急性生理与慢性健康状况评分Ⅱ对连续性肾脏替代治疗患者的预后评估
|
摘要
目的探讨急性生理与慢性健康状况评分Ⅱ(APACHEⅡ)对连续性肾脏替代治疗(CRRT患者的预后评估价值。方法回顾分析2016年1月1日至2017年6月30日佛山市第一人民医院各科行CRRT的205例危重患者的临床资料,根据患者行CRRT前24 h内的生理指标最差值进行APACHEⅡ评分,用Logistic回归分析影响CRRT患者死亡的危险因素,并用受试者工作特征曲线(ROC曲线)与Hosmer-Lemeshow拟合优度检验评价APACHEⅡ评分的分辨力和校准力,以Logistic回归分析它对预后的影响。结果 205例CRRT患者中81例死亡,死亡风险为39.51%。死亡组APACHEⅡ评分为(26.63±7.24),存活组为(21.00±6.29),两组之间差异有统计学意义(P <0.001)。心率(OR=1.021,95%CI:1.001～1.040,P=0.035)为CRRT患者死亡的独立危险因素,而GCS积分(OR=0.882,95%CI:0.819～0.949,P=0.001)评分的ROC曲线下面积(AUC)为0.725(95%CI:0.632～0.818,P <0.001),且Hosmer-Lemeshow拟合优度检验提示模型拟合较好。Logistic回归分析显示APACHEⅡ评分≥24(OR=4.89,95%CI:2.280～10.498,P <0.001)是CRRT患者死亡的独立预测指标。结论 APACHEⅡ在CRRT前24 h内的评分能较好区分病情的严重程度,并作为预测模型显示出对于整体预后较好的分辨力与校准力,且APACHEⅡ评分≥24是CRRT患者死亡的独立预测指标。
Objective To explore the prognostic value of acute physiology and chronic health evaluation Ⅱ(APACHEⅡ)scoring system in patients under continuous renal replacement therapy(CRRT). Methods A to-tal of 205 severe patients under CRRT in the departments of the First People′s Hospital of Foshan from January 1,2016 to June 30,2017 were enrolled. APACHEⅡ score was evaluated according to the worst value of physiologic variables 24 hours before CRRT. The risk factors of the mortality of CRRT patients were analyzed by logistic regres-sion. Discrimination and calibration of APACHEⅡ was assessed by receiver operating characteristic(ROC)curve and Hosmer-Lemeshow goodness-of-fit test. Besides,its effect on mortality was evaluated by logistic regression.Results Among 205 patients,81 patients died and the mortality was 39.51%. The APACHEⅡ score was 26.63 ±7.24 and 21.00 ± 6.29(P < 0.001)in death and survival groups,respectively. Heart rate(OR = 1.021,95%CI:1.001 ～ 1.040,P = 0.035)was the independent risk factors for CRRT patients,while GCS score(OR = 0.882,95%CI:0.819 ～ 0.949,P = 0.001)was the independent protective factors for CRRT patients. The area under the ROC curve of APACHEⅡ was 0.725(95%CI:0.632 ～ 0.818,P < 0.001)and the results of Hosmer-Lemeshow goodness-of-fit test indicated good calibration of this model. Logistic regression analysis showed that APACHEⅡ≥24(OR = 4.89,95%CI:2.280 ～ 10.498,P < 0.001)was independent predictors of death in CRRT patients.Conclusions The APACHEⅡ score just evaluated 24 hours before CRRT can discern the severity of patients′illness. The model present good discrimination and calibration in predicting patients′ outcome. APACHEⅡ≥ 24 is found to be the independent predictors of death in CRRT patients.
Objective To explore the prognostic value of acute physiology and chronic health evaluation Ⅱ(APACHEⅡ)scoring system in patients under continuous renal replacement therapy(CRRT). Methods A to-tal of 205 severe patients under CRRT in the departments of the First People′s Hospital of Foshan from January 1,2016 to June 30,2017 were enrolled. APACHEⅡ score was evaluated according to the worst value of physiologic variables 24 hours before CRRT. The risk factors of the mortality of CRRT patients were analyzed by logistic regres-sion. Discrimination and calibration of APACHEⅡ was assessed by receiver operating characteristic(ROC)curve and Hosmer-Lemeshow goodness-of-fit test. Besides,its effect on mortality was evaluated by logistic regression.Results Among 205 patients,81 patients died and the mortality was 39.51%. The APACHEⅡ score was 26.63 ±7.24 and 21.00 ± 6.29(P < 0.001)in death and survival groups,respectively. Heart rate(OR = 1.021,95%CI:1.001 ～ 1.040,P = 0.035)was the independent risk factors for CRRT patients,while GCS score(OR = 0.882,95%CI:0.819 ～ 0.949,P = 0.001)was the independent protective factors for CRRT patients. The area under the ROC curve of APACHEⅡ was 0.725(95%CI:0.632 ～ 0.818,P < 0.001)and the results of Hosmer-Lemeshow goodness-of-fit test indicated good calibration of this model. Logistic regression analysis showed that APACHEⅡ≥24(OR = 4.89,95%CI:2.280 ～ 10.498,P < 0.001)was independent predictors of death in CRRT patients.Conclusions The APACHEⅡ score just evaluated 24 hours before CRRT can discern the severity of patients′illness. The model present good discrimination and calibration in predicting patients′ outcome. APACHEⅡ≥ 24 is found to be the independent predictors of death in CRRT patients.
引文
[1]谢媛,刘子梦,郑粉双,等.连续肾脏替代疗法不同剂量选择治疗重症肺炎合并急性肾损伤[J].实用医学杂志,2018,34(21):3598-3602.
[2]丁利民,罗文峰,黄小梅,等.肾脏替代治疗在公民死亡器官捐献供肾移植中的临床效果[J].实用医学杂志,2018,34(8):1273-1277.
[3]LEE H F,LIN S C,LU C L,et al.Revised acute physiology and chronic health evaluation score as a predictor of neurosurgery intensive care unit readmission:a case-controlled study[J].J Crit Care,2010,25(2):294-299.
[4]COSTA E SILVA V T,DE CASTRO I,LIANO F,et al.Sequential evaluation of prognostic models in the early diagnosis of acute kidney injury in the intensive care unit[J].Kidney Int,2009,75(9):982-986.
[5]KNAUS W A,DRAPER E A,WAGNER D P,et al.APACHEII:a severity of disease classification system[J].Crit Care Med,1985,13(10):818-829.
[6]PARK M,VOS P,VLASKAMP B N,et al.The influence of APACHE II score on the average noise level in an intensive care unit:an observational study[J].BMC Anesthesiol,2015,15:42.
[7]罗运山,刘易林,邓霞梅,等.可溶性髓样细胞触发性受体-1清除率评估脓毒症休克患者预后的价值[J].实用医学杂志,2018,34(1):67-70.
[8]LEE H,LIM C W,HONG H P,et al.Efficacy of the APACHE II score at ICU discharge in predicting post-ICU mortality and ICU readmission in critically ill surgical patients[J].Anaesth Intensive Care,2015,43(2):175-186.
[9]HWANG S Y,LEE J H,LEE Y H,et al.Comparison of the sequential organ failure assessment,acute physiology and chronic health evaluation ii scoring system,and trauma and injury severity score method for predicting the outcomes of intensive care unit trauma patients[J].Am J Emerg Med,2012,30(5):749-753.
[10]CHUNG I S,PARK M,KO J S,et al.Which score system can best predict recipient outcomes after living donor liver transplantation?[J].Transplant Proc,2012,44(2):393-395.
[11]OKIN P M,KJELDSEN S E,JULIUS S,et al.All-cause and cardiovascular mortality in relation to changing heart rate during treatment of hypertensive patients with electrocardiographic left ventricular hypertrophy[J].Eur Heart J,2010,31(18):2271-2279.
[12]SWEDBERG K,KOMAJDA M,BOHM M,et al.Ivabradine and outcomes in chronic heart failure(SHIFT):a randomised placebo-controlled study[J].Lancet,2010,376(9744):875-885.
[13]HO J E,BITTNER V,DEMICCO D A,et al.Usefulness of heart rate at rest as a predictor of mortality,hospitalization for heart failure,myocardial infarction,and stroke in patients with stable coronary heart disease(Data from the Treating to New Targets[TNT]trial)[J].Am J Cardiol,2010,105(7):905-911.
[14]ABRAHAM W T,FONAROW G C,ALBERT N M,et al.Predictors of in-hospital mortality in patients hospitalized for heart failure:insights from the organized program to initiate lifesaving treatment in hospitalized patients with heart failure(OPTI-MIZE-HF)[J].J Am Coll Cardiol,2008,52(5):347-356.
[15]POCOCK S J,WANG D,PFEFFER M A,et al.Predictors of mortality and morbidity in patients with chronic heart failure[J].Eur Heart J,2006,27(1):65-75.
[16]HEIDLAND U E,STRAUER B E.Left ventricular muscle mass and elevated heart rate are associated with coronary plaque disruption[J].Circulation,2001,104(13):1477-1482.
[17]PEREL P,PRIETO-MERINO D,SHAKUR H,et al.Predicting early death in patients with traumatic bleeding:development and validation of prognostic model[J].BMJ,2012,345:e5166.
[18]HUDAK A M,CAESAR R R,FROL A B,et al.Functional outcome scales in traumatic brain injury:a comparison of the Glasgow Outcome Scale(Extended)and the Functional Status Examination[J].J Neurotrauma,2005,22(11):1319-1326.
[19]BALDI G,ALTOMONTE F,ALTOMONTE M,et al.Intracranial haemorrhage in patients on antithrombotics:clinical presentation and determinants of outcome in a prospective multicentric study in Italian emergency departments[J].Cerebrovasc Dis,2006,22(4):286-293.
[2]丁利民,罗文峰,黄小梅,等.肾脏替代治疗在公民死亡器官捐献供肾移植中的临床效果[J].实用医学杂志,2018,34(8):1273-1277.
[3]LEE H F,LIN S C,LU C L,et al.Revised acute physiology and chronic health evaluation score as a predictor of neurosurgery intensive care unit readmission:a case-controlled study[J].J Crit Care,2010,25(2):294-299.
[4]COSTA E SILVA V T,DE CASTRO I,LIANO F,et al.Sequential evaluation of prognostic models in the early diagnosis of acute kidney injury in the intensive care unit[J].Kidney Int,2009,75(9):982-986.
[5]KNAUS W A,DRAPER E A,WAGNER D P,et al.APACHEII:a severity of disease classification system[J].Crit Care Med,1985,13(10):818-829.
[6]PARK M,VOS P,VLASKAMP B N,et al.The influence of APACHE II score on the average noise level in an intensive care unit:an observational study[J].BMC Anesthesiol,2015,15:42.
[7]罗运山,刘易林,邓霞梅,等.可溶性髓样细胞触发性受体-1清除率评估脓毒症休克患者预后的价值[J].实用医学杂志,2018,34(1):67-70.
[8]LEE H,LIM C W,HONG H P,et al.Efficacy of the APACHE II score at ICU discharge in predicting post-ICU mortality and ICU readmission in critically ill surgical patients[J].Anaesth Intensive Care,2015,43(2):175-186.
[9]HWANG S Y,LEE J H,LEE Y H,et al.Comparison of the sequential organ failure assessment,acute physiology and chronic health evaluation ii scoring system,and trauma and injury severity score method for predicting the outcomes of intensive care unit trauma patients[J].Am J Emerg Med,2012,30(5):749-753.
[10]CHUNG I S,PARK M,KO J S,et al.Which score system can best predict recipient outcomes after living donor liver transplantation?[J].Transplant Proc,2012,44(2):393-395.
[11]OKIN P M,KJELDSEN S E,JULIUS S,et al.All-cause and cardiovascular mortality in relation to changing heart rate during treatment of hypertensive patients with electrocardiographic left ventricular hypertrophy[J].Eur Heart J,2010,31(18):2271-2279.
[12]SWEDBERG K,KOMAJDA M,BOHM M,et al.Ivabradine and outcomes in chronic heart failure(SHIFT):a randomised placebo-controlled study[J].Lancet,2010,376(9744):875-885.
[13]HO J E,BITTNER V,DEMICCO D A,et al.Usefulness of heart rate at rest as a predictor of mortality,hospitalization for heart failure,myocardial infarction,and stroke in patients with stable coronary heart disease(Data from the Treating to New Targets[TNT]trial)[J].Am J Cardiol,2010,105(7):905-911.
[14]ABRAHAM W T,FONAROW G C,ALBERT N M,et al.Predictors of in-hospital mortality in patients hospitalized for heart failure:insights from the organized program to initiate lifesaving treatment in hospitalized patients with heart failure(OPTI-MIZE-HF)[J].J Am Coll Cardiol,2008,52(5):347-356.
[15]POCOCK S J,WANG D,PFEFFER M A,et al.Predictors of mortality and morbidity in patients with chronic heart failure[J].Eur Heart J,2006,27(1):65-75.
[16]HEIDLAND U E,STRAUER B E.Left ventricular muscle mass and elevated heart rate are associated with coronary plaque disruption[J].Circulation,2001,104(13):1477-1482.
[17]PEREL P,PRIETO-MERINO D,SHAKUR H,et al.Predicting early death in patients with traumatic bleeding:development and validation of prognostic model[J].BMJ,2012,345:e5166.
[18]HUDAK A M,CAESAR R R,FROL A B,et al.Functional outcome scales in traumatic brain injury:a comparison of the Glasgow Outcome Scale(Extended)and the Functional Status Examination[J].J Neurotrauma,2005,22(11):1319-1326.
[19]BALDI G,ALTOMONTE F,ALTOMONTE M,et al.Intracranial haemorrhage in patients on antithrombotics:clinical presentation and determinants of outcome in a prospective multicentric study in Italian emergency departments[J].Cerebrovasc Dis,2006,22(4):286-293.