Bein T, Fröhlich D, Frey A, Metz C, Taeger K
Klinik für Anästhesiologie, Klinikum der Universität Regensburg.
Anaesthesist. 1995 Jan;44(1):37-42. doi: 10.1007/s001010050130.
The Acute Physiology and Chronic Health Evaluation model (APACHE II, APACHE III) is used to describe the severity of illness and predict the outcome in critically ill patients. APACHE III, introduced in 1991, has not yet been validated in Europe. We calculated APACHE II and APACHE III scores in patients after admission to the intensive care unit (ICU) and compared the prognostic value on hospital mortality. METHOD. One hundred fifty patients with stay of over 24 h were enrolled in the study and prospectively and consecutively investigated. APACHE II and III scores were calculated as described by the authors. The mean and median values of the survivors were compared with the non-surviving group (Mann-Whitney U test). Receiver operating characteristics (ROC analysis) and the areas under the ROC curves were plotted. RESULTS. Of the 150 patients, 34 died during their hospital stay (22.7%). The mean and median APACHE II and III scores were significantly higher (P < 0.001) in the non-surviving group. The area under the ROC curve was higher for APACHE III (0.899) compared to APACHE II (0.847). CONCLUSIONS. APACHE II and APACHE III were both found to have good prognostic value in general ICU patients. Our results suggest that the APACHE III version includes a more precise prediction of hospital mortality than APACHE II. A new aspect of APACHE III is an expanded modification of the Glasgow Coma Scale to assess neurologic derangements.
急性生理学与慢性健康状况评估模型（APACHE II、APACHE III）用于描述危重症患者的疾病严重程度并预测其预后。1991年推出的APACHE III在欧洲尚未得到验证。我们计算了重症监护病房（ICU）患者入院后的APACHE II和APACHE III评分，并比较了它们对医院死亡率的预测价值。方法。150例住院时间超过24小时的患者纳入本研究，并进行前瞻性连续调查。按照作者描述的方法计算APACHE II和III评分。将存活组的均值和中位数与非存活组进行比较（Mann-Whitney U检验）。绘制受试者工作特征曲线（ROC分析）及ROC曲线下面积。结果。150例患者中，34例在住院期间死亡（22.7%）。非存活组的APACHE II和III评分均值及中位数显著更高（P < 0.001）。与APACHE II（0.847）相比，APACHE III的ROC曲线下面积更高（0.899）。结论。APACHE II和APACHE III在一般ICU患者中均具有良好的预后价值。我们的结果表明，APACHE III版本对医院死亡率的预测比APACHE II更精确。APACHE III的一个新特点是对格拉斯哥昏迷量表进行了扩展修改以评估神经功能紊乱。
