Kabbani Loay S, Escobar Guillermo A, Knipp Brian, Deatrick Christopher B, Duran Ahmet, Upchurch Gilbert R, Napolitano Lena M
Division of Vascular Surgery, Department of Surgery, University of Michigan Medical Center, Ann Arbor, MI, USA.
Ann Vasc Surg. 2010 Nov;24(8):1060-7. doi: 10.1016/j.avsg.2010.07.011.
No prior studies, to our knowledge, have examined the performance of the Acute Physiology and Chronic Health Evaluation (APACHE) III score in predicting mortality of patients undergoing open thoracoabdominal aortic aneurysm (TAAA) or open abdominal aortic aneurysm (AAA) repair. We sought to evaluate APACHE III scores in the prediction of postoperative mortality in elective TAAA and AAA repairs.
Over a 9-year period (July 1998 through June 2007), prospective data (demographics, admitting diagnosis, APACHE III score, intensive care unit [ICU] and hospital length of stay, ICU and hospital mortality) were collected by a dedicated APACHE III coordinator for all patients admitted to a tertiary academic surgical ICU (20 beds). Observational and comparative analyses were performed. Emergent repairs for ruptured aneurysms were excluded from the study.
Forty-one patients underwent open elective repair of TAAA and 404 underwent open elective repair of AAA. Mean age of the TAAA group was 63.4 ± 9.8 years and the AAA group was 70.3 ± 8.3 years. Mean APACHE III score was 54 (range: 10-103) for the TAAA group and 45 (range: 11-103) for the AAA group. The in-hospital mortality rate for TAAA patients was 4.9% (n = 2) and for AAA patients was 2.0% (n = 8). Mean APACHE III scores on ICU admission were significantly greater in nonsurvivors versus survivors (79 vs. 45, p < 0.0001). For the entire patient cohort, the APACHE III score on ICU admission was an excellent discriminator of hospital mortality (receiver operating characteristic and area under the curve 0.92 [standard error of 0.05, 95% CI: 0.83-1.0]).
APACHE III is an accurate predictor of survival to hospital discharge in both open elective TAAA and AAA repairs.
据我们所知，此前尚无研究探讨急性生理学与慢性健康状况评估（APACHE）III评分对接受开胸胸腹主动脉瘤（TAAA）或开腹主动脉瘤（AAA）修复手术患者死亡率的预测性能。我们旨在评估APACHE III评分在择期TAAA和AAA修复手术术后死亡率预测中的作用。
在9年期间（1998年7月至2007年6月），由一名专职的APACHE III协调员收集一所三级学术性外科重症监护病房（20张床位）所有入院患者的前瞻性数据（人口统计学资料、入院诊断、APACHE III评分、重症监护病房[ICU]及住院时间、ICU及医院死亡率）。进行观察性和对比分析。研究排除动脉瘤破裂的急诊修复病例。
41例患者接受了择期TAAA开胸修复手术，404例接受了择期AAA开腹修复手术。TAAA组的平均年龄为63.4±9.8岁，AAA组为70.3±8.3岁。TAAA组的平均APACHE III评分为54分（范围：10 - 103分），AAA组为45分（范围：11 - 103分）。TAAA患者的院内死亡率为4.9%（n = 2），AAA患者为2.0%（n = 8）。非幸存者在ICU入院时的平均APACHE III评分显著高于幸存者（79分对45分，p < 0.0001）。对于整个患者队列，ICU入院时的APACHE III评分是医院死亡率的优秀判别指标（受试者工作特征曲线下面积为0.92[标准误0.05，95%可信区间：0.83 - 1.0]）。
APACHE III是择期TAAA和AAA开胸修复手术患者出院生存情况的准确预测指标。
