Department of Pulmonary & Critical Care Medicine, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China.
Department of General Surgery, The 8th Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, China.
J Healthc Eng. 2020 Mar 19;2020:6432048. doi: 10.1155/2020/6432048. eCollection 2020.
To prospectively investigate early prognostic assessments of patients with Multiple Organ Dysfunction Syndrome in the Elderly (MODSE) who were receiving invasive mechanical ventilation (IMV).
The clinical data of 351 patients were enrolled prospectively between January 2013 and January 2018. The Acute Physiology and Chronic Health Evaluation II (APACHE II), APACHE III, Simplified Acute Physiology Score (SAPS II), and Multiple Organ Dysfunction Score (MODS) were calculated. According to the outcome of 28-day, the patients were divided into survivors and nonsurvivors. Additionally, based on whether weaning could be implemented, all patients were divided into a successful-weaning group and a failure-to-wean group.
According to the prognosis, the areas under the receiver operating characteristic curve of the APACHE II, APACHE III, SAPS II, and MODS scoring systems were 0.837, 0.833, 0.784, and 0.860, respectively. MODS exhibited the highest sensitivity, whereas APACHE II showed the highest specificity, and successful weaning was conducive to ameliorating patients' prognosis. Multivariate logistic regression analyses revealed that underlying lung disease, plasma albumin, serum creatinine level, number of failing organs, and IMV duration were related to prognosis of weaning, with odds ratios (ORs) of 1.447, 0.820, 1.603, 2.374, and 3.105, respectively.
The APACHE II, APACHE III, SAPS II, and MODS systems could perform excellent prognostic assessment for patients with Multiple Organ Dysfunction Syndrome in the elderly. Underlying lung disease, plasma albumin, serum creatinine, number of failing organs, and IMV duration were independent prognostic factors of weaning in MODSE patients with invasive mechanical ventilation.
前瞻性研究接受有创机械通气（IMV）的老年多器官功能障碍综合征（MODSE）患者的早期预后评估。
2013 年 1 月至 2018 年 1 月，前瞻性纳入 351 例患者的临床资料。计算急性生理学和慢性健康评估 II（APACHE II）、APACHE III、简化急性生理学评分（SAPS II）和多器官功能障碍评分（MODS）。根据 28 天的结果，将患者分为存活组和非存活组。此外，根据是否能够撤机，所有患者分为撤机成功组和撤机失败组。
根据预后，APACHE II、APACHE III、SAPS II 和 MODS 评分系统的受试者工作特征曲线下面积分别为 0.837、0.833、0.784 和 0.860。MODS 显示出最高的灵敏度，而 APACHE II 显示出最高的特异性，成功撤机有利于改善患者的预后。多变量逻辑回归分析显示，基础肺部疾病、血浆白蛋白、血清肌酐水平、衰竭器官数量和 IMV 持续时间与撤机预后相关，优势比（ORs）分别为 1.447、0.820、1.603、2.374 和 3.105。
APACHE II、APACHE III、SAPS II 和 MODS 系统可对老年多器官功能障碍综合征患者进行出色的预后评估。基础肺部疾病、血浆白蛋白、血清肌酐、衰竭器官数量和 IMV 持续时间是老年 MODSE 患者接受有创机械通气撤机的独立预后因素。
