Forrest D M, Djurdjev O, Zala C, Singer J, Lawson L, Russell J A, Montaner J S
British Columbia Center for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada.
Chest. 1998 Jul;114(1):199-206. doi: 10.1378/chest.114.1.199.
To validate a previously developed multisystem organ failure (MSOF) score with and without the addition of the lactate dehydrogenase (LDH) level as a predictor of survival to hospital discharge in patients with AIDS-related Pneumocystis carinii pneumonia (PCP) and acute respiratory failure (ARF).
Retrospective chart review between April 1, 1991, and September 30, 1996.
University-affiliated tertiary care center in downtown Vancouver, British Columbia, Canada.
All patients with PCP-related ARF admitted to the ICU of St. Paul's Hospital during the study period.
As putative prognostic instruments, data were extracted regarding the APACHE II (acute physiology and chronic health evaluation II), acute lung injury (ALI), AIDS, and modified MSOF scores, as well as LDH levels, at entry to the ICU. Patients were stratified based on an LDH level of < or > or = 2,000 U/L and this threshold was assessed in its predictability of outcome when added to each of the above scores. For APACHE II, the score was categorized in six groups and evaluated with and without inclusion of the LDH. Receiver operating characteristic curves were constructed for LDH and for each score with and without the LDH level to assess accuracy of prediction. The area under each curve was calculated and compared to estimate the statistical significance of observed differences.
There were 40 admissions to the ICU of 38 patients with 52.5% mortality. The ALI and AIDS scores were not predictive of outcome. The modified MSOF and APACHE II scores were significant predictors of survival and the performance of both was enhanced by the addition of LDH.
Both the APACHE II and the modified MSOF scores were significant predictors of outcome in the patient population studied. These results validate the modified MSOF score as an effective predictor of survival to hospital discharge among patients with AIDS-related PCP who develop ARF and the performance of the score is enhanced by the addition of the LDH level.
验证先前开发的多系统器官衰竭（MSOF）评分，在加入乳酸脱氢酶（LDH）水平和不加入该水平的情况下，作为艾滋病相关卡氏肺孢子虫肺炎（PCP）和急性呼吸衰竭（ARF）患者出院生存预测指标的有效性。
1991年4月1日至1996年9月30日的回顾性病历审查。
加拿大不列颠哥伦比亚省温哥华市中心的大学附属三级护理中心。
研究期间入住圣保罗医院重症监护病房的所有PCP相关ARF患者。
作为假定的预后工具，在患者进入重症监护病房时，提取关于急性生理与慢性健康状况评估II（APACHE II）、急性肺损伤（ALI）、艾滋病和改良MSOF评分以及LDH水平的数据。根据LDH水平<或>或 = 2000 U/L对患者进行分层，并评估该阈值在加入上述各评分时对预后的预测能力。对于APACHE II，将评分分为六组，并在纳入和不纳入LDH的情况下进行评估。构建LDH以及各评分在纳入和不纳入LDH水平时的受试者工作特征曲线，以评估预测准确性。计算每条曲线下的面积并进行比较，以估计观察到的差异的统计学显著性。
38例患者共40次入住重症监护病房，死亡率为52.5%。ALI和艾滋病评分不能预测预后。改良MSOF和APACHE II评分是生存的显著预测指标，加入LDH后两者的性能均得到增强。
APACHE II和改良MSOF评分在所研究的患者群体中均是预后的显著预测指标。这些结果验证了改良MSOF评分作为发生ARF的艾滋病相关PCP患者出院生存的有效预测指标，并且加入LDH水平可提高该评分的性能。
