Martínez-Alario J, Tuesta I D, Plasencia E, Santana M, Mora M L
Department of Critical Care, Hospital Universitario de Canarias, Spain.
Circulation. 1999 May 11;99(18):2378-82. doi: 10.1161/01.cir.99.18.2378.
Our purpose was to assess the performance of general severity systems (Acute Physiology and Chronic Health Evaluation [APACHE], Simplified Acute Physiology Score [SAPS], and Mortality Probability Models [MPM]) and to compare them with the Parsonnet score to predict mortality after cardiac surgery.
This was a prospective observational study of 465 cardiac surgery patients in a tertiary referral center. Probabilities of hospital death for patients were estimated by applying the 4 models and were compared with actual mortality rates. Performance of the 4 systems was assessed by evaluating calibration with the Hosmer-Lemeshow goodness-of-fit test and discrimination with receiver operating characteristic (ROC) curves. chi2 values were 3. 71 for Parsonnet, 4.52 for MPM II0, 4.30 for MPM II24, 5.16 for SAPS II, and 10.57 for APACHE II. The area under the ROC curve was 0.857 for Parsonnet, 0.783 for MPM II0, 0.796 for MPM II24, 0.771 for SAPS II, and 0.803 for APACHE II.
In our experience, the Parsonnet score performs very well, with calibration and discrimination very high, better than general severity systems, and it is an appropriate tool to assess mortality in cardiac surgery patients. In our experience, the general severity systems perform well to predict mortality after cardiac surgery, with high calibration of MPM II24, MPM II0, and SAPS II; minor calibration for APACHE II; and high discrimination for 3 general systems, but not as well as the Parsonnet score.
我们的目的是评估一般严重程度系统（急性生理与慢性健康评估[APACHE]、简化急性生理学评分[SAPS]和死亡概率模型[MPM]）的性能，并将它们与帕森内特评分进行比较，以预测心脏手术后的死亡率。
这是一项在三级转诊中心对465例心脏手术患者进行的前瞻性观察研究。通过应用这4种模型估计患者的医院死亡概率，并与实际死亡率进行比较。通过用Hosmer-Lemeshow拟合优度检验评估校准以及用受试者工作特征（ROC）曲线评估鉴别能力，来评估这4种系统的性能。帕森内特评分的卡方值为3.71，MPM II0为4.52，MPM II24为4.30，SAPS II为5.16，APACHE II为10.57。ROC曲线下面积，帕森内特评分为0.857，MPM II0为0.783，MPM II24为0.796，SAPS II为0.771，APACHE II为0.803。
根据我们的经验，帕森内特评分表现非常出色，校准和鉴别能力都很高，优于一般严重程度系统，是评估心脏手术患者死亡率的合适工具。根据我们的经验，一般严重程度系统在预测心脏手术后的死亡率方面表现良好，MPM II24、MPM II0和SAPS II校准度高；APACHE II校准度稍低；3种一般系统鉴别能力高，但不如帕森内特评分。
