Wagner D P, Knaus W A, Draper E A
Arch Intern Med. 1986 Jul;146(7):1389-96.
Initial physiologic data from 1625 nonoperative patients with 18 acute life-threatening diseases treated in an intensive care unit suggest a uniform predictable relationship between acute changes in normal physiologic balance and a patient's risk of death. We found that incremental deviations from normal physiologic balance represent equivalent and predictable incremental risks to survival, regardless of the disease initiating the physiologic disturbance. The relative impact of these physiologic abnormalities on outcome may depend on our understanding of the disease's mechanism of action. Diseases for which there is good understanding of underlying pathophysiology and precise treatment appear to have lower death rates throughout the range of physiologic imbalance compared with those for which pathophysiologic knowledge is limited or unknown. These results document the importance of pathophysiologic understanding to improving survival from acute disease. More importantly, they suggest a predictable relationship between risk of death and physiologic abnormalities for a wide range of diseases. The existence of such a relationship could greatly expand our prognostic ability and permit improved evaluation of new therapeutic discoveries.
来自1625名在重症监护病房接受治疗的患有18种急性危及生命疾病的非手术患者的初始生理数据表明，正常生理平衡的急性变化与患者的死亡风险之间存在一致的可预测关系。我们发现，与引发生理紊乱的疾病无关，偏离正常生理平衡的增量偏差代表着对生存的等效且可预测的增量风险。这些生理异常对结果的相对影响可能取决于我们对疾病作用机制的理解。与那些病理生理学知识有限或未知的疾病相比，对于其潜在病理生理学有深入了解且有精确治疗方法的疾病，在整个生理失衡范围内似乎死亡率更低。这些结果证明了病理生理学理解对提高急性疾病生存率的重要性。更重要的是，它们表明了广泛疾病的死亡风险与生理异常之间存在可预测的关系。这种关系的存在可以极大地扩展我们的预后能力，并允许对新的治疗发现进行更好的评估。
