Silvestre Joana, Coelho Luis, Pereira João Gonçalves, Mendes Vitor, Tapadinhas Camila, Póvoa Pedro
Unidade de Terapia Intensiva Polivalente, Hospital São Francisco Xavier, Centro Hospitalar Lisboa Ocidental - Lisboa, Portugal.
. Centro de Estudos de Doenças Crônicas, Faculdade de Ciências Médicas, Universidade Nova de Lisboa - Lisboa, Portugal.
Rev Bras Ter Intensiva. 2018 Oct-Dec;30(4):453-459. doi: 10.5935/0103-507X.20180062. Epub 2019 Jan 10.
To determine the performance of soluble urokinase-type plasminogen activator receptor upon intensive care unit discharge to predict post intensive care unit mortality.
A prospective observational cohort study was conducted during a 24-month period in an 8-bed polyvalent intensive care unit. APACHE II, SOFA, C-reactive protein, white cell count and soluble urokinase-type plasminogen activator receptor on the day of intensive care unit discharge were collected from patients who survived intensive care unit admission.
Two hundred and two patients were included in this study, 29 patients (18.6%) of whom died after intensive care unit discharge. Nonsurvivors were older and more seriously ill upon intensive care unit admission with higher severity scores, and nonsurvivors required extended use of vasopressors than did survivors. The area under the receiver operating characteristics curves of SOFA, APACHE II, C-reactive protein, white cell count, and soluble urokinase-type plasminogen activator receptor at intensive care unit discharge as prognostic markers of hospital death were 0.78 (95%CI 0.70 - 0.86); 0.70 (95%CI 0.61 - 0.79); 0.54 (95%CI 0.42 - 0.65); 0.48 (95%CI 0.36 - 0.58); and 0.68 (95%CI 0.58 - 0.78), respectively. SOFA was independently associated with a higher risk of in-hospital mortality (OR 1.673; 95%CI 1.252 - 2.234), 28-day mortality (OR 1.861; 95%CI 1.856 - 2.555) and 90-day mortality (OR 1.584; 95%CI 1.241 - 2.022).
At intensive care unit discharge, soluble urokinase-type plasminogen activator receptor is a poor predictor of post intensive care unit prognosis.
确定可溶性尿激酶型纤溶酶原激活物受体在重症监护病房出院时预测重症监护病房后死亡率的性能。
在一个拥有8张床位的多科重症监护病房进行了一项为期24个月的前瞻性观察队列研究。从重症监护病房入院存活的患者中收集重症监护病房出院当天的急性生理与慢性健康状况评分系统II（APACHE II）、序贯器官衰竭评估（SOFA）、C反应蛋白、白细胞计数和可溶性尿激酶型纤溶酶原激活物受体。
本研究纳入了202例患者，其中29例（18.6%）在重症监护病房出院后死亡。非幸存者在重症监护病房入院时年龄更大、病情更严重，严重程度评分更高，且非幸存者比幸存者需要更长时间使用血管升压药。重症监护病房出院时，SOFA、APACHE II、C反应蛋白、白细胞计数和可溶性尿激酶型纤溶酶原激活物受体作为医院死亡预后标志物的受试者工作特征曲线下面积分别为0.78（95%置信区间0.70 - 0.86）；0.70（95%置信区间0.61 - 0.79）；0.54（95%置信区间0.42 - 0.65）；0.48（95%置信区间0.36 - 0.58）；和0.68（95%置信区间0.58 - 0.78）。SOFA与院内死亡风险较高（比值比1.673；95%置信区间1.252 - 2.234）、28天死亡率（比值比1.861；95%置信区间1.856 - 2.555）和90天死亡率（比值比1.584；95%置信区间1.241 - 2.022）独立相关。
在重症监护病房出院时，可溶性尿激酶型纤溶酶原激活物受体对重症监护病房后预后的预测能力较差。
