von Bierbrauer A, Burchardt C, Müller H H, von Wichert P
Abteilung Medizinische Poliklinik-Intensivmedizin im Zentrum Innere Medizin, Philipps-Universität Marburg.
Med Klin (Munich). 1998 Sep 15;93(9):524-32. doi: 10.1007/BF03042661.
Scoring systems are important tools for quality control and stratification of study populations in intensive care medicine. The study aims to systematically evaluate predictive ability and severity classification ability of the combined physiologic-therapeutic Hannover Intensiv Score (HIS). Such data are not existing regarding medical intensive care medicine.
1060 consecutive patients (ICU stay > 4 hours) being admitted to a medical ICU were prospectively investigated. HIS was determined for all patients each day during ICU stay. The results were compared to the physiologically based APACHE II and to the therapeutically based TISS, which both were determined as well.
HIS provided sufficient discrimination between survival and nonsurvival [hospital mortality; area under the ROC curve (AUC) = 0.822] with no significant differences compared to APACHE II (AUC = 0.838) and TISS (AUC = 0.798), respectively. During longer course of ICU stay HIS offers better outcome prognostication compared to the unilateral systems with respect to specificity and total correct classification rate. There was a nearly linear increase of hospital mortality with an increase of day-1-HIS. The same was observed with APACHE II and TISS. Mean day-1-scores for survivors were significantly higher compared to non-survivors with all systems (p < 0.0001). Day-1-HIS moderately correlates with both other systems (APACE II: r = 0.766; TISS: r = 0.814).
The Hannover Intensiv Score as a model of a combined physiologic-therapeutic scoring system was successfully validated concerning hospital outcome prediction and severity of disease classification in a large medical ICU population. Thus, for these applications it can be used in similar German ICUs. A main argument for applying the system is the employment of a fairly small set of easily accessible parameters.
评分系统是重症医学中用于质量控制和研究人群分层的重要工具。本研究旨在系统评估联合生理 - 治疗的汉诺威重症评分（HIS）的预测能力和严重程度分类能力。关于内科重症医学，尚无此类数据。
对1060例连续入住内科重症监护病房（ICU住院时间>4小时）的患者进行前瞻性研究。在患者ICU住院期间，每天为所有患者测定HIS。将结果与基于生理指标的急性生理与慢性健康状况评分系统II（APACHE II）以及基于治疗指标的治疗干预评分系统（TISS）进行比较，后两者也进行了测定。
HIS在生存与非生存（医院死亡率）之间提供了充分的区分度[ROC曲线下面积（AUC）=0.822]，与APACHE II（AUC =0.838）和TISS（AUC =0.798）相比，分别无显著差异。在较长的ICU住院期间，就特异性和总正确分类率而言，HIS与单一指标系统相比，能提供更好的预后预测。随着第1天HIS的增加，医院死亡率几乎呈线性上升。APACHE II和TISS也观察到同样情况。所有系统中，幸存者的第1天平均评分显著高于非幸存者（p<0.0001）。第1天HIS与其他两个系统均呈中度相关（APACHE II：r =0.766；TISS：r =0.814）。
作为联合生理 - 治疗评分系统模型的汉诺威重症评分，在大型内科ICU人群中关于医院结局预测和疾病严重程度分类方面已成功验证。因此，对于这些应用，它可用于类似的德国ICU。应用该系统的一个主要理由是采用了一组相当少且易于获取的参数。
