McCluskey A, Thomas A N, Bowles B J, Kishen R
Department of Intensive Care, Hope Hospital, Salford.
Anaesthesia. 1996 Aug;51(8):724-7. doi: 10.1111/j.1365-2044.1996.tb07883.x.
The prognostic value of serial measurements of serum albumin concentration during the first 72 h after admission to a general adult intensive care unit was retrospectively reviewed in 348 consecutive critically ill patients over a one year period. The accuracy of the admission APACHE II (Acute Physiology And Chronic Health Evaluation) score in correctly predicting patient outcome was compared with the serum albumin concentration measured at different times after intensive care unit admission. Multiple logistical regression analyses were performed to evaluate whether combining APACHE II and serum albumin into a unified risk index improved prognostic accuracy. Serum albumin concentration on admission was lower in non-survivors than in survivors and decreased more rapidly in non-survivors (p < 0.001). The admission serum albumin concentration was found to be an insensitive prognostic indicator. However, serum albumin measured after 24 h was as accurate as the admission APACHE II score in correctly classifying patients according to outcome. There was a good correlation between the admission APACHE II score and serum albumin measured after 24 h but not between the admission APACHE II and the admission serum albumin. Combining the APACHE II score and serial albumin concentrations into a unified risk of death equation did not improve the accuracy of outcome prediction.
在一年时间里，对348例入住普通成人重症监护病房的连续危重症患者进行回顾性研究，分析入院后72小时内连续测量血清白蛋白浓度的预后价值。将入院时急性生理与慢性健康状况评估（APACHE II）评分正确预测患者预后的准确性与重症监护病房入院后不同时间测量的血清白蛋白浓度进行比较。进行多元逻辑回归分析，以评估将APACHE II评分和血清白蛋白纳入统一风险指数是否能提高预后准确性。非幸存者入院时的血清白蛋白浓度低于幸存者，且在非幸存者中下降更快（p<0.001）。入院时的血清白蛋白浓度被发现是一个不敏感的预后指标。然而，24小时后测量的血清白蛋白在根据预后正确分类患者方面与入院时的APACHE II评分一样准确。入院时的APACHE II评分与24小时后测量的血清白蛋白之间存在良好相关性，但入院时的APACHE II评分与入院时的血清白蛋白之间不存在相关性。将APACHE II评分和连续白蛋白浓度纳入统一的死亡风险方程并不能提高预后预测的准确性。
