Headley J, Theriault R, Smith T L
Department of Medical Oncology (Breast Medical Oncology), University of Texas M. D. Anderson Cancer Center, Houston 77030.
Cancer. 1992 Jul 15;70(2):497-503. doi: 10.1002/1097-0142(19920715)70:2<497::aid-cncr2820700220>3.0.co;2-h.
To determine the validity and predictive accuracy of the Acute Physiology and Chronic Health Evaluation (APACHE II) scoring system for severity of illness by comparing the actual hospital mortality with the predicted mortality for patients with breast cancer admitted to the intensive care unit (ICU).
APACHE II scores were calculated based on retrospective evaluation of the medical records of 52 patients with breast cancer who received ICU care. The relationships between hospital mortality and APACHE II scores, number of sites of metastatic disease, duration of metastatic disease, number of chemotherapeutic regimens given for metastatic disease, presence of neutropenia or thrombocytopenia, age, reason for ICU admission, and length of ICU stay were assessed.
Twenty-two patients (42%) died during the hospital stay during in which they were admitted to the ICU. Predicted mortality based on a logistic regression model using APACHE II scores was 21 patients (40%). APACHE II specificity was 87%; sensitivity was 54%. There were significant relationships between presence of metastatic disease, number of metastatic sites, reason for ICU admission, and length of ICU stay. Patients with more than two sites of metastatic disease and those with respiratory failure had particularly poor chances of survival. Regression analysis incorporating the number of sites of metastatic disease, reason for ICU admission (whether for a pulmonary or a cardiovascular problem), and APACHE II score suggested that APACHE II could predict hospital survival.
This retrospective study showed that APACHE II scores were associated with hospital mortality in patients with breast cancer who were admitted to ICU. The number of metastatic sites and the type of major organ system failure were also associated with outcome. Regression analysis suggested that APACHE II scores were independently associated with survival outcome.
通过比较入住重症监护病房（ICU）的乳腺癌患者的实际医院死亡率和预测死亡率，来确定急性生理与慢性健康状况评估（APACHE II）评分系统对疾病严重程度的有效性和预测准确性。
基于对52例接受ICU治疗的乳腺癌患者病历的回顾性评估计算APACHE II评分。评估医院死亡率与APACHE II评分、转移病灶部位数量、转移疾病持续时间、针对转移疾病给予的化疗方案数量、中性粒细胞减少或血小板减少的存在情况、年龄、入住ICU的原因以及ICU住院时间之间的关系。
22例患者（42%）在入住ICU期间的住院过程中死亡。使用APACHE II评分的逻辑回归模型预测的死亡率为21例患者（40%）。APACHE II的特异性为87%；敏感性为54%。转移疾病的存在、转移部位数量、入住ICU的原因以及ICU住院时间之间存在显著关系。有两个以上转移部位的患者和呼吸衰竭患者的生存机会特别低。纳入转移部位数量、入住ICU的原因（无论是肺部还是心血管问题）以及APACHE II评分的回归分析表明，APACHE II可以预测医院生存情况。
这项回顾性研究表明，APACHE II评分与入住ICU的乳腺癌患者的医院死亡率相关。转移部位数量和主要器官系统衰竭类型也与预后相关。回归分析表明，APACHE II评分与生存结果独立相关。
