Ho Kwok M, Dobb Geoffrey J, Knuiman Matthew, Finn Judith, Lee Kok Y, Webb Steven A R
Department of Intensive Care, Royal Perth Hospital, Wellington Street, Perth, WA 6000, Australia.
Crit Care. 2006 Feb;10(1):R4. doi: 10.1186/cc3913.
The Acute Physiology and Chronic Health Evaluation (APACHE) II score is widely used in the intensive care unit (ICU) as a scoring system for research and clinical audit purposes. Physiological data for calculation of the APACHE II score are derived from the worst values in the first 24 hours after admission to the ICU. The collection of physiological data on admission only is probably logistically easier, and this approach is used by some ICUs. This study compares the performance of APACHE II scores calculated using admission data with those obtained from the worst values in the first 24 hours.
This was a retrospective cohort study using prospectively collected data from a tertiary ICU. There were no missing physiological data and follow-up for mortality was available for all patients in the database. The admission and the worst 24-hour physiological variables were used to generate the admission APACHE II score and the worst 24-hour APACHE II score, and the corresponding predicted mortality, respectively.
There were 11,107 noncardiac surgery ICU admissions during 11 years from 1 January 1993 to 31 December 2003. The mean admission and the worst 24-hour APACHE II score were 12.7 and 15.4, and the derived predicted mortality estimates were 15.5% and 19.3%, respectively. The actual hospital mortality was 16.3%. The overall discrimination ability, as measured by the area under the receiver operating characteristic curve, of the admission APACHE II model (83.8%, 95% confidence interval = 82.9-84.7) and the worst 24-hour APACHE II model (84.6%, 95% confidence interval = 83.7-85.5) was not significantly different (P = 1.00).
Substitution of the worst 24-hour physiological variables with the admission physiological variables to calculate the admission APACHE II score maintains the overall discrimination ability of the traditional APACHE II model. The admission APACHE II model represents a potential alternative model to the worst 24-hour APACHE II model in critically ill nontrauma patients.
急性生理学与慢性健康状况评估（APACHE）II评分在重症监护病房（ICU）中被广泛用作研究和临床审计目的的评分系统。计算APACHE II评分的生理数据源自入住ICU后最初24小时内的最差值。仅收集入院时的生理数据在后勤方面可能更容易，一些ICU采用这种方法。本研究比较了使用入院数据计算的APACHE II评分与从前24小时最差值获得的评分的性能。
这是一项回顾性队列研究，使用了从一家三级ICU前瞻性收集的数据。没有缺失的生理数据，数据库中的所有患者均有死亡率随访。分别使用入院时和最差的24小时生理变量来生成入院APACHE II评分和最差24小时APACHE II评分以及相应的预测死亡率。
从1993年1月1日至2003年12月31日的11年中，有11107例非心脏手术患者入住ICU。入院时和最差24小时的APACHE II评分平均值分别为12.7和15.4，得出的预测死亡率估计值分别为15.5%和19.3%。实际医院死亡率为16.3%。入院APACHE II模型（83.8%，95%置信区间=82.9 - 84.7）和最差24小时APACHE II模型（84.6%，95%置信区间=83.7 - 85.5）的总体辨别能力，通过受试者操作特征曲线下面积衡量，无显著差异（P = 1.00）。
用入院时的生理变量替代最差的24小时生理变量来计算入院APACHE II评分，可保持传统APACHE II模型的总体辨别能力。在重症非创伤患者中，入院APACHE II模型是最差24小时APACHE II模型的一种潜在替代模型。
