Montaner J S, Hawley P H, Ronco J J, Russell J A, Quieffin J, Lawson L M, Schechter M T
AIDS Research Program, St Paul's Hospital, Vancouver, Canada.
Chest. 1992 Dec;102(6):1823-8. doi: 10.1378/chest.102.6.1823.
To evaluate the ability of a variety of scoring systems to predict mortality of patients admitted to an intensive care unit (ICU) with acute respiratory failure (ARF) secondary to AIDS-related Pneumocystis carinii pneumonia (PCP).
All patients with AIDS-related PCP admitted to ICU at St. Paul's Hospital between January 1, 1985 and April 1, 1991 were reviewed. For each case, the following scores were calculated from data obtained within 24 h of ICU admission: acute physiology and chronic health evaluation II (APACHE II); acute lung injury score; AIDS score as described by Justice and Feinstein; and modified multisystem organ failure (MSOF) score. The serum lactate dehydrogenase (LDH) level was also recorded when obtained within 24 h of ICU admission.
A total of 52 ICU admissions in 51 patients were studied. Overall mortality was 65 percent. Mortality increased with increasing MSOF (p < 0.05) score and LDH (p < 0.05). Based on receiver operating characteristic (ROC) curves, the MSOF score and the LDH were found to be good predictors of mortality. Multivariate logistic regression showed that the MSOF score was the only independent predictor of mortality (p < 0.05). The AIDS score, APACHE II, and the acute lung injury score were not significantly associated with mortality. Addition of the serum LDH level improved the performance of both the MSOF and AIDS scores, though the AIDS score plus LDH performed no better than the LDH alone. Of all the scores tested, the MSOF plus LDH level was the best (p < 0.005) predictor of mortality.
The modified MSOF score and the serum LDH level are the best predictors of mortality of patients admitted to ICU with ARF secondary to AIDS-related PCP. The performance of the MSOF score was enhanced when the LDH level was added. The AIDS score, APACHE II, and the acute lung injury score were not found to be useful in this group of critically ill patients.
评估多种评分系统预测因艾滋病相关卡氏肺孢子虫肺炎（PCP）继发急性呼吸衰竭（ARF）而入住重症监护病房（ICU）患者死亡率的能力。
回顾了1985年1月1日至1991年4月1日期间入住圣保罗医院ICU的所有艾滋病相关PCP患者。对于每个病例，根据ICU入院后24小时内获得的数据计算以下评分：急性生理与慢性健康评估II（APACHE II）；急性肺损伤评分；由贾斯蒂斯和费恩斯坦描述的艾滋病评分；以及改良多系统器官功能衰竭（MSOF）评分。当在ICU入院后24小时内获得血清乳酸脱氢酶（LDH）水平时也进行记录。
共研究了51例患者的52次ICU入院情况。总体死亡率为65%。死亡率随MSOF（p<0.05）评分和LDH（p<0.05）升高而增加。根据受试者工作特征（ROC）曲线，发现MSOF评分和LDH是死亡率的良好预测指标。多因素逻辑回归显示MSOF评分是死亡率的唯一独立预测指标（p<0.05）。艾滋病评分、APACHE II和急性肺损伤评分与死亡率无显著相关性。血清LDH水平的加入改善了MSOF和艾滋病评分的表现，尽管艾滋病评分加LDH并不比单独的LDH表现更好。在所有测试的评分中，MSOF加LDH水平是死亡率的最佳（p<0.
