Jacobs S, Zuleika M, Mphansa T
Department of Intensive Care and Anaesthesia, Riyadh Armed Forces Hospital, Kingdom of Saudi Arabia.
Crit Care Med. 1999 Apr;27(4):741-4. doi: 10.1097/00003246-199904000-00027.
To demonstrate if daily Multiple Organ Dysfunction scoring could describe outcome groups in septic shock better than daily Acute Physiology and Chronic Health Evaluation (APACHE) II and Organ Failure scores.
A prospective cohort study.
A medical and surgical adult intensive care unit (ICU) at a tertiary referral center.
Daily data collection over a 14-month period was performed on 368 ICU patients, 39 of whom developed septic shock while in the ICU. These data were entered into a computer programmed to calculate APACHE II, Organ Failure, and Multiple Organ Dysfunction scores. The admission Multiple Organ Dysfunction scores for nonsurvivors and survivors of septic shock in the ICU was 6.5 +/- 2.7 and 6.6 +/- 2.8 (SD), respectively. These patients deteriorated due to the development of septic shock during their ICU stay resulting in a maximum Multiple Organ Dysfunction score of 12.2 +/- 3.7 in nonsurvivors and 9.4 +/- 2.7 in survivors (p < .05). The difference between the maximum and initial Multiple Organ Dysfunction scores (delta score) was also significantly greater in nonsurvivors than in survivors (5.6 +/- 4.7 vs. 2.8 +/- 3.0) (p < .05). There were no significant differences between the maximum and delta scores in the outcome groups using the APACHE II and Organ Failure scoring systems. These results were mirrored by 2.3 +/- 0.7 and 1.7 +/- 0.5 organ failures in nonsurvivors and survivors, respectively (p < .01). For all 368 patients, the initial and maximum Multiple Organ Dysfunction scores were 3.5 +/- 2.5 and 10.5 +/- 3.6, respectively.
Maximum and delta Multiple Organ Dysfunction scores mirrored organ dysfunction and could accurately describe the outcome groups, whereas daily APACHE II and Organ Failure scores could not.
验证每日多器官功能障碍评分是否比每日急性生理与慢性健康状况评分系统（APACHE）II及器官衰竭评分能更好地描述感染性休克的预后分组。
一项前瞻性队列研究。
一家三级转诊中心的内科及外科成人重症监护病房（ICU）。
在14个月期间对368例ICU患者进行每日数据收集，其中39例在ICU期间发生感染性休克。这些数据被录入计算机程序以计算APACHE II、器官衰竭及多器官功能障碍评分。ICU中感染性休克非幸存者和幸存者的入院多器官功能障碍评分分别为6.5±2.7和6.6±2.8（标准差）。这些患者在ICU住院期间因发生感染性休克而病情恶化，非幸存者的最高多器官功能障碍评分为12.2±3.7，幸存者为9.4±2.7（p<0.05）。非幸存者的最高与初始多器官功能障碍评分差值（δ评分）也显著高于幸存者（5.6±4.7对2.8±3.0）（p<0.05）。在使用APACHE II和器官衰竭评分系统的预后分组中，最高评分与δ评分之间无显著差异。非幸存者和幸存者分别出现2.3±0.7和1.7±0.5次器官衰竭，反映了上述结果（p<0.01）。对于所有368例患者，初始和最高多器官功能障碍评分分别为3.5±2.5和10.5±3.6。
最高和δ多器官功能障碍评分反映了器官功能障碍情况，能够准确描述预后分组，而每日APACHE II和器官衰竭评分则不能。
