Carneiro A V, Leitão M P, Lopes M G, De Pádua F
UCIM do Serviço de Medicina 4 e Serviço de Patologia Cirúrgica, Hospital Universitário de Santa Maria, Lisboa.
Acta Med Port. 1997 Nov;10(11):751-60.
Outcome prediction in critical surgical patients admitted to intensive care units (ICU) has been established using several scoring systems. To evaluate the predictive performance of the Acute Physiology, Age and Chronic Health Evaluation (APACHE III) scoring system in these patients, we studied a population admitted to a surgical ICU in our University Hospital.
We collected prospective data on 220 consecutive patients admitted over a period of 12 months. APACHE III (A3) scores were obtained over the first 24 hours of ICU admission (APACHE II scores were also calculated); data also included age, sex, acute and chronic diseases, ICU and hospital length of stay (LOS), patient location prior to ICU admission and outcome. The relationship of hospital mortality with A3 scores was analyzed using logistic regression, with the discriminatory power of these systems being assessed by the area under the ROC curve and percentage of correct classification.
Patient's mean age was 57 +/- 17 years and 44% were male; 53.6% were elective and 46.4% were emergency postoperative patients; 5% of patients had co-morbidities; ICU mortality rate was 10% and in-hospital mortality rate (HMR) was 15%; mean ICU LOS was 3.9 +/- 5.6 days and mean hospital LOS was 9.4 +/- 8.2 days; mean scores were: APACHE III = 33 +/- 2 and APACHE II = 9 +/- 6 points. There was a significant relationship between ascending A3 scores and HMR. APACHE III had a correct classification rate of 87.3% and an area under the ROC curve of 0.830.
In a population of critical surgical patients admitted to our ICU the APACHE III scoring system demonstrated an excellent prognostic performance as measured by contingency tables and areas under the ROC curve; this system can be a useful tool for outcome prediction in critical surgical patients.
使用多种评分系统已能对入住重症监护病房（ICU）的外科重症患者的预后进行预测。为评估急性生理学与慢性健康状况评分系统（APACHE III）在这些患者中的预测性能，我们对我院外科ICU收治的患者群体进行了研究。
我们收集了连续12个月收治的220例患者的前瞻性数据。在入住ICU的最初24小时内获取APACHE III（A3）评分（同时也计算了APACHE II评分）；数据还包括年龄、性别、急慢性疾病、ICU住院时间和住院时间（LOS）、入住ICU前患者的位置以及预后情况。使用逻辑回归分析医院死亡率与A3评分的关系，通过ROC曲线下面积和正确分类百分比评估这些系统的鉴别能力。
患者的平均年龄为57±17岁，44%为男性；53.6%为择期手术患者，46.4%为急诊术后患者；5%的患者有合并症；ICU死亡率为10%，住院死亡率（HMR）为15%；平均ICU住院时间为3.9±5.6天，平均住院时间为9.4±8.2天；平均评分如下：APACHE III = 33±2分，APACHE II = 9±6分。A3评分升高与HMR之间存在显著关系。APACHE III的正确分类率为87.3%，ROC曲线下面积为0.830。
在我院ICU收治的外科重症患者群体中，APACHE III评分系统通过列联表和ROC曲线下面积测量显示出优异的预后预测性能；该系统可作为外科重症患者预后预测的有用工具。
