APACHEⅡ/Ⅲ评分系统对综合医院住院患者病情预后评估作用的比较研究

APACHE Ⅱ and Ⅲ score systems for evaluation of prognosis of general hospital inpatients

摘要:

目的  评估急性生理学及慢性健康状况评分系统APACHEⅡ与APACHEⅢ在临床应用中对住院患者病情预后判断及预测死亡风险的预警价值，探讨两者在临床中的有效性及应用前景。方法  回顾性分析208例患者的临床资料，对生存组和死亡组患者分别进行APACHEⅡ与APACHEⅢ评分，比较其差异性，采用ROC曲线下面积比较这两个评分方法对临床患者的预后评估能力。结果  生存组的APACHEⅡ与APACHEⅢ评分依次为（13.720±4.870）和（39.255±11.737）；两者均低于死亡组的（17.625±3.815）和（55.625±10.042）（P < 0.01）；APACHEⅡ与APACHEⅢ评分的ROC曲线下面积分别为0.688和0.869；95%CI分别是0.536，0.841和0.782，0.956。APACHEⅢ评分的灵敏度优于APACHEⅡ（P <0.05）。结论  APACHEⅢ评分对临床住院患者的病情预后评估作用优于APACHEⅡ评分，可对综合医院多学科住院患者的预后及死亡风险进行有效预测，值得临床进一步推广使用。

Abstract:

Objective To assess the early warning function of Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ and Ⅲ score in analyzing the disease prognosis and predicting the risk of death in hospitalized patients, and to discuss the clinical effectiveness and application prospect of the two systems. Methods The clinical data of 158 cases were retrospectively analyzed. The patients of the survival group and the death group were scored with APACHE Ⅱ and APACHE Ⅲ systems, and their differences were compared. Meanwhile, the area under the ROC curve (AUC) was applied to compare the two scoring methods for prognosis evaluation of clinical patients. Results  The scores of APACHE Ⅱ and Ⅲ in the survivor group [(13.720 ± 4.870) and (39.255 ± 11.737) respectively] were significantly lower than those in the death group [(17.625 ± 3.815) and (55.625 ±10.042) respectively, P < 0.01].  The AUC of APACHE Ⅱ and Ⅲ were 0.688 and 0.869 respectively. The 95% confidence interval were 0.536-0.841 and 0.782-0.956, respectively. The APACHE Ⅱ scoring was more sensitive than the APACHE Ⅲ scoring (P < 0.05). Conclusions The APACHE Ⅲ scoring is better in  assessment of inpatient prognosis than APACHE Ⅱ scoring, and can effectively evaluate patients' prognosis and predict the risk of death. Therefore, it is worthy of further promotion.