急性生理学与慢性健康状况评分系统Ⅱ对重症结核病患者耐结核治疗的预测价值：一项回顾性研究。
APACHE-II score for anti-tuberculosis tolerance in critically ill patients: a retrospective study.
机构信息
Department of Tuberculosis Intensive Care Unit, Tuberculosis Diagnosis and Treatment Center of Zhejiang Province, Hang Zhou Red Cross Hospital, Hang Zhou, 310003, China.
出版信息
BMC Infect Dis. 2019 Feb 4;19(1):106. doi: 10.1186/s12879-019-3751-7.
BACKGROUND
To investigate the status of anti-tuberculosis treatment in critically ill patients, and to explore the value of APACHE-II score in guiding anti-tuberculosis treatment.
METHODS
This analysis included critically ill patients with tuberculosis. The utility of APACHE-II score for predicting drug withdrawal was evaluated using receiver operating characteristic (ROC) curve analysis.
RESULTS
Among 320 patients enrolled (58 ± 22 years; 256 males), 147 (45.9%) had drugs withdrawn. The drug withdrawal group had higher APACHE-II score (median [interquartile range]: 21 [3-52] vs. 17 [4-42] points), higher CD4%, lower hemoglobin level, higher rates of chronic obstructive pulmonary disease (COPD) and chronic renal failure, and lower rate of extrapulmonary tuberculosis (P < 0.05). Logistic regression identified APACHE-II score > 18 (odds ratio [95% confidence interval]: 2.099 [1.321-3.334], P < 0.01), COPD (1.913 [1.028-3.561], P < 0.05) and hemoglobin level (0.987 [0.977-0.997], P < 0.05) as independent factors associated with drug withdrawal. At an optimal cutoff of 18.5, the sensitivity, specificity, positive predictive value and negative predictive value of APACHE-II score for predicting drug withdrawal was 59.2, 61.8, 56.9 and 64.1%, respectively.
CONCLUSIONS
APACHE-II score > 18 points might predict patient tolerance of anti-tuberculosis treatment.
背景
为了调查危重症结核病患者的抗结核治疗状况，并探讨急性生理学与慢性健康状况评分系统Ⅱ（APACHE-Ⅱ）评分在指导抗结核治疗中的价值。
方法
本分析纳入了结核病危重症患者。采用受试者工作特征（ROC）曲线分析评估 APACHE-Ⅱ评分预测停药的效能。
结果
共纳入 320 例患者（58±22 岁；256 例男性），147 例（45.9%）患者停药。停药组的 APACHE-Ⅱ评分较高（中位数[四分位间距]：21[3-52]分比 17[4-42]分），CD4%较高，血红蛋白水平较低，慢性阻塞性肺疾病（COPD）和慢性肾衰竭的发生率较高，肺外结核病的发生率较低（P<0.05）。Logistic 回归分析确定 APACHE-Ⅱ评分>18 分（比值比[95%置信区间]：2.099[1.321-3.334]，P<0.01）、COPD（1.913[1.028-3.561]，P<0.05）和血红蛋白水平（0.987[0.977-0.997]，P<0.05）是与停药相关的独立因素。APACHE-Ⅱ评分预测停药的最佳截断值为 18.5 时，其灵敏度、特异度、阳性预测值和阴性预测值分别为 59.2%、61.8%、56.9%和 64.1%。
结论
APACHE-Ⅱ评分>18 分可能预示患者对抗结核治疗的耐受性。
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