Department of Neurocritical Care Unit, Xuanwu Hospital, Capital Medical University, Beijing 100053, China.
Chin Med J (Engl). 2013 Mar;126(6):1132-7.
Severity scoring systems are useful tools for measuring the severity of the disease and its outcome. This pilot study was to verify and compare the prognostic performance of the Simplified Acute Physiology Score II (SAPS II) and Glasgow Coma Scale (GCS) in neuro-intensive care unit (N-ICU) patients.
A total of 1684 patients consecutively admitted to the N-ICU at Xuanwu Hospital between January 1, 2005 and December 31, 2011 were enrolled in this study. The data-base included admission data, at 24-, 48-, and 72-hour SAPS II and GCS. Repeated measure data analysis of variance, Logistic regression analysis, the Hosmer-Lemeshow goodness-of-fit statistic, and the area under the receiver operating characteristic were used to evaluate the performance.
There was a significant difference between the SAPS II or GCS score at four time points (F = 16.110, P = 0.000 or F = 8.108, P = 0.000). The SAPS II scores or GCS score at four time points interacted with the outcomes with significant difference (F = 116.771, P = 0.000 or F = 65.316, P = 0.000). Calibration of the SAPS II or GCS score at each time point on all patients was good. The percentage of a risk estimate prediction corresponding to observed mortality was also good. The 72-hour score have the greatest consistency. Discriminations of the SAPS II or GCS score at each time were all satisfactory. The 72-hour score had the greatest discriminative power. The cut-off value was 33 (sensitivity of 85.2% and specificity of 74.3%) and 6 (sensitivity of 70.6% and specificity of 65.0%). The SAPS II at each time point on all patients showed better calibration, consistency and discrimination than GCS. The binary Logistic regression analysis identified physiological variables, GCS, age, and disease category as significant independent risk factors of death. After the two variables including underlying disease and type of admission were excluded, we built the simplified SAPS II model. A correlation was suggested between the simplified SAPS II score at each time point and outcome, regardless of the diagnosis.
The GCS scoring system tends to be a little weaker in the predictive power than the SAPS II scoring system in this Chinese cohort of N-ICU patients. The advantage of SAPS II scoring system still exists that it dose not need to take into account the diagnosis or diseases categories, even in the special N-ICU. The simplified SAPS II scoring system is considered a new idea for the estimation of effectiveness.
严重程度评分系统是衡量疾病严重程度及其预后的有用工具。本初步研究旨在验证和比较简化急性生理学评分 II （SAPS II）和格拉斯哥昏迷评分（GCS）在神经重症监护病房（N-ICU）患者中的预后性能。
本研究纳入了 2005 年 1 月 1 日至 2011 年 12 月 31 日期间连续入住宣武医院 N-ICU 的 1684 例患者。数据库包括入院时、24 小时、48 小时和 72 小时的 SAPS II 和 GCS 数据。采用重复测量方差分析、Logistic 回归分析、Hosmer-Lemeshow 拟合优度统计和受试者工作特征曲线下面积评估其性能。
四个时间点的 SAPS II 或 GCS 评分之间存在显著差异（F = 16.110，P = 0.000 或 F = 8.108，P = 0.000）。SAPS II 评分或 GCS 评分在四个时间点与结局之间存在显著交互作用（F = 116.771，P = 0.000 或 F = 65.316，P = 0.000）。所有患者各时间点 SAPS II 或 GCS 评分的校准均良好。风险估计预测与观察死亡率的百分比也很好。72 小时评分的一致性最好。各时间点 SAPS II 或 GCS 评分的区分度均满意。72 小时评分的区分度最大。截断值为 33（灵敏度为 85.2%，特异性为 74.3%）和 6（灵敏度为 70.6%，特异性为 65.0%）。所有患者各时间点的 SAPS II 评分在校准、一致性和区分度方面均优于 GCS。二元 Logistic 回归分析确定生理变量、GCS、年龄和疾病类型为死亡的显著独立危险因素。排除潜在疾病和入院类型这两个变量后，我们建立了简化 SAPS II 模型。无论诊断如何，提示各时间点简化 SAPS II 评分与结局之间存在相关性。
在本中国 N-ICU 患者队列中，GCS 评分系统的预测能力略低于 SAPS II 评分系统。SAPS II 评分系统仍然具有优势，即无需考虑诊断或疾病类别，即使在特殊的 N-ICU 中也是如此。简化的 SAPS II 评分系统被认为是一种评估疗效的新方法。
