中国危重病急救医学
中國危重病急救醫學
중국위중병급구의학
CHINESE CRITICAL CARE MEDICINE
2013年
2期
115-118
,共4页
崔云亮%王涛%吴相伟%陈德昌
崔雲亮%王濤%吳相偉%陳德昌
최운량%왕도%오상위%진덕창
查尔森合并症指数评分系统%危重病%预后%重症监护病房
查爾森閤併癥指數評分繫統%危重病%預後%重癥鑑護病房
사이삼합병증지수평분계통%위중병%예후%중증감호병방
Charlson weighted index of comorbidities scoring system%Critical illness%Outcome%Intensive care unit
目的 探讨查尔森合并症指数(WIC)评分系统评价基础疾病对于重症监护病房(ICU)危重患者28 d死亡风险的影响.方法 单中心、回顾性分析上海长征医院2009年1月至2011年10月ICU 406例危重病患者的临床信息,按照28 d治疗转归分为死亡组(104例)和存活组(302例)；记录一般临床资料；计算入院时WIC评分和入院24h急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分.采用logistic回归分析影响患者预后的因素.结果 与存活组比较,死亡组患者年龄、WIC评分、APACHEⅡ评分、严重脓毒症的比例及主要致病因素如肺部感染的比例均较高,多发伤的比例较低.单因素分析显示,年龄、WIC评分、APACHEⅡ评分、肺部感染、多发伤、严重脓毒症与患者28 d预后相关.多因素logistic回归分析提示,WIC评分[优势比(OR)=1.538,95％可信区间(95％CI)为1.265 ～ 1.869,P=0.000]、APACHEⅡ评分(OR=1.193,95％CI为1.137～1.252,P=0.000)、肺部感染(OR=0.546,95％CI为0.304～0.982,P=0.043)、严重脓毒症(OR=0.178,95％CI为0.098 ～ 0.323,P=0.000)与患者28 d预后独立相关.WIC评分、APACHEⅡ评分及二者合并后预测预后的受试者工作特征曲线(ROC曲线)下面积[AUC(95％CI)]依次为0.657 (0.592～ 0.722)、0.790(0.739 ～ 0.841)、0.821(0.772 ～ 0.869).结论 WIC评分系统可以较好地评价ICU危重患者的28 d预后.
目的 探討查爾森閤併癥指數(WIC)評分繫統評價基礎疾病對于重癥鑑護病房(ICU)危重患者28 d死亡風險的影響.方法 單中心、迴顧性分析上海長徵醫院2009年1月至2011年10月ICU 406例危重病患者的臨床信息,按照28 d治療轉歸分為死亡組(104例)和存活組(302例)；記錄一般臨床資料；計算入院時WIC評分和入院24h急性生理學與慢性健康狀況評分繫統Ⅱ(APACHEⅡ)評分.採用logistic迴歸分析影響患者預後的因素.結果 與存活組比較,死亡組患者年齡、WIC評分、APACHEⅡ評分、嚴重膿毒癥的比例及主要緻病因素如肺部感染的比例均較高,多髮傷的比例較低.單因素分析顯示,年齡、WIC評分、APACHEⅡ評分、肺部感染、多髮傷、嚴重膿毒癥與患者28 d預後相關.多因素logistic迴歸分析提示,WIC評分[優勢比(OR)=1.538,95％可信區間(95％CI)為1.265 ～ 1.869,P=0.000]、APACHEⅡ評分(OR=1.193,95％CI為1.137～1.252,P=0.000)、肺部感染(OR=0.546,95％CI為0.304～0.982,P=0.043)、嚴重膿毒癥(OR=0.178,95％CI為0.098 ～ 0.323,P=0.000)與患者28 d預後獨立相關.WIC評分、APACHEⅡ評分及二者閤併後預測預後的受試者工作特徵麯線(ROC麯線)下麵積[AUC(95％CI)]依次為0.657 (0.592～ 0.722)、0.790(0.739 ～ 0.841)、0.821(0.772 ～ 0.869).結論 WIC評分繫統可以較好地評價ICU危重患者的28 d預後.
목적 탐토사이삼합병증지수(WIC)평분계통평개기출질병대우중증감호병방(ICU)위중환자28 d사망풍험적영향.방법 단중심、회고성분석상해장정의원2009년1월지2011년10월ICU 406례위중병환자적림상신식,안조28 d치료전귀분위사망조(104례)화존활조(302례)；기록일반림상자료；계산입원시WIC평분화입원24h급성생이학여만성건강상황평분계통Ⅱ(APACHEⅡ)평분.채용logistic회귀분석영향환자예후적인소.결과 여존활조비교,사망조환자년령、WIC평분、APACHEⅡ평분、엄중농독증적비례급주요치병인소여폐부감염적비례균교고,다발상적비례교저.단인소분석현시,년령、WIC평분、APACHEⅡ평분、폐부감염、다발상、엄중농독증여환자28 d예후상관.다인소logistic회귀분석제시,WIC평분[우세비(OR)=1.538,95％가신구간(95％CI)위1.265 ～ 1.869,P=0.000]、APACHEⅡ평분(OR=1.193,95％CI위1.137～1.252,P=0.000)、폐부감염(OR=0.546,95％CI위0.304～0.982,P=0.043)、엄중농독증(OR=0.178,95％CI위0.098 ～ 0.323,P=0.000)여환자28 d예후독립상관.WIC평분、APACHEⅡ평분급이자합병후예측예후적수시자공작특정곡선(ROC곡선)하면적[AUC(95％CI)]의차위0.657 (0.592～ 0.722)、0.790(0.739 ～ 0.841)、0.821(0.772 ～ 0.869).결론 WIC평분계통가이교호지평개ICU위중환자적28 d예후.
Objective To investigate the efficiency of original diseases by the Charlson weighted index of comorbidities (WIC) in predicting 28-day mortality in patients with critical illnesses in intensive care unit (ICU).Methods A single-center retrospective analysis of clinical data of 406 patients admitted between January 2009 and October 2011 to Shanghai Changzheng Hospital was conducted.The patients were divided into non-survivor group (n=104) and survivor group (n=302) according to 28-day outcome.The data were recorded,and the WIC and the acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score were calculated.Logistic regression analysis was used to determine the independent predictors for 28-day mortality.Results Compared with survivors,the average age,WIC and APACHE Ⅱ scores,severe sepsis,pneumonia,and multiple injuries were higher in non-survivors.The univariate analysis showed that age,the WIC score,APACHE Ⅱ score,pneumonia,multiple injuries and severe sepsis were related with patients' 28-day prognosis.The multivariate logistic regression revealed that 28-day prognosis depended significantly on WIC score [odds ratio (OR)=1.538,95％ confidence interval (95％CI) 1.265-1.869,P=0.000],APACHE Ⅱ score (OR=1.193,95％CI 1.137-1.252,P=0.000),pneumonia (OR=0.546,95％CI 0.304-0.982,P=0.043),and severe sepsis (OR =0.178,95％ CI 0.098-0.323,P=0.000).The area under the receiver operating characteristics curve (ROC curve) in predicting mortality was 0.657 (0.592-0.722) for the WIC score,0.790 (0.739-0.841) for APACHE Ⅱ score and 0.821 (0.772-0.869) for their combination.Conclusion The WIC scoring system can be a good evaluation method for 28-day prognosis in ICU patients.
