González-Pérez L, Monedero P, de Irala J, Kadri C, Lushchenkov D
Departamento de Anestesiología y Reanimación, Clínica Universitaria de Navarra.
Rev Esp Anestesiol Reanim. 2007 Aug-Sep;54(7):405-13.
To assess the prognosis of cancer patients in an intensive care unit (ICU), to compare the capabilities of severity scoring systems to predict hospital death, and to improve prediction by adding new variables.
Cohort study in a medical-surgical ICU of a university hospital. Demographic and oncologic characteristics were collected along with death records for all nonsurgical cancer patients admitted between January 1995 and June 2000. Severity scores and risk of death were calculated.
In the cohort of 250 patients studied, the hospital mortality rate was 58% and the ICU mortality rate was 38.8%. The best predictions were made with the third version of the Acute Physiology and Chronic Health Evaluation (APACHE III), the total maximum Sequential Organ Failure Assessment (SOFA) score, and the total maximum Multiple Organ Dysfunction Score (MODS). The APACHE II and the Simplified Acute Physiology Score (SAPS), version II, were good predictors, whereas the systems of the International Council on Mining and Metals overestimated hospital mortality and the Modality Prediction Model at 0 and 24 hours (MPM0 and MPM24) and the Logistic Organ Dysfunction System underestimated it. The total maximum SOFA and MODS scores had the greatest discriminating capability and the SOFA0, the MODS0, MPM0, and MPM24 had the poorest. All assessment systems except the APACHE III improved when we added new mortality-associated variables: prior functional status, diabetes, radiographic lung infiltrates, mechanical ventilation, and vasoactive support.
Medical oncology patients should not all be denied intensive care. None of the systems assessed offer clinically relevant advantages for predicting hospital mortality in nonsurgical oncology patients in the ICU, although we recommend the SAPS II because it includes oncologic variables, is easy to score, and has good prognostic capability.
评估重症监护病房（ICU）中癌症患者的预后，比较严重程度评分系统预测医院死亡的能力，并通过添加新变量来改善预测。
在一所大学医院的内科 - 外科ICU进行队列研究。收集了1995年1月至2000年6月期间所有非手术癌症患者的人口统计学和肿瘤学特征以及死亡记录。计算严重程度评分和死亡风险。
在研究的250例患者队列中，医院死亡率为58%，ICU死亡率为38.8%。使用急性生理学与慢性健康状况评估（APACHE III）第三版、序贯器官衰竭评估（SOFA）总分最大值以及多器官功能障碍评分（MODS）总分最大值进行的预测最佳。APACHE II和简化急性生理学评分（SAPS）第二版是良好的预测指标，而国际采矿与金属理事会的系统高估了医院死亡率，0小时和24小时模式预测模型（MPM0和MPM24）以及逻辑器官功能障碍系统则低估了死亡率。SOFA总分最大值和MODS总分最大值具有最大的鉴别能力，而SOFA0、MODS0、MPM0和MPM24的鉴别能力最差。当我们添加新的与死亡率相关的变量：先前的功能状态、糖尿病、胸部X光浸润、机械通气和血管活性支持时，除APACHE III外的所有评估系统的预测能力均有所提高。
不应一概拒绝为肿瘤内科患者提供重症监护。在ICU中，对于预测非手术肿瘤患者的医院死亡率，所评估系统均未显示出临床相关优势，不过我们推荐SAPS II，因为它包含肿瘤学变量，易于评分且具有良好的预后预测能力。
