预测外科重症监护病房的生存率、住院时间和费用：急性生理与慢性健康状况评分系统II（APACHE II）与重症监护病房生存率预测模型（ICISS）的比较

Predicting survival, length of stay, and cost in the surgical intensive care unit: APACHE II versus ICISS.

作者信息

Osler T M, Rogers F B, Glance L G, Cohen M, Rutledge R, Shackford S R

机构信息

University of Vermont College of Medicine, Burlington, USA.

出版信息

J Trauma. 1998 Aug;45(2):234-7; discussion 237-8. doi: 10.1097/00005373-199808000-00006.

DOI:10.1097/00005373-199808000-00006

PMID:9715178

Abstract

BACKGROUND

Risk stratification of patients in the intensive care unit (ICU) is an important tool because it permits comparison of patient populations for research and quality control. Unfortunately, currently available scoring systems were developed primarily in medical ICUs and have only mediocre performance in surgical ICUs. Moreover, they are very expensive to purchase and use. We conceived a simple risk-stratification tool for the surgical ICU that uses readily available International Classification of Diseases, Ninth Revision, codes to predict outcome. Called ICISS (International Classification of Disease Illness Severity Score), our score is the product of the survival risk ratios (obtained from an independent data set) for all International Classification of Diseases, Ninth Revision, diagnosis codes.

METHODS

A total of 5,322 noncardiac patients admitted to a surgical ICU during an 8-year period had their Acute Physiology and Chronic Health Evaluation (APACHE) II scores compared with their ICISS as predictors of outcome (survival/nonsurvival, length of stay, and charges).

RESULTS

ICISS proved to be a much better predictor of survival than APACHE (receiver operating characteristic (ROC) APACHE = 0.806; Hosmer-Lemeshow (HL) APACHE = 22.56; ROC ICISS = 0.892; HL ICISS = 12.06) or the APACHE survival probability (ROC = 0.836; HL = 34.47). These differences were highly statistically significant (p < 0.001). ICISS was also better correlated with ICU length of stay (APACHE R2 = 0.06; ICISS R2 = 0.32) and ICU charges (APACHE R2 = 0.07; ICISS R2 = 0.39). When combined in a logistic model with ICISS, APACHE II added slightly to the predictive power of ICISS alone (combined ROC = 0.903) but degraded the calibration of the model (combined HL = 16.29; p = 0.038).

CONCLUSION

Because ICISS is both more accurate and much less expensive to calculate than APACHE II score, ICISS should replace APACHE II score as the standard risk stratification tool in surgical ICUs.

摘要

背景

重症监护病房（ICU）患者的风险分层是一项重要工具，因为它有助于对不同患者群体进行比较，以开展研究和进行质量控制。遗憾的是，目前可用的评分系统主要是在医疗ICU中开发的，在外科ICU中的表现仅属中等。此外，购买和使用这些系统的成本非常高。我们构思了一种用于外科ICU的简单风险分层工具，该工具使用易于获取的《国际疾病分类》第九版编码来预测预后。我们的评分称为ICISS（国际疾病病情严重程度评分），是所有《国际疾病分类》第九版诊断编码的生存风险比（从独立数据集获得）的乘积。

方法

在8年期间，共有5322名非心脏手术患者入住外科ICU，将他们的急性生理与慢性健康状况评估（APACHE）II评分与ICISS评分作为预后（生存/非生存、住院时间和费用）预测指标进行比较。

结果

事实证明，ICISS在预测生存方面比APACHE表现更好（受试者工作特征曲线（ROC）：APACHE = 0.806；霍斯默-莱梅肖检验（HL）：APACHE = 22.56；ROC ICISS = 0.892；HL ICISS = 12.06），也优于APACHE生存概率（ROC = 0.836；HL = 34.47）。这些差异具有高度统计学意义（p < 0.001）。ICISS与ICU住院时间的相关性也更好（APACHE R2 = 0.06；ICISS R2 = 0.32），与ICU费用的相关性同样更好（APACHE R2 = 0.07；ICISS R2 = 0.39）。当与ICISS一起纳入逻辑模型时，APACHE II单独对ICISS的预测能力略有提升（联合ROC = 0.903），但降低了模型的校准度（联合HL = 16.29；p = 0.038）。