Kądziołka Izabela, Świstek Rafał, Borowska Karolina, Tyszecki Paweł, Serednicki Wojciech
Department of Anaesthesiology and Intensive Therapy, University Hospital in Krakow, Poland.
Department of Medical Didactics, Collegium Medicum, Jagiellonian University in Krakow, Poland.
Anaesthesiol Intensive Ther. 2019;51(2):107-111. doi: 10.5114/ait.2019.86275.
Disease's severity classification systems are applied to measure the risk of death and to choose the best therapy for patients admitted to intensive care unit (ICU). The aim of the study was to verify risk of death calculated with APACHE II (Acute Physiology and Chronic Health Evaluation II), SAPS II (Simplified Acute Physiology Score II), SOFA (Sequential Organ Failure Assessment) and evaluate correlation between these scores. The usefulness of SOFA score as a sole scale also was assessed.
This was a retrospective study conducted in 30-beds ICU in Kraków, Poland. Every male and female patient over 18 years old who was admitted to the ICU between 18.04.2016 and 12.08.2016 was included in the analysis. Patients who were transferred from another ICU were excluded from the research. APACHE II, SAPS II, SOFA were calculated after admission using laboratory results and clinical examination. Discrimination and calibration were used to validate these scoring system.
Analysis included 86 patients. The outcomes were compared within survivors and non-survivors groups. The prediction of death was statistically significant only for APACHE II and SAPS II. The best AUROC was for APACHE II 0.737 and SAPS II 0.737; discrimination for SOFA was not statistically significant. There was high correlation only between SAPS II and APACHE II results (r ≥ 0.7, P < 0.01). The calibration was excellent for SAPS II, P = 0.991, and slightly worse for APACHE II, P = 0.685, and SOFA, P = 0.540. Patients who survived spent more days on ICU (P < 0.01), mean Length of Stay (LOS) in this group was 38.25 ± 16.80 days.
APACHE II and SAPS II scales have better discrimination, calibration and power to predict deaths on ICU than SOFA. Among these scales SOFA did not achieve expected results.
疾病严重程度分类系统用于衡量死亡风险，并为重症监护病房（ICU）的患者选择最佳治疗方案。本研究的目的是验证通过急性生理学与慢性健康状况评分系统II（APACHE II）、简化急性生理学评分II（SAPS II）、序贯器官衰竭评估（SOFA）计算出的死亡风险，并评估这些评分之间的相关性。还评估了SOFA评分作为单一量表的实用性。
这是一项在波兰克拉科夫一家拥有30张床位的ICU进行的回顾性研究。分析纳入了2016年4月18日至2016年8月12日期间入住该ICU的所有18岁以上的男性和女性患者。从其他ICU转来的患者被排除在研究之外。入院后使用实验室检查结果和临床检查计算APACHE II、SAPS II、SOFA评分。采用辨别力和校准来验证这些评分系统。
分析纳入了86例患者。在存活组和非存活组之间比较结果。仅APACHE II和SAPS II对死亡的预测具有统计学意义。最佳曲线下面积（AUROC）对于APACHE II为0.737，对于SAPS II为0.737；SOFA的辨别力无统计学意义。仅SAPS II与APACHE II结果之间存在高度相关性（r≥0.7，P<0.01）。SAPS II的校准极佳，P=0.991，APACHE II稍差，P=0.685，SOFA更差，P=0.540。存活患者在ICU的天数更多（P<0.01），该组的平均住院时间（LOS）为38.25±16.80天。
与SOFA相比，APACHE II和SAPS II量表在预测ICU患者死亡方面具有更好的辨别力、校准能力和效能。在这些量表中，SOFA未达到预期结果。
