中华急诊医学杂志
中華急診醫學雜誌
중화급진의학잡지
CHINESE JOURNAL OF EMERGENCY MEDICINE
2013年
7期
744-748
,共5页
崔云亮%王涛%田昭涛%吴相伟%林兆奋%陈德昌
崔雲亮%王濤%田昭濤%吳相偉%林兆奮%陳德昌
최운량%왕도%전소도%오상위%림조강%진덕창
查尔森合并症指数%急性生理与慢性健康状况评分Ⅱ%脓毒症相关性器官功能衰竭评分%肺部感染%预后
查爾森閤併癥指數%急性生理與慢性健康狀況評分Ⅱ%膿毒癥相關性器官功能衰竭評分%肺部感染%預後
사이삼합병증지수%급성생리여만성건강상황평분Ⅱ%농독증상관성기관공능쇠갈평분%폐부감염%예후
WIC%APACHE Ⅱ score%SOFA score%Pneumonia%Outcome
目的 应用查尔森合并症指数(Charlson's weighted index of comorbidities,WIC)评价基础疾病对ICU肺部感染患者28 d死亡风险的影响.方法 回顾性分析上海长征医院2010年10月至2012年2月的160例肺部感染患者,临床资料包括年龄、性别、社区获得性肺炎(CAP)或者院内获得性肺炎(HAP)、基础疾病、是否发生急性呼吸窘迫综合征(ARDS)、是否严重脓毒症和28 d病死率；入院24h内计算WIC评分、急性生理与慢性健康状况(APACHE)Ⅱ评分和脓毒症相关性器官功能衰竭评分(sepsis related organ failure assessment,SOFA)评分.用Logistic回归分析影响患者预后的因素,绘制受试者工作曲线(ROC)比较各评分对预后的判断.结果 在160例入组患者中,CAP患者76例(48.8％),HAP患者82例(51.2％),男性106例(66.3％),女性54例(33.7％),存活99例(61.9％),死亡61例(38.1％).年龄(62.4±17.3)岁.与存活组比较,死亡组的WIC分值、APACHEⅡ分值和SOFA评分较高(P＜0.05).多因素Logistic回归分析提示,年龄(OR=1.049,95％ CI:1.011～1.088,P=0.011)、WIC评分(OR＝1.725,95％CI:1.194～2.492,P=0.004)、APACHEⅡ评分(OR=1.175,95％CI:1.058 ～ 1.305,P＝0.003)、SOFA评分(OR=1.277,95％ CI:1.048～1.556,P=O.015)、是否ARDS(OR＝0.081,95％ CI:0.008 ～0.829,P=0.034)、是否严重脓毒症(OR=0.149,95％ CI:0.232～0.622,P＝0.004)与肺部感染患者28 d预后相关.WIC评分、APACHEⅡ评分、SOFA评分及三者合并后预测概率的受试者工作曲线(ROC)曲线下面积(95％CI)依次为0.639(0.547～0.730)、0.782(0.709～0.856)、0.79 (0.714 ～0.866)、0.842 (0.777～0.907).结论 WIC评分系统可以较好的评价基础疾病对ICU肺部感染患者28 d预后的影响.
目的 應用查爾森閤併癥指數(Charlson's weighted index of comorbidities,WIC)評價基礎疾病對ICU肺部感染患者28 d死亡風險的影響.方法 迴顧性分析上海長徵醫院2010年10月至2012年2月的160例肺部感染患者,臨床資料包括年齡、性彆、社區穫得性肺炎(CAP)或者院內穫得性肺炎(HAP)、基礎疾病、是否髮生急性呼吸窘迫綜閤徵(ARDS)、是否嚴重膿毒癥和28 d病死率；入院24h內計算WIC評分、急性生理與慢性健康狀況(APACHE)Ⅱ評分和膿毒癥相關性器官功能衰竭評分(sepsis related organ failure assessment,SOFA)評分.用Logistic迴歸分析影響患者預後的因素,繪製受試者工作麯線(ROC)比較各評分對預後的判斷.結果 在160例入組患者中,CAP患者76例(48.8％),HAP患者82例(51.2％),男性106例(66.3％),女性54例(33.7％),存活99例(61.9％),死亡61例(38.1％).年齡(62.4±17.3)歲.與存活組比較,死亡組的WIC分值、APACHEⅡ分值和SOFA評分較高(P＜0.05).多因素Logistic迴歸分析提示,年齡(OR=1.049,95％ CI:1.011～1.088,P=0.011)、WIC評分(OR＝1.725,95％CI:1.194～2.492,P=0.004)、APACHEⅡ評分(OR=1.175,95％CI:1.058 ～ 1.305,P＝0.003)、SOFA評分(OR=1.277,95％ CI:1.048～1.556,P=O.015)、是否ARDS(OR＝0.081,95％ CI:0.008 ～0.829,P=0.034)、是否嚴重膿毒癥(OR=0.149,95％ CI:0.232～0.622,P＝0.004)與肺部感染患者28 d預後相關.WIC評分、APACHEⅡ評分、SOFA評分及三者閤併後預測概率的受試者工作麯線(ROC)麯線下麵積(95％CI)依次為0.639(0.547～0.730)、0.782(0.709～0.856)、0.79 (0.714 ～0.866)、0.842 (0.777～0.907).結論 WIC評分繫統可以較好的評價基礎疾病對ICU肺部感染患者28 d預後的影響.
목적 응용사이삼합병증지수(Charlson's weighted index of comorbidities,WIC)평개기출질병대ICU폐부감염환자28 d사망풍험적영향.방법 회고성분석상해장정의원2010년10월지2012년2월적160례폐부감염환자,림상자료포괄년령、성별、사구획득성폐염(CAP)혹자원내획득성폐염(HAP)、기출질병、시부발생급성호흡군박종합정(ARDS)、시부엄중농독증화28 d병사솔；입원24h내계산WIC평분、급성생리여만성건강상황(APACHE)Ⅱ평분화농독증상관성기관공능쇠갈평분(sepsis related organ failure assessment,SOFA)평분.용Logistic회귀분석영향환자예후적인소,회제수시자공작곡선(ROC)비교각평분대예후적판단.결과 재160례입조환자중,CAP환자76례(48.8％),HAP환자82례(51.2％),남성106례(66.3％),녀성54례(33.7％),존활99례(61.9％),사망61례(38.1％).년령(62.4±17.3)세.여존활조비교,사망조적WIC분치、APACHEⅡ분치화SOFA평분교고(P＜0.05).다인소Logistic회귀분석제시,년령(OR=1.049,95％ CI:1.011～1.088,P=0.011)、WIC평분(OR＝1.725,95％CI:1.194～2.492,P=0.004)、APACHEⅡ평분(OR=1.175,95％CI:1.058 ～ 1.305,P＝0.003)、SOFA평분(OR=1.277,95％ CI:1.048～1.556,P=O.015)、시부ARDS(OR＝0.081,95％ CI:0.008 ～0.829,P=0.034)、시부엄중농독증(OR=0.149,95％ CI:0.232～0.622,P＝0.004)여폐부감염환자28 d예후상관.WIC평분、APACHEⅡ평분、SOFA평분급삼자합병후예측개솔적수시자공작곡선(ROC)곡선하면적(95％CI)의차위0.639(0.547～0.730)、0.782(0.709～0.856)、0.79 (0.714 ～0.866)、0.842 (0.777～0.907).결론 WIC평분계통가이교호적평개기출질병대ICU폐부감염환자28 d예후적영향.
Objective To estimate the validity of Charlson' s weighted index of comorbidities (WIC) used to predicting 28-day mortality among ICU pneumonia patients with underlying diseases.Methods Aretrospective analysis of 160 adult patients with pneumonia admitted to a multi-discipline ICU of Shanghai Changzheng hospital between October 2010 and February 2012 was carried out.Clinical data were collected including age,gender,community acquired pneumonia (CAP) or hospital acquired pneumonia (HAP),underlying diseases,severity-of-sepsis,and 28-day mortality.WIC scores,acute physiology and chronic health evaluation (APACHE) Ⅱ,and sepsis related organ failure assessment (SOFA) were assessed within the first 24 hours after admission.Logistic regression analyses were used to evaluate the predictors for outcome.The receiver operating characteristic curve (ROC) was used to compare the performance of these scores between different methods.Results Of 160 enrolled patients,76 (48.8％) were CAP,82 (51.2％) HAP,and 106 (66.3％) male,54 (33.7％) female,and 99 (61.9％) patients survived and 61 (38.1％) died.The average age was (62.4 ± 17.3) years old.Compared with survivors,WIC,APACHE Ⅱ and SOFA scores were significantly higher in death group (P ＜ 0.05).The multivariate logistic regression revealed that risk of death depends predominantly on age (OR =1.049,95％ CI:1.011-1.088,P =0.011),WIC (OR =1.725,95％ CI:1.194-2.492,P =0.004),APACHE Ⅱ score (OR =1.175,95％CI:1.058-1.305,P =0.003),SOFA score (OR =1.277,95％ CI:1.048-1.556,P =0.015),presence of ARDS (OR =0.081,95％ CI:0.008-0.829,P =0.034),and complicated with severe sepsis (OR =0.149,95％ CI:0.232-0.622,P =0.004).The area under the receiver operating characteristics curve in predicting mortality was 0.639 (0.547-0.730) for the WIC,0.782 (0.709-0.856) for APACHE Ⅱ score,0.79 (0.714-0.866) for SOFA score and 0.842 (0.777-0.907) for the merger of three.Conclusions In pneumonia patients of ICU,WIC is a useful approach to predicting 28-day mortality,and the risk of death significantly depends on co-morbidities.
