Kollef M H, Allen B T
Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO 63110.
Chest. 1994 Dec;106(6):1822-8. doi: 10.1378/chest.106.6.1822.
To identify objective factors, available at the time of surgical evaluation, associated with outcome for patients in the medical ICU undergoing abdominal surgery.
Single-center, prospective observational study.
An academic tertiary care center.
The study included 1,617 consecutive patients in the medical ICU.
Prospective patient surveillance and data collection.
Patient demographics, severity of illness, organ system derangements, abdominal processes requiring surgery, and hospital mortality.
Sixty-seven patients in the medical ICU (4.1 percent) developed an acute abdominal process potentially amenable to surgical intervention. Eleven of these patients (16.4 percent) elected not to undergo surgery (mortality = 100 percent). Forty-two of the 56 patients who underwent surgery survived (75.0 percent). Stepwise logistic regression analysis identified two independent objective predictors of mortality for this patient cohort (p < 0.05): an organ system failure index (OSFI) > 2 (adjusted odds ratio [AOR] = 19.5; 95 percent confidence interval [CI], 7.4 to 51.5; p < 0.001); and an APACHE II score > 18 (AOR = 9.4; CI = 3.1 to 28.3; p = 0.03). The observed mortality following surgery was stratified according to the presence or absence of these two factors: neither present, 5.1 percent; APACHE II > 18 present alone, 33 percent; OSFI > 2 present alone, 60 percent; and both present, 88.9 percent (p < 0.001). Surgical nonsurvivors and patients electing not to undergo surgery were similar without significant differences for demographics, severity of illness, or organ system derangements at the time of surgical evaluation.
The number of organ system derangements and the severity of illness, as assessed by APACHE II, appear to be useful discriminators of outcome for patients in the medical ICU undergoing abdominal surgery. These data suggest potential outcome predictors for this selected group of patients in the ICU.
确定在外科评估时可获得的与医学重症监护病房（ICU）接受腹部手术患者预后相关的客观因素。
单中心前瞻性观察性研究。
一所学术性三级医疗中心。
该研究纳入了医学ICU的1617例连续患者。
前瞻性患者监测和数据收集。
患者人口统计学资料、疾病严重程度、器官系统紊乱情况、需要手术的腹部病情以及医院死亡率。
医学ICU中有67例患者（4.1%）发生了可能适合手术干预的急性腹部病情。其中11例患者（16.4%）选择不接受手术（死亡率=100%）。接受手术的56例患者中有42例存活（75.0%）。逐步逻辑回归分析确定了该患者队列死亡率的两个独立客观预测因素（p<0.05）：器官系统衰竭指数（OSFI）>2（调整优势比[AOR]=19.5；95%置信区间[CI]，7.4至51.5；p<0.001）；以及急性生理与慢性健康状况评分系统（APACHE II）>18（AOR=9.4；CI=3.1至28.3；p=0.03）。根据这两个因素的有无对术后观察到的死亡率进行分层：两者均无，5.1%；仅APACHE II>18，33%；仅OSFI>2，60%；两者均有，88.9%（p<0.001）。手术死亡患者和选择不接受手术的患者在人口统计学资料、疾病严重程度或外科评估时的器官系统紊乱情况方面相似，无显著差异。
通过APACHE II评估的器官系统紊乱数量和疾病严重程度似乎是医学ICU接受腹部手术患者预后的有用判别指标。这些数据提示了该ICU特定患者群体潜在的预后预测因素。
