Nejmi Hicham, Rebahi Houssam, Ejlaidi Aziz, Abouelhassan Taoufik, Samkaoui Mohamed Abdenasser
Department of Anaesthesia, Emergency and Intensive Care Medicine, University-Hospital Mohammed VI, Medical School of Marrakech, Cadi Ayyad University, Marrakech, Morocco.
Indian J Crit Care Med. 2014 Jun;18(6):369-75. doi: 10.4103/0972-5229.133895.
We aim to assess and to compare the predicting power for in-hospital mortality (IHM) of the Acute Physiology and Chronic Health Evaluation-II (APACHE-II) and the Simplified Acute Physiology Score-II (SAPS-II) for traumatic brain injury (TBI).
This retrospective cohort study was conducted during a period of 2 years and 9 months in a Moroccan intensive care unit. Data were collected during the first 24 h of each admission. The clinical and laboratory parameters were analyzed and used as per each scoring system to calculate the scores. Univariate and multivariate analyses through regression logistic models were performed, to predict IHM after moderate and severe TBIs. Areas under the receiver operating characteristic curves (AUROC), specificities and sensitivities were determined and also compared.
A total of 225 patients were enrolled. The observed IHM was 51.5%. The univariate analysis showed that the initial Glasgow coma scale (GCS) was lower in nonsurviving patients (mean GCS = 6) than the survivors (mean GCS = 9) with a statistically significant difference (P = 0.0024). The APACHE-II and the SAPS-II of the nonsurviving patients were higher than those of the survivors (respectively 20.4 ± 6.8 and 31.2 ± 13.6 for nonsurvivors vs. 15.7 ± 5.4 and 22.7 ± 10.3 for survivors) with a statistically significant difference (P = 0.0032 for APACHE-II and P = 0.0045 for SAPS-II). Multivariate analysis: APACHE-II was superior for predicting IHM (AUROC = 0.92).
The APACHE-II is an interesting tool to predict IHM of head injury patients. This is particularly relevant in Morocco, where TBI is a greater public health problem than in many other countries.
我们旨在评估并比较急性生理学与慢性健康状况评估系统-II（APACHE-II）和简化急性生理学评分系统-II（SAPS-II）对创伤性脑损伤（TBI）患者院内死亡率（IHM）的预测能力。
这项回顾性队列研究在摩洛哥一家重症监护病房进行，为期2年9个月。在每次入院的最初24小时内收集数据。分析临床和实验室参数，并根据每个评分系统用于计算得分。通过回归逻辑模型进行单变量和多变量分析，以预测中度和重度TBI后的IHM。确定并比较受试者工作特征曲线下面积（AUROC）、特异性和敏感性。
共纳入225例患者。观察到的IHM为51.5%。单变量分析显示，未存活患者的初始格拉斯哥昏迷量表（GCS）（平均GCS = 6）低于存活患者（平均GCS = 9），差异具有统计学意义（P = 0.0024）。未存活患者的APACHE-II和SAPS-II高于存活患者（未存活者分别为20.4±6.8和31.2±13.6，存活者分别为15.7±5.4和22.7±10.3），差异具有统计学意义（APACHE-II为P = 0.0032，SAPS-II为P = 0.0045）。多变量分析：APACHE-II在预测IHM方面更具优势（AUROC = 0.92）。
APACHE-II是预测头部受伤患者IHM的一个有效工具。这在摩洛哥尤为重要，因为在该国TBI是一个比许多其他国家更严重的公共卫生问题。
