Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
Department of Critical Care Medicine and Division of Cardiology, Department of Medicine, University of Alberta Hospital, Edmonton, Alberta.
Am Heart J. 2020 Jun;224:57-64. doi: 10.1016/j.ahj.2020.02.018. Epub 2020 Feb 28.
Critical care risk scores can stratify mortality risk among cardiac intensive care unit (CICU) patients, yet risk score performance across common CICU admission diagnoses remains uncertain.
We evaluated performance of the Acute Physiology and Chronic Health Evaluation (APACHE)-III, APACHE-IV, Sequential Organ Failure Assessment (SOFA) and Oxford Acute Severity of Illness Score (OASIS) scores at the time of CICU admission in common CICU admission diagnoses. Using a database of 9,898 unique CICU patients admitted between 2007 and 2015, we compared the discrimination (c-statistic) and calibration (Hosmer-Lemeshow statistic) of each risk score in patients with selected admission diagnoses.
Overall hospital mortality was 9.2%. The 3182 (32%) patients with a critical care diagnosis such as cardiac arrest, shock, respiratory failure, or sepsis accounted for >85% of all hospital deaths. Mortality discrimination by each risk score was comparable in each admission diagnosis (c-statistic 95% CI values were generally overlapping for all scores), although calibration was variable and best with APACHE-III. The c-statistic values for each score were 0.85-0.86 among patients with acute coronary syndromes, and 0.76-0.79 among patients with heart failure. Discrimination for each risk score was lower in patients with critical care diagnoses (c-statistic range 0.68-0.78) compared to non-critical cardiac diagnoses (c-statistic range 0.76-0.86).
The tested risk scores demonstrated inconsistent performance for mortality risk stratification across admission diagnoses in this CICU population, emphasizing the need to develop improved tools for mortality risk prediction among critically-ill CICU patients.
危重病风险评分可以对心脏重症监护病房（CICU）患者的死亡率进行分层，但在常见的 CICU 入院诊断中，风险评分的表现仍不确定。
我们评估了急性生理学和慢性健康评估（APACHE）-III、APACHE-IV、序贯器官衰竭评估（SOFA）和牛津急性疾病严重程度评分（OASIS）在常见 CICU 入院诊断中的入院时评分在 CICU 患者中的表现。使用 2007 年至 2015 年间 9898 名独特的 CICU 患者的数据库，我们比较了每个风险评分在选定入院诊断患者中的区分度（c 统计量）和校准（Hosmer-Lemeshow 统计量）。
总的医院死亡率为 9.2%。有心脏骤停、休克、呼吸衰竭或败血症等重症监护诊断的 3182 名（32%）患者占所有医院死亡人数的 85%以上。每个风险评分的死亡率区分度在每个入院诊断中相似（所有评分的 c 统计量 95%置信区间值通常重叠），尽管校准情况不同，APACHE-III 最佳。在急性冠状动脉综合征患者中，每个评分的 c 统计量值为 0.85-0.86，在心力衰竭患者中为 0.76-0.79。与非重症心脏诊断相比（c 统计量范围为 0.76-0.86），每个风险评分在重症监护诊断患者中的区分度较低（c 统计量范围为 0.68-0.78）。
在该 CICU 人群中，经过测试的风险评分在入院诊断中死亡率分层的表现不一致，这强调需要开发更好的工具来预测危重症 CICU 患者的死亡率风险。
