Aggarwal Ashutosh N, Sarkar Pralay, Gupta Dheeraj, Jindal Surinder K
Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Respirology. 2006 Mar;11(2):196-204. doi: 10.1111/j.1440-1843.2006.00828.x.
There are little data on the value of using severity scoring systems developed in western countries to assess critically ill patients in India. The authors evaluated the performance of Acute Physiology and Chronic Health Evaluation version II (APACHE II), Simplified Acute Physiology Score version II (SAPS II) and Mortality Probability Models version II at admission and at 24 h (MPM(0) and MPM(24), respectively) in predicting patient outcomes in their Respiratory Intensive Care Unit.
Data from 459 consecutive adult admissions were collected prospectively. Standardized mortality ratios were computed as an index of the overall model performance. Model calibration was assessed using Lemeshow-Hosmer goodness-of-fit tests and through calibration curves. Model discrimination was assessed through receiver operating curve analysis and by drawing 2 x 2 classification matrices.
Overall standardized mortality ratio exceeded 1.5 for all models. All models had modest discrimination (area under receiver-operating-characteristic curves 0.66-0.78) and poor calibration (high Lemeshow-Hosmer C and H statistic values). All models had a tendency to underpredict hospital death in patients with lower mortality probability estimates. There were no major differences between the models with regard to either discrimination or calibration performance.
Standard severity scoring systems developed in western countries are poor at predicting patient outcome in critically ill patients admitted to a respiratory intensive care unit in Northern India. Caution must be exercised in using such models in their present form on Indian patients until either they are customized for local use or fresh models are developed from Indian cohorts.
关于使用西方国家开发的严重程度评分系统评估印度重症患者价值的数据很少。作者评估了急性生理学与慢性健康状况评估Ⅱ版（APACHEⅡ）、简化急性生理学评分Ⅱ版（SAPSⅡ）和死亡率概率模型Ⅱ版在入院时和24小时时（分别为MPM(0)和MPM(24)）对呼吸重症监护病房患者预后的预测性能。
前瞻性收集了459例连续成人入院患者的数据。计算标准化死亡率比值作为整体模型性能的指标。使用Lemeshow-Hosmer拟合优度检验并通过校准曲线评估模型校准。通过受试者工作曲线分析和绘制2×2分类矩阵评估模型辨别力。
所有模型的总体标准化死亡率比值均超过1.5。所有模型的辨别力中等（受试者工作特征曲线下面积为0.66 - 0.78）且校准不佳（Lemeshow-Hosmer C和H统计值较高）。所有模型在死亡率概率估计较低的患者中都有低估医院死亡的趋势。在辨别力或校准性能方面，各模型之间没有重大差异。
西方国家开发的标准严重程度评分系统在预测印度北部呼吸重症监护病房收治的重症患者的预后方面表现不佳。在以目前形式将此类模型用于印度患者时必须谨慎，直到它们针对当地使用进行定制或从印度队列开发出新的模型。
