Dara Saqib I, Afessa Bekele, Bajwa Abubakr A, Albright Robert C
Division of Pulmonary and Critical Care Medicine and Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minn 55905, USA.
Mayo Clin Proc. 2004 Nov;79(11):1385-90. doi: 10.4065/79.11.1385.
To describe the clinical course of patients with end-stage renal disease (ESRD) admitted to the intensive care unit (ICU) and to compare the performance of Acute Physiology and Chronic Health Evaluation (APACHE) III and Sequential Organ Failure Assessment (SOFA) in predicting their outcome.
This retrospective cohort study consisted of patients with ESRD admitted to 3 ICUs between January 1, 1997, and November 30, 2002. Data on demographics, APACHE III score, SOFA score, development of sepsis and organ failure, use of mechanical ventilation, and mortality were collected.
Of the 476 patients with ESRD who underwent dialysis during the study period, 93 (20%) required admission to the ICU. The most common ICU admission diagnosis was gastrointestinal bleeding. The first day median (Interquartile range) APACHE III score, SOFA score, and APACHE III predicted hospital mortality rate were 64 (47-79), 6 (5-8), and 12.9% (4.2%-30.8%), respectively. The observed ICU, hospital, and 30-day mortality rates were 9%, 16%, and 22%, respectively. Nonrenal organ failure developed in 48 patients (52%) and sepsis in 15 patients (16%). Mechanical ventilation was required In 26 patients (28%). The area under the receiver operating characteristic curve for the first-day APACHE III probability of hospital death in predicting 30-day mortality was 0.78 (95% confidence interval, 0.68-0.86) compared with 0.66 (95% confidence interval, 0.55-0.76) for the SOFA score (P = .16).
The observed hospital mortality of patients with ESRD admitted to the ICU is relatively low. There is no statistically significant difference in the performance of APACHE III and SOFA prognostic models in discriminating between 30-day survivors and nonsurvivors.
描述入住重症监护病房（ICU）的终末期肾病（ESRD）患者的临床病程，并比较急性生理与慢性健康状况评估（APACHE）III和序贯器官衰竭评估（SOFA）在预测其预后方面的表现。
这项回顾性队列研究纳入了1997年1月1日至2002年11月30日期间入住3个ICU的ESRD患者。收集了人口统计学数据、APACHE III评分、SOFA评分、脓毒症和器官衰竭的发生情况、机械通气的使用情况及死亡率。
在研究期间接受透析的476例ESRD患者中，93例（20%）需要入住ICU。最常见的ICU入院诊断是胃肠道出血。第一天的APACHE III评分中位数（四分位间距）、SOFA评分及APACHE III预测的医院死亡率分别为64（47 - 79）、6（5 - 8）和12.9%（4.2% - 30.8%）。观察到的ICU、医院及30天死亡率分别为9%、16%和22%。48例患者（52%）发生了非肾性器官衰竭，15例患者（16%）发生了脓毒症。26例患者（占28%）需要机械通气。第一天APACHE III预测医院死亡概率用于预测30天死亡率时，受试者工作特征曲线下面积为0.78（95%置信区间，0.68 - 0.86），而SOFA评分为0.66（95%置信区间，0.55 - 0.76）（P = 0.16）。
入住ICU的ESRD患者观察到的医院死亡率相对较低。APACHE III和SOFA预后模型在区分30天存活者和非存活者方面的表现无统计学显著差异。
