Takahira S, Kanno Y, Okada H, Sugahara S, Nakamoto H, Suzuki H
Department of Nephrology, Saitama Medical School, Iruma, Japan.
Ther Apher. 2001 Feb;5(1):31-5. doi: 10.1046/j.1526-0968.2001.005001031.x.
A number of patients with multiple organ failure (MOF) regardless of accompanying acute renal failure have been treated with continuous hemodiafiltration (CHDF). However, despite its high cost, the costs/benefits of CHDF for MOF patients still need to be evaluated. Although many scoring systems were established to predict the outcome of MOF, their predictive powers were not estimated in MOF patients undergoing CHDF. Therefore, using 52 Japanese patients with MOF treated with CHDF for more than 1 week, we estimated the predictive powers of multiple organ dysfunction (MOD) scores and acute physiology and chronic health evaluation (APACHE) III scores, retrospectively. The patients were divided into 2 groups according to outcome at Day 28 after the initiation of CHDF. In both scoring systems, the median values at Day 0 were not significantly different between the survival (n = 19) and the nonsurvival (n = 33) groups. In contrast, at Day 3, the median values of MOD scores was 4 (0-14) in the survival group and 9 (1-12) in the nonsurvival group (p = 0.0035). The median value of APACHE III scores were 37 (19-97) and 87 (16-150) at Day 3, respectively (p < 0.0001). In the survival group, APACHE III scores significantly decreased from the median value of 64 (32-89) to 37 (p = 0.0269), and in the nonsurvival group, it increased significantly from the median value of 70 (29-103) to 87 (p = 0.0116). In contrast, no significant changes were observed in the MOD scores. In conclusion, the MOD score and the APACHE III score systems had less power to predict the outcome of MOF patients undergoing CHDF at Day 0. However, rescoring at Day 3 of each index was much more powerful to accurately predict the outcome of such patients.
许多患有多器官功能衰竭（MOF）的患者，无论是否伴有急性肾衰竭，都接受了持续血液透析滤过（CHDF）治疗。然而，尽管其成本高昂，但CHDF对于MOF患者的成本效益仍有待评估。尽管已经建立了许多评分系统来预测MOF的结局，但在接受CHDF治疗的MOF患者中，尚未对这些评分系统的预测能力进行评估。因此，我们回顾性地评估了52例接受CHDF治疗超过1周的日本MOF患者的多器官功能障碍（MOD）评分和急性生理与慢性健康状况评估（APACHE）III评分的预测能力。根据CHDF开始后第28天的结局，将患者分为两组。在这两种评分系统中，生存组（n = 19）和非生存组（n = 33）在第0天的中位数无显著差异。相比之下，在第3天，生存组的MOD评分中位数为4（0 - 14），非生存组为9（1 - 12）（p = 0.0035）。第3天APACHE III评分的中位数分别为37（19 - 97）和87（16 - 150）（p < 0.0001）。在生存组中，APACHE III评分从中位数64（32 - 89）显著下降至37（p = 0.0269），而在非生存组中，从中位数70（29 - 103）显著增加至87（p = 0.0116）。相比之下，MOD评分未观察到显著变化。总之，MOD评分和APACHE III评分系统在第0天对接受CHDF治疗的MOF患者结局的预测能力较弱。然而，在第3天对每个指标重新评分则更能准确预测此类患者的结局。
