重症监护患者入院时低钙血症与通过急性生理学及慢性健康状况评分系统（APACHE-II）和序贯器官衰竭评估（SOFA）评分所衡量的疾病严重程度之间的关系

Relationship of on Admission Hypocalcaemia and Illness Severity as Measured by APACHE-II and SOFA Score in Intensive Care Patients'.

作者信息

Dey Samarjit, Karim Habib Md Reazaul, Yunus Mohd, Barman Angkita, Bhattacharyya Prithwis, Borthakur Manas Pratim

机构信息

Assistant Professor, Department of Anaesthesiology, Critical Care and Pain Medicine, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India.

Assistant Professor, Department of Anaesthesiology, Critical Care and Pain Medicine, Andaman and Nicobar Island Institute of Medical Sciences, Port Blair, Andaman and Nicobar, India.

出版信息

J Clin Diagn Res. 2017 Mar;11(3):UC01-UC03. doi: 10.7860/JCDR/2017/22895.9402. Epub 2017 Mar 1.

DOI:10.7860/JCDR/2017/22895.9402

PMID:28511481

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5427407/

Abstract

INTRODUCTION

Hypocalcaemia is very much prevalent in critically ill patients yet very less is known about its association with severity of illness. Acute Physiology and Chronic Health Evaluation (APACHE) and Sequential Organ Failure Assessment (SOFA) are two commonly used and validated scoring tool used to assess the severity of illness in critically ill patients.

AIM

To analyze the relation of on admission hypocalcaemia with severity of illness as measured by APACHE-II and SOFA scores.

MATERIALS AND METHODS

After institute approval, 111 patients admitted during May to June 2016 were evaluated. Age, sex, on admission, ionized calcium (iCa0) levels, first day APACHE-II and SOFA scores were collected. Data were then divided in different classes based on iCa0 levels (i.e., normocalcaemic, mild, moderate and severe hypocalcaemic), APACHE-II and SOFA scores and their relationship was assessed using INSTAT software (GraphPad Software, Inc, La Zolla, CA, USA) with appropriate statistical tests.

RESULTS

Seventy eight (70.27%) patients were having hypocalcaemia on admission (<1.15 mmol/L). The mean APACHE-II score of normocalcaemic patients were significantly (p<0.05) lower as compared to moderate and severe hypocalcaemic patients (15.57±6.85 versus 21.72±6.37 and 15.57±6.85 versus 22.34±7.53, respectively). The mean iCa0 level in patients with APACHE-II > 20 were significantly lower than patients with APACHE-II < 9 (0.88±0.26 versus 1.09±0.24, p <0.05) but the mean iCa0 level in patients with SOFA > 9 were not significantly lower than patients with SOFA < 4 (0.99±0.41 versus 1.04±0.23, p > 0.05). The relative risk of on admission hypocalcaemia across increasing illness severity was also not statistically significant. Both relative risk of mortality and length of ICU stay were higher in on admission moderate hypocalcaemic patients as compared to normocalcaemic but the difference was not statistically significant.

CONCLUSION

On admission, hypocalcaemia has inconsistent correlation with increasing illness severity in adult intensive care patients. iCa0 of 0.81-0.90 mmol/L appears to have maximum deleterious effect with regard to mortality and length of ICU stay.

摘要

引言

低钙血症在重症患者中非常普遍，但关于其与疾病严重程度的关联却知之甚少。急性生理学与慢性健康状况评估（APACHE）和序贯器官衰竭评估（SOFA）是两种常用且经过验证的评分工具，用于评估重症患者的疾病严重程度。

目的

分析入院时低钙血症与通过APACHE-II和SOFA评分衡量的疾病严重程度之间的关系。

材料与方法

经机构批准，对2016年5月至6月期间入院的111例患者进行评估。收集患者的年龄、性别、入院时的离子钙（iCa0）水平、第一天的APACHE-II和SOFA评分。然后根据iCa0水平（即正常血钙、轻度、中度和重度低钙血症）、APACHE-II和SOFA评分将数据分为不同类别，并使用INSTAT软件（美国加利福尼亚州拉霍亚的GraphPad Software公司）及适当的统计检验评估它们之间的关系。

结果

78例（70.27%）患者入院时存在低钙血症（<1.15 mmol/L）。正常血钙患者的平均APACHE-II评分显著低于中度和重度低钙血症患者（分别为15.57±6.85与21.72±6.37以及15.57±6.85与22.34±7.53，p<0.05）。APACHE-II>20的患者的平均iCa0水平显著低于APACHE-II<9的患者（0.88±0.26与1.09±0.24，p<0.05），但SOFA>9的患者的平均iCa0水平并不显著低于SOFA<4的患者（0.99±0.41与1.04±0.23，p>0.05）。随着疾病严重程度增加，入院时低钙血症的相对风险也无统计学意义。入院时中度低钙血症患者的死亡率和ICU住院时间的相对风险均高于正常血钙患者，但差异无统计学意义。