Heidenreich P A, Foster E, Cohen N H
Department of Medicine, University of California, San Francisco 94143-0624, USA.
Crit Care Med. 1996 Nov;24(11):1835-40. doi: 10.1097/00003246-199611000-00013.
To determine the clinical variables that affect the prognosis of critically ill patients with sustained unexplained hypotension. A further goal was to develop a prognostic scoring system based on clinical data available at the onset of hypotension.
Prospective cohort study.
The intensive care units (ICUs) of an academic medical center.
One hundred one adult ICU patients with sustained (> 60 mins) unexplained hypotension. Using the initial 50 patients (derivation set), a prognostic score was developed that was then tested in the next 51 patients (validation set).
None
The main outcome variable was death or hospital discharge. The overall hospital mortality in the combined sets was 58%. Using a multivariable model we identified three independent (p < .05) predictors of hospital mortality, including the Acute Physiology and Chronic Health Evaluation (APACHE) II score at the time of hypotension, the time from hospital admission to hypotensive episode, and hospital admission for surgery or treatment of malignancy. These variables were weighted and combined to create a Hypotension Score which separated patients in the combined sets into three prognostic groups: a) Hypotension Score of < 40, mortality 7%, (n = 27); b) Hypotension Score of 40 to 64, mortality 70%, (n = 50); and c) Hypotension Score of > or = 65, mortality 92%, (n = 24). The area under the receiver operating characteristic curve was .85 for the derivation set and .83 for the validation set vs. .76 for the APACHE II score alone.
The prognosis of hypotension in the critical care setting is highly variable, but can be predicted from patient characteristics.
确定影响持续不明原因低血压的危重症患者预后的临床变量。另一个目标是基于低血压发作时可用的临床数据开发一种预后评分系统。
前瞻性队列研究。
一所学术医疗中心的重症监护病房（ICU）。
101例持续（>60分钟）不明原因低血压的成年ICU患者。使用最初的50例患者（推导集）开发了一种预后评分，然后在接下来的51例患者（验证集）中进行测试。
无
主要结局变量为死亡或出院。合并组的总体医院死亡率为58%。使用多变量模型，我们确定了三个独立的（p<0.05）医院死亡率预测因素，包括低血压时的急性生理与慢性健康状况评估（APACHE）II评分、从入院到低血压发作的时间以及因手术或恶性肿瘤治疗而入院。对这些变量进行加权并合并，以创建低血压评分，该评分将合并组中的患者分为三个预后组：a）低血压评分<40，死亡率7%，（n = 27）；b）低血压评分40至64，死亡率70%，（n = 50）；c）低血压评分≥65，死亡率92%，（n = 24）。推导集的受试者工作特征曲线下面积为0.85，验证集为0.83，而单独的APACHE II评分为0.76。
重症监护环境中低血压的预后差异很大，但可以根据患者特征进行预测。
