Chen Y-C, Tian Y-C, Liu N-J, Ho Y-P, Yang C, Chu Y-Y, Chen P-C, Fang J-T, Hsu C-W, Yang C-W, Tsai M-H
Division of Critical Care Nephrology, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan.
Int J Clin Pract. 2006 Feb;60(2):160-6. doi: 10.1111/j.1742-1241.2005.00634.x.
The aim of the study was to evaluate the usefulness of sequential organ failure assessment (SOFA) and acute physiology, age, chronic health evaluation III (APACHE III) scoring systems obtained on the first day of intensive care unit (ICU) admission in predicting hospital mortality in critically ill cirrhotic patients. The study enrolled 102 cirrhotic patients consecutively admitted to ICU during a 1-year period. Twenty-five demographic, clinical and laboratory variables were analysed as predicators of survival. Information considered necessary to calculate the Child-Pugh, SOFA and APACHE III scores on the first day of ICU admission was also gathered. Overall hospital mortality was 68.6%. Multiple logistic regression analysis revealed that mean arterial pressure, SOFA and APACHE III scores were significantly related to prognosis. Goodness-of-fit was good for the SOFA and APACHE III models. Both predictive models displayed a similar degree of the best Youden index (0.68) and overall correctness (84%) of prediction. The SOFA and APACHE III models displayed good areas under the receiver-operating characteristic curve (0.917 +/- 0.028 and 0.912 +/- 0.029, respectively). Finally, a strong and significant positive correlation exists between SOFA and APACHE III scores for individual patients (r(2) = 0.628, p < 0.001). This investigation confirms the grave prognosis for cirrhotic patients admitted to ICU. Both SOFA and APACHE III scores are excellent tools to predict the hospital mortality in critically ill cirrhotic patients. The overall predictive accuracy of SOFA and APACHE III is superior to that of Child-Pugh system. The role of these scoring systems in describing the dynamic aspects of clinical courses and allocating ICU resources needs to be clarified.
本研究的目的是评估在重症监护病房（ICU）入院第一天获得的序贯器官衰竭评估（SOFA）和急性生理功能、年龄、慢性健康状况评估III（APACHE III）评分系统对预测重症肝硬化患者医院死亡率的有效性。该研究纳入了1年内连续入住ICU的102例肝硬化患者。分析了25个人口统计学、临床和实验室变量作为生存预测指标。还收集了计算ICU入院第一天Child-Pugh、SOFA和APACHE III评分所需的信息。医院总体死亡率为68.6%。多因素逻辑回归分析显示，平均动脉压、SOFA和APACHE III评分与预后显著相关。SOFA和APACHE III模型的拟合优度良好。两个预测模型均显示出相似程度的最佳约登指数（0.68）和总体预测正确率（84%）。SOFA和APACHE III模型在受试者工作特征曲线下的面积良好（分别为0.917±0.028和0.912±0.029）。最后，个体患者的SOFA和APACHE III评分之间存在强且显著的正相关（r² = 0.628，p < 0.001）。本调查证实了入住ICU的肝硬化患者预后严重。SOFA和APACHE III评分都是预测重症肝硬化患者医院死亡率的优秀工具。SOFA和APACHE III的总体预测准确性优于Child-Pugh系统。这些评分系统在描述临床病程动态方面和分配ICU资源中的作用有待阐明。
