开始透析时的简化急性生理学评分系统3（SAPS 3）可预测接受体外膜肺氧合和急性透析支持的患者的医院死亡率。

SAPS 3 at dialysis commencement is predictive of hospital mortality in patients supported by extracorporeal membrane oxygenation and acute dialysis.

作者信息

Tsai Ching-Wei, Lin Yu-Feng, Wu Vin-Cent, Chu Tzong-Shinn, Chen Yung-Ming, Hu Fu-Chang, Wu Kwan-Dun, Ko Wen-Je

机构信息

Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch and National Taiwan University Hospital, Taipei, Taiwan.

出版信息

Eur J Cardiothorac Surg. 2008 Dec;34(6):1158-64. doi: 10.1016/j.ejcts.2008.07.025. Epub 2008 Aug 30.

DOI:10.1016/j.ejcts.2008.07.025

PMID:18757205

Abstract

OBJECTIVE

This study examined the association between hospital mortality and five illness-severity scoring systems evaluated at different time points in the intensive care unit (ICU) as well as clinical variables as predictors in critically ill patients supported by extracorporeal membrane oxygenation (ECMO) and acute dialysis.

METHODS

This multicenter prospective observational study included 104 patients who received ECMO support and acute dialysis from January 2002 to December 2006. Patients' demographic, clinical and laboratory variables were analyzed as predictors of survival. The SAPS 2, APACHE II, SOFA, MODS, and SAPS 3 scores upon ICU admission and at acute dialysis commencement were evaluated to predict the patient's hospital mortality.

RESULTS

Hospital mortality for the study group was 76% (79/104). Among the five scoring systems, only SAPS 3 score showed a significant difference between survivors and non-survivors either upon ICU admission (p=0.038) or at dialysis commencement (p=0.001). SAPS 3 score at dialysis commencement showed the best discrimination ability by using the area under the receiver operating characteristic curve (SOFA, 0.55; SAPS 2, 0.56; MODS, 0.58; APACHE II, 0.59; and SAPS 3, 0.73). Multiple logistic regression analysis indicated that SAPS 3 score at dialysis commencement (OR: 1.070, 95% CI: 1.016-1.216) and IABP usage before ECMO (OR: 4.181, 95% CI: 1.448-12.075) were two independent risk factors for hospital mortality.

CONCLUSIONS

Among five common ICU scoring systems evaluated at different time points, SAPS 3 at dialysis commencement is the best risk adjustment systems to predict hospital mortality in critically ill patients supported by ECMO and acute dialysis. Furthermore, the SAPS 3 score at dialysis commencement and IABP usage before ECMO are two major independent predictors for hospital mortality in patients supported by ECMO and acute dialysis.

摘要

目的

本研究探讨了重症监护病房（ICU）不同时间点评估的五种疾病严重程度评分系统与医院死亡率之间的关联，以及作为体外膜肺氧合（ECMO）和急性透析支持的危重症患者预测指标的临床变量。

方法

这项多中心前瞻性观察性研究纳入了2002年1月至2006年12月期间接受ECMO支持和急性透析的104例患者。分析患者的人口统计学、临床和实验室变量作为生存预测指标。评估ICU入院时和急性透析开始时的SAPS 2、APACHE II、SOFA、MODS和SAPS 3评分，以预测患者的医院死亡率。

结果

研究组的医院死亡率为76%（79/104）。在这五种评分系统中，只有SAPS 3评分在ICU入院时（p = 0.038）或透析开始时（p = 0.001）在幸存者和非幸存者之间显示出显著差异。透析开始时的SAPS 3评分通过使用受试者操作特征曲线下面积显示出最佳的区分能力（SOFA，0.55；SAPS 2，0.56；MODS，0.58；APACHE II，0.59；SAPS 3，0.73）。多因素逻辑回归分析表明，透析开始时的SAPS 3评分（OR：1.070，95%CI：1.016 - 1.216）和ECMO前使用主动脉内球囊反搏（IABP）（OR：4.181，95%CI：1.448 - 12.075）是医院死亡率的两个独立危险因素。