short-term and long-term outcomes in septic patients. Charlson＇s weighted index of comorbidities （WIC） and the chronic health score （CHS）, which...Background Comorbidity is one of the most important determinants ot short-term and long-term outcomes in septic patients. Charlson＇s weighted index of comorbidities （WIC） and the chronic health score （CHS）, which is a component of the acute physiology and chronic health evaluation （APACHE） II, are two frequently-used measures of comorbidity. In this study, we assess the performance of WIC and CHS in predicting the hospital mortality of intensive care unit （ICU） patients with sepsis. Methods A total of 338 adult patients with sepsis were admitted to a multisystem ICU between October 2010 and August 2012. Clinical data were collected, including age, gender, underlying diseases, key predisposing causes, severity-of- sepsis, and hospital mortality. The APACHE II, CHS, acute physiology score （APS）, sequential organ failure assessment （SOFA） and WIC scores were assessed within the first 24 hours of admission. Univariate and multiple Logistic regression analyses were used to compare the performance of WlC and CHS. The area under the receiver operating characteristic curve （AUC） was used to predict hospital mortality over classes of risk. Results Of all the enrolled patients, 224 patients survived and 114 patients died. The surviving patients had significantly lower WlC, CHS, APACHE II, and SOFA scores than the non-surviving patients （P 〈0.05）. Combining WIC or CHS with other administrative data showed that the hospital mortality was significantly associated with age, severe sepsis, key predisposing causes such as pneumonia, a history of underlying diseases such as hypertension and congestive cardiac failure, and WlC, CHS and APS scores （P 〈0.05）. The AUC for the hospital mortality were 0.564 （95% confidence interval （CO 0.496-0.631） of CHS, 0.663 （95% CI 0.599-0.727） of WIC, 0.770 （95% CI 0.718-0.822） of APACHE II, 0.856 （95% Cl 0.815-0.897） of the CHS combined with other administrative data, and 0.857 （95% CI 0.817-0.897） of the WlC combined with other administrative data. The diagnostic value of WIC was better than that of CHS （P=0.0015）. Conclusions The WlC and CHS scores might be independent determinants for hospital mortality among ICU patients with sepsis. WlC might be an even better predictor of the mortality of septic patients with comorbidities than CHS. Chin Med J 2014;127 （14）： 2623-2627展开更多
目的探讨基础疾病评分系统查尔森基础疾病权重指数(Charlson’s weighted index of comorbidities,WIC)评估脓毒症患者预后的价值。方法回顾性分析3年收治的234例脓毒症患者的临床资料,计算WIC评分及急性病理生理和慢性健康状况评分Ⅱ(A...目的探讨基础疾病评分系统查尔森基础疾病权重指数(Charlson’s weighted index of comorbidities,WIC)评估脓毒症患者预后的价值。方法回顾性分析3年收治的234例脓毒症患者的临床资料,计算WIC评分及急性病理生理和慢性健康状况评分Ⅱ(APACHEⅡ),根据28d预后情况分为存活组和死亡组,分析WIC评分对患者预后的评估价值。结果共有234例脓毒症患者纳入研究,死亡77例(32.9%)。WIC评分越高,患者的死亡风险越大;多因素logistic回归分析提示WIC评分是决定脓毒症患者预后的危险因素(OR=1.434,95%CI:1.097～1.875,P=0.008);WIC评分、APACHEⅡ评分以及两者联合预测死亡概率的ROC曲线下面积(95%CI)分别0.670(0.591～0.748)、0.770(0.703～0.837)和0.821(0.757～0.885)。结论 WIC评分可以较好地评估基础疾病对于危重病患者预后的影响。展开更多
目的:研究查尔森合并症指数(Charlson's weighted index of comorbidities,WIC)评分系统在急诊病人留院观察时间预测中的应用。方法:回顾性分析3 353例急诊留院观察病人的相关资料。按照留院观察时间对3 353例病人(不包括死亡病人)...目的:研究查尔森合并症指数(Charlson's weighted index of comorbidities,WIC)评分系统在急诊病人留院观察时间预测中的应用。方法:回顾性分析3 353例急诊留院观察病人的相关资料。按照留院观察时间对3 353例病人(不包括死亡病人)进行分组,留院观察时间≥72 h为A组(2 239例),留院观察时间<72 h为B组(1 114例)。对影响病人留院观察的因素进行logistic回归分析,包括病人的年龄、性别、基础疾病、居住条件(是否居住养老院)、留院观察疾病诊断,以及急性生理与慢性健康状况(APACHE)Ⅱ评分和留院观察的WIC评分。同时,根据受试者工作特征曲线(ROC),评定WIC评分在病人留院观察时间中的预测作用。结果:3 353例急诊留院观察病人中,因泌尿和内分泌系统疾病留院病人299例(8.9%),消化系统疾病522例(15.6%),循环和神经系统疾病838例(25.0%),呼吸系统疾病1 356例(40.4%),其他原因疾病338例(10.1%)。A组急诊病人的APACHEⅡ评分和WIC评分均高于B组(P<0.01)。年龄、居住养老院、WIC评分和APACHEⅡ评分均可影响病人留院观察时间(P<0.01)。多因素logistic回归分析显示,年龄、居住养老院、APACHEⅡ评分、WIC评分无共线性关系,均为影响病人留院观察时间的独立相关因素(P<0.01),APACHEⅡ评分的ROC曲线下面积为0.796,WIC评分的为0.691,两者结合的ROC曲线下面积为0.892。结论:基于基础疾病评价的WIC评分系统能够较好地预测急诊病人留院观察时间。展开更多
目的比较急性生理与慢性健康状况评分Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)、国家早期预警评分(national early warning score,NEWS)、肺栓塞严重程度指数(pulmonary embolism severity index,PESI)和Charlso...目的比较急性生理与慢性健康状况评分Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)、国家早期预警评分(national early warning score,NEWS)、肺栓塞严重程度指数(pulmonary embolism severity index,PESI)和Charlson合并症指数(Charlson comorbidity index,CCI)四种评分对肺栓塞(pulmonary embolism,PE)预后的影响。方法采用病例-对照方法回顾性分析2010~2017年湘雅二医院诊断的PE患者的临床资料,按病死组和存活组计算两组患者的4种临床评分。比较两组间危险因素的差异,并采用logistic回归分析得出与病死率相关的独立危险因素。采用ROC工作曲线比较四种临床评分对PE病死率的预后诊断价值。统计分析采用SPSS 24.0和Medcalc 18.2.1软件。结果共纳入318例患者,病死率13.2%。病死组的APACHEⅡ、NEWS、PESI、CCI评分均高于存活组,两组差异有统计学意义(P<0.05)。对预后的危险因素进行logistic回归分析,发现脑血管疾病、心率、白细胞、肌钙蛋白T、动脉血氧分压、右心室功能不全是患者90天病死率的独立危险因素。APACHEⅡ、CCI、PESI、NEWS的ROC曲线下面积分别是0.886、0.728、0.715、0.731,其中APACHEⅡ的曲线下面积最大,优于NEWS、CCI、PESI(P<0.05),NEWS、CCI、PESI三者间比较,差异无统计学意义。结论APACHEⅡ可能是对PE患者病死率的最佳预测指标,优于NEWS、CCI、PESI。展开更多
文摘Background Comorbidity is one of the most important determinants ot short-term and long-term outcomes in septic patients. Charlson＇s weighted index of comorbidities （WIC） and the chronic health score （CHS）, which is a component of the acute physiology and chronic health evaluation （APACHE） II, are two frequently-used measures of comorbidity. In this study, we assess the performance of WIC and CHS in predicting the hospital mortality of intensive care unit （ICU） patients with sepsis. Methods A total of 338 adult patients with sepsis were admitted to a multisystem ICU between October 2010 and August 2012. Clinical data were collected, including age, gender, underlying diseases, key predisposing causes, severity-of- sepsis, and hospital mortality. The APACHE II, CHS, acute physiology score （APS）, sequential organ failure assessment （SOFA） and WIC scores were assessed within the first 24 hours of admission. Univariate and multiple Logistic regression analyses were used to compare the performance of WlC and CHS. The area under the receiver operating characteristic curve （AUC） was used to predict hospital mortality over classes of risk. Results Of all the enrolled patients, 224 patients survived and 114 patients died. The surviving patients had significantly lower WlC, CHS, APACHE II, and SOFA scores than the non-surviving patients （P 〈0.05）. Combining WIC or CHS with other administrative data showed that the hospital mortality was significantly associated with age, severe sepsis, key predisposing causes such as pneumonia, a history of underlying diseases such as hypertension and congestive cardiac failure, and WlC, CHS and APS scores （P 〈0.05）. The AUC for the hospital mortality were 0.564 （95% confidence interval （CO 0.496-0.631） of CHS, 0.663 （95% CI 0.599-0.727） of WIC, 0.770 （95% CI 0.718-0.822） of APACHE II, 0.856 （95% Cl 0.815-0.897） of the CHS combined with other administrative data, and 0.857 （95% CI 0.817-0.897） of the WlC combined with other administrative data. The diagnostic value of WIC was better than that of CHS （P=0.0015）. Conclusions The WlC and CHS scores might be independent determinants for hospital mortality among ICU patients with sepsis. WlC might be an even better predictor of the mortality of septic patients with comorbidities than CHS. Chin Med J 2014;127 （14）： 2623-2627
文摘目的探讨基础疾病评分系统查尔森基础疾病权重指数(Charlson’s weighted index of comorbidities,WIC)评估脓毒症患者预后的价值。方法回顾性分析3年收治的234例脓毒症患者的临床资料,计算WIC评分及急性病理生理和慢性健康状况评分Ⅱ(APACHEⅡ),根据28d预后情况分为存活组和死亡组,分析WIC评分对患者预后的评估价值。结果共有234例脓毒症患者纳入研究,死亡77例(32.9%)。WIC评分越高,患者的死亡风险越大;多因素logistic回归分析提示WIC评分是决定脓毒症患者预后的危险因素(OR=1.434,95%CI:1.097～1.875,P=0.008);WIC评分、APACHEⅡ评分以及两者联合预测死亡概率的ROC曲线下面积(95%CI)分别0.670(0.591～0.748)、0.770(0.703～0.837)和0.821(0.757～0.885)。结论 WIC评分可以较好地评估基础疾病对于危重病患者预后的影响。
