Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, Connecticut 06102, USA.
Surg Infect (Larchmt). 2011 Oct;12(5):385-90. doi: 10.1089/sur.2010.096. Epub 2011 Oct 17.
The (Immunodeficiency, Blood pressure [<90 mm Hg], Multilobular intiltrates [chest x-ray], Platelets [<100×10⁹/L], hospitalization [<10 days] before the onset of ventilator-associated pneumonia [VAP]) IBMP-10 is a new scoring system proposed as an easy-to-use alternative to the Acute Physiology and Chronic Health Evaluation II (APACHE II) score for predicting mortality in patients with ventilator-associated pneumonia (VAP). The objective of this study was to determine the validity of the IBMP-10 score compared with APACHE II in predicting mortality for an independent population consisting predominantly of surgical and neurotrauma patients.
The IBMP-10 and APACHE II scores on the day of VAP diagnosis were calculated, and areas under the receiver-operating characteristic curves (AUROCs) were compared to determine the tests' abilities to predict 14- and 28-day mortality.
A total of 168 patients meeting the radiologic and clinical criteria for VAP for a single hospitalization between 2004 and 2007 were included; 80% of these were from the surgical or neurotrauma intensive care unit. Overall mortality rates were 15% and 23% at 14 and 28 days, respectively. The AUROC for the IMBP-10 score for predicting 14-day mortality was 0.609 (p=0.084) compared with 0.648 (p=0.017) for the APACHE II score. Both IBMP-10 and APACHE II AUROCs for predicting 14-day mortality were lower than observed in the original score validation (0.808 and 0.743, respectively). The AUROCs for predicting 28-day mortality were 0.602 (p=0.056) and 0.705 (p<0.001) for IBMP10 and APACHE II, respectively.
The IBMP-10 score was less reliable than the APACHE II score in predicting 14-day mortality in this independent population of VAP patients. This finding highlights the need for additional validation of new disease severity scoring systems in a study population independent of the population used to derive score criteria, as well as in more specific populations of critically ill patients.
免疫缺陷、血压（<90mmHg）、多小叶浸润（胸部 X 射线）、血小板（<100×10⁹/L）、住院时间（<10 天）在呼吸机相关性肺炎（VAP）发病前的免疫缺陷、血压（<90mmHg）、多小叶浸润（胸部 X 射线）、血小板（<100×10⁹/L）、住院时间（<10 天）在呼吸机相关性肺炎（VAP）发病前的免疫缺陷、血压（<90mmHg）、多小叶浸润（胸部 X 射线）、血小板（<100×10⁹/L）、住院时间（<10 天）在呼吸机相关性肺炎（VAP）发病前的（免疫缺陷、血压（<90mmHg）、多小叶浸润（胸部 X 射线）、血小板（<100×10⁹/L）、住院时间（<10 天）在呼吸机相关性肺炎（VAP）发病前的（免疫缺陷、血压（<90mmHg）、多小叶浸润（胸部 X 射线）、血小板（<100×10⁹/L）、住院时间（<10 天）在呼吸机相关性肺炎（VAP）发病前的免疫缺陷、血压（<90mmHg）、多小叶浸润（胸部 X 射线）、血小板（<100×10⁹/L）、住院时间（<10 天）在呼吸机相关性肺炎（VAP）发病前的（Immunodeficiency, Blood pressure [<90 mm Hg], Multilobular intiltrates [chest x-ray], Platelets [<100×10⁹/L], hospitalization [<10 days] before the onset of ventilator-associated pneumonia [VAP]) 评分是一种新的评分系统，作为急性生理学和慢性健康评估 II（APACHE II）评分的一种简单易用的替代方法，用于预测呼吸机相关性肺炎（VAP）患者的死亡率。本研究的目的是确定 IBMP-10 评分与 APACHE II 相比在预测主要为外科和神经创伤患者的 VAP 患者死亡率方面的有效性。
计算 VAP 诊断当天的 IBMP-10 和 APACHE II 评分，并比较受试者工作特征曲线（AUROC）下面积，以确定两种检测方法预测 14 天和 28 天死亡率的能力。
共纳入 2004 年至 2007 年间因单一住院而符合 VAP 放射学和临床标准的 168 例患者；其中 80%来自外科或神经创伤重症监护病房。分别有 15%和 23%的患者在 14 天和 28 天的死亡率。IBMP-10 评分预测 14 天死亡率的 AUROC 为 0.609（p=0.084），APACHE II 评分的 AUROC 为 0.648（p=0.017）。IBMP-10 和 APACHE II 预测 14 天死亡率的 AUROC 均低于原始评分验证时的观察值（分别为 0.808 和 0.743）。IBMP-10 和 APACHE II 预测 28 天死亡率的 AUROC 分别为 0.602（p=0.056）和 0.705（p<0.001）。
在这个独立的 VAP 患者群体中，IBMP-10 评分预测 14 天死亡率的可靠性不如 APACHE II 评分。这一发现强调了在独立于评分标准推导人群的研究人群中以及在更具体的危重症患者人群中，需要对新的疾病严重程度评分系统进行额外验证。
