Ho Yu-Pin, Chen Yung-Chang, Yang Chun, Lien Jau-Min, Chu Yin-Yi, Fang Ji-Tseng, Chiu Cheng-Tang, Chen Pang-Chi, Tsai Ming-Hung
Division of Gastroenterology, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan.
J Intensive Care Med. 2004 Mar-Apr;19(2):105-10. doi: 10.1177/0885066603261991.
Cirrhotic patients admitted to the medical intensive care unit (ICU) are associated with high mortality rates. The prognosis of critically ill cirrhotic patients is determined by the extent of hepatic and extrahepatic organ dysfunction. This study was conducted to assess and compare the accuracy of the Child-Pugh classification and APACHE II scores, obtained on the first day of ICU admission, in predicting hospital mortality in critically ill cirrhotic patients. One hundred thirty-five patients diagnosed with liver cirrhosis were admitted to the medical ICU between January 2002 and March 2003. Information considered necessary to compute the Child-Pugh and APACHE II scores on the first day of ICU admission was prospectively collected. The overall hospital mortality rate was 66.6%. Liver disease was most commonly attributed to hepatitis B viral infection. The APACHE II scores demonstrate a good fit using the Hosmer and Lemeshow goodness-of-fit test. Furthermore, by using the areas under receiver operating characteristic (AUROC) curve, the APACHE II scores demonstrated a better discriminative power (AUROC 0.833 +/- 0.039) than Child-Pugh scores (AUROC 0.75 +/- 0.05) (P=.024). This investigation confirms the grave prognosis for the cirrhotic patients admitted to the ICU. While both Child-Pugh and the APACHE II scores can satisfactorily predict the outcomes for critically ill cirrhotic patients, APACHE II is more powerful in discriminating the survivors from the nonsurvivors.
入住内科重症监护病房（ICU）的肝硬化患者死亡率很高。重症肝硬化患者的预后取决于肝脏和肝外器官功能障碍的程度。本研究旨在评估和比较在ICU入院第一天获得的Child-Pugh分级和APACHE II评分在预测重症肝硬化患者医院死亡率方面的准确性。2002年1月至2003年3月期间，135例被诊断为肝硬化的患者入住内科ICU。前瞻性收集了计算ICU入院第一天Child-Pugh和APACHE II评分所需的信息。总体医院死亡率为66.6%。肝病最常见的原因是乙型肝炎病毒感染。使用Hosmer和Lemeshow拟合优度检验，APACHE II评分显示出良好的拟合度。此外，通过使用受试者工作特征（AUROC）曲线下的面积，APACHE II评分显示出比Child-Pugh评分（AUROC 0.75 +/- 0.05）更好的辨别力（AUROC 0.833 +/- 0.039）（P = 0.024）。这项调查证实了入住ICU的肝硬化患者预后严重。虽然Child-Pugh和APACHE II评分都能令人满意地预测重症肝硬化患者的预后，但APACHE II在区分幸存者和非幸存者方面更具效力。
