Dougnac A, Andresen M, Rabagliati R, Landerretche J, François P, Del Pino L V, Prado J
Departmento de Medicina Interna, P Universidad Católica de Chile, Santiago.
Rev Med Chil. 1993 Jan;121(1):52-8.
Patients admitted to intensive care units (ICU) experience constant changes in their general condition. Therefore, the determination of Apache score within the first 24 hours of admission may not be a reliable index of severity. The aim of this study was to measure daily Apache scores in ICU patients, and to determine if the maximum score (Maximum Apache) attained during hospitalization had a better prognostic value than that of admission. We measured daily Apache scores to 314 patients admitted to Hospital Clínico UC ICU. Mean admission score was 17.5 +/- 9.3 (range: 1-47) and mean maximum score was 18.6 +/- 9.7 (range: 1-47), p < 0.001. Mortality during ICU stay was 17.2%, and 8.6% during hospitalization after ICU discharge. Only 78.3% of patients attained their maximum apache score during the first 24 hours of admission, whereas 21.7% attained it during the rest of ICU hospitalization. Excluding subjects with less than one day of ICU stay, 33% of patients attained maximum Apache score after 24 hours of ICU admission. Statistical analysis showed that maximum Apache score was a better predictor of mortality than that of admission.
入住重症监护病房（ICU）的患者总体状况不断变化。因此，入院后24小时内的急性生理与慢性健康状况评分系统（Apache）评分可能并非严重程度的可靠指标。本研究的目的是测量ICU患者的每日Apache评分，并确定住院期间达到的最高评分（最高Apache评分）是否比入院时的评分具有更好的预后价值。我们对314名入住科利尼科大学医院ICU的患者进行了每日Apache评分测量。平均入院评分为17.5±9.3（范围：1 - 47），平均最高评分为18.6±9.7（范围：1 - 47），p<0.001。ICU住院期间的死亡率为17.2%，ICU出院后住院期间的死亡率为8.6%。只有78.3%的患者在入院后24小时内达到最高Apache评分，而21.7%的患者在ICU住院的其余时间达到该评分。排除ICU住院时间少于一天的患者后，33%的患者在ICU入院24小时后达到最高Apache评分。统计分析表明，最高Apache评分比入院评分更能预测死亡率。
