CAJ | 학술논문

目的评估简化急性生理评分(SAPS)Ⅱ预测危重神经疾病患者死亡概率的可行性和可靠性.方法纳入2005年1月至2007年12月神经内科重症监护病房(N-ICU)患者653例,记录入院后0、24、48、72 h的SAPSⅡ分值,并计算医院死亡概率(PHM).疾病病种分为脑出血、脑梗死、中枢神经系统感染、神经肌肉疾病和其他神经疾病5类.经两样本均数比较的t检验比较生存组与死亡组SAPSⅡ分值,经单因素回归分析判断不同时间点SAPSⅡ分值与预后的关系;经校准度(Hosmer-Lemeshow拟合优度检验)和分辨度(ROC曲线下面积)分析判断SAPSⅡ性能;经多因素Logistic回归分析判断神经疾病种类与预后的关系.结果不同时间点死亡组SAPSⅡ分值(分别为46.53±12.22、47.28±13.84、48.58±14.18和49.06±14.61)明显高于生存组分值(分别为34.70±11.78、30.28±12.24、29.79±12.36和29.69±12.96,t=11.12、14.02、14.43和13.49,均P＜0.01);不同时间点SAPSⅡ分值与预后均相关(OR值分别为1.080、1.100、1.109和1.100,P＜0.01);不同时间点SAPSⅡ分值Hosmer-Lemeshow拟合优度检验结果为校准度均较高,分别x2=5.305、7.557、6.369和8.540(P＞0.05);48和72 h分值预测病死率与实际病死率的总一致率分别为82.6%和83.4%,ROC曲线下面积分别为0.825和0.847;多因素分析疾病病种与预后无关.结论 SAPSⅡ适用于N-ICU危重症神经疾病患者的病情评估和死亡概率预测,48和72 h评估最为准确,且不受疾病病种影响.
목적 평고간화급성생리평분(SAPS)Ⅱ예측위중신경질병환자사망개솔적가행성화가고성.방법 납입2005년1월지2007년12월신경내과중증감호병방(N-ICU)환자653례,기록입원후0、24、48、72 h적SAPSⅡ분치,병계산의원사망개솔(PHM).질병병충분위뇌출혈、뇌경사、중추신경계통감염、신경기육질병화기타신경질병5류.경량양본균수비교적t검험비교생존조여사망조SAPSⅡ분치,경단인소회귀분석판단불동시간점SAPSⅡ분치여예후적관계;경교준도(Hosmer-Lemeshow의합우도검험)화분변도(ROC곡선하면적)분석판단SAPSⅡ성능;경다인소Logistic회귀분석판단신경질병충류여예후적관계.결과 불동시간점사망조SAPSⅡ분치(분별위46.53±12.22、47.28±13.84、48.58±14.18화49.06±14.61)명현고우생존조분치(분별위34.70±11.78、30.28±12.24、29.79±12.36화29.69±12.96,t=11.12、14.02、14.43화13.49,균P＜0.01);불동시간점SAPSⅡ분치여예후균상관(OR치분별위1.080、1.100、1.109화1.100,P＜0.01);불동시간점SAPSⅡ분치Hosmer-Lemeshow의합우도검험결과위교준도균교고,분별x2=5.305、7.557、6.369화8.540(P＞0.05);48화72 h분치예측병사솔여실제병사솔적총일치솔분별위82.6%화83.4%,ROC곡선하면적분별위0.825화0.847;다인소분석질병병충여예후무관.결론 SAPSⅡ괄용우N-ICU위중증신경질병환자적병정평고화사망개솔예측,48화72 h평고최위준학,차불수질병병충영향.
Objective To evaluate feasibility and reliability of using Simplified Acute Physiology Score Ⅱ (SAPS Ⅱ)in predicting mortality in critically ill patients with neurological diseases.Methods All 653 patients hospitalized in neurological intensive care unit (N-ICU) from Jan 2005 to Dec 2007 were retrospectively studied.SAPSⅡ scores were scaled upon admission at 24,48 and 72 h,and possibility of hospital mortality (PHM) was calculated based on SAPS Ⅱ score.Neurological diseases diagnosis made initially at time of hospitalization was classified into five categories:intracranial hemorrhage,cerebral infarction,neurologic infection,neuromuscular diseases and other neurologic diseases.At each of four time points,the SAPSⅡscores were compared between the survival group and death group,and the relationship of SAPS Ⅱ score and prognosis were analyzed.The calibration of the SAPS Ⅱ were accessed with the Hosmer-Lemeshow goodness-of-fit chi-squared statistic and the discrimination with area under the receiver operating characteristic curve (AUROC).Multivariate logistic regression was used to analyze the relationship between disease category and prognosis.Results SAPS Ⅱ scores in the death group (46.53±12.22,47.28±13.84,48.58±14.18 and 49.06±14.61)at each time point were significantly higher than those in the survival group (34.70±11.78,30.28±12.24,29.79±12.36 and 29.69±12.96;t=11.12,14.02,14.43 and 13.49 at 0,24,48 and 72 h,respectively,P＜0.01).Furthermore,univariate logistic regression analyses demonstrated that SAPS Ⅱ score was correlated with prognosis (OR=1.080,1.100,1.109,1.100 at 0,24,48 and 72 h,respectively,P＜0.01).The scores at 48 and 72 h were more accurate in predicting mortality.SAPS Ⅱ had good calibration at each time points (x2=5.305,7.557,6.369 and 8.540,P＞0.05),however,the consistency of expected mortality with observed mortality was satisfactory only at 48 and 72 h(82.6%,83.4%),so was the discrimination ( AUROC=0.825,0.847 respectively).There was no correlation between disease categories and outcome.Conclusion SAPS Ⅱ scoring,best evaluated at 48 and 72 h after hospitalization,can be used as a reliable predictor of probability of mortality in patients hospitalized in N-ICU and prediction can be applied in these patients with all different neurology diseases.