Bodmann K F, Ehlers B, Häbel U, Ritschel P, Rühmkorf K
Medizinische Klinik I, Städtisches Krankenhaus Hildesheim.
Dtsch Med Wochenschr. 1997 Jul 25;122(30):919-25. doi: 10.1055/s-2008-1047709.
Computer-based data collection and objective gathering of degree of illness severity and risk of death with a prognostic scoring system make it possible to obtain, in addition to epidemiological and aetiological data, risk-related outcome values for patients in an intensive care unit.
All 2054 patients who during a 2-year period (1995-1996) had stayed in a medical intensive care unit (MICU) for more than 4 hours were studied prospectively. The simplified acute physiology score II (SAPS II), risk of death, duration of stay in the MICU and in the hospital, and death rates during MICU and hospital stay were determined. Mean and median values and histograms of the various parameters as well as the standardized mortality index (SMI: observed/ predicted death rate with 99% confidence limits) were calculated for each of the patients and certain defined subgroups (basic disease, age, risk). Receiver operating characteristics curves (discrimination) and calibration curves were obtained for SAPS II.
Mean age for the cohort was 59.8 years, duration of stay in the MICU 3.1 days, in hospital 14.7 days, SAPS II was 30.3 points, death risk 0.17, death rate during ICU stay was 8.3%, during hospital stay 13.9% and the SMI 0.8% (0.74-0.88). Cardiac disease was the most common underlying condition (60%), while the small group of neurological conditions was remarkable for the high degree of severity and unfavourable prognosis. Both death rate and degree of disease severity increased with age. But the SMI was not significantly higher than 1.0 in both the elderly patients and the high-risk group of patients (on ventilator, renal replacement procedures, death risk > 0.5).
Most patients in a MICU have underlying cardiac disease. Permanently available neurological consultation is essential. The high hospital death rate for elderly patients and those requiring respiratory support is a problem of disease severity, not of the quality of treatment. The risk of death is high on transfer to a general ward. Determination of the SMI is recommended for internal quality control in an ICU.
基于计算机的数据收集以及使用预后评分系统客观收集疾病严重程度和死亡风险，使得除了流行病学和病因学数据之外，还能够获取重症监护病房患者的风险相关结局值。
对在两年期间（1995 - 1996年）入住内科重症监护病房（MICU）超过4小时的所有2054例患者进行前瞻性研究。确定简化急性生理学评分II（SAPS II）、死亡风险、在MICU和医院的住院时间以及在MICU和住院期间的死亡率。计算了每位患者以及某些特定定义亚组（基础疾病、年龄、风险）的各种参数的均值、中位数和直方图以及标准化死亡率指数（SMI：观察到的/预测的死亡率，置信区间为99%）。获得了SAPS II的受试者工作特征曲线（辨别力）和校准曲线。
该队列的平均年龄为59.8岁，在MICU的住院时间为3.1天，在医院的住院时间为14.7天，SAPS II为30.3分，死亡风险为0.17，在ICU住院期间的死亡率为8.3%，在住院期间为13.9%，SMI为0.8%（0.74 - 0.88）。心脏病是最常见的基础疾病（60%），而一小部分神经系统疾病因其严重程度高和预后不良而引人注目。死亡率和疾病严重程度均随年龄增加。但在老年患者和高危患者组（使用呼吸机、进行肾脏替代治疗、死亡风险>0.5）中，SMI均未显著高于1.0。
MICU中的大多数患者患有基础心脏病。长期提供神经科会诊至关重要。老年患者和需要呼吸支持的患者的高医院死亡率是疾病严重程度的问题，而非治疗质量的问题。转至普通病房时死亡风险很高。建议在ICU中使用SMI进行内部质量控制。
