Comparison of Severity-of-Illness Scores in Critically Ill Obstetric Patients: A 6-Year Retrospective Cohort*
Comparison of Severity-of-Illness Scores in Critically Ill Obstetric Patients: A 6-Year Retrospective Cohort*
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DOI：
10.1097/ccm.0000000000000124
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发表时间：
2014-05-01
影响因子：
8.8
通讯作者：
Bourjeily, Ghada
中科院分区：
文献类型：
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作者：
Rojas-Suarez, Jose;Paternina-Caicedo, Angel J.;Bourjeily, Ghada
目的：本研究的目的是评估围产期妇女简化急性生理学评分 2、简化急性生理学评分 3、死亡概率模型 II 和死亡概率模型 III 对死亡率预测的判别和校准。设计：一项回顾性队列研究。地点：拉斐尔卡尔沃妇产医院，卡塔赫纳（哥伦比亚）的一家大型教学医院。患者：所有收治于该医院的产科患者2006 年至 2011 年 ICU。干预措施：无。测量和主要结果：纳入了 726 名产科重症监护患者。所有分数均显示出良好的辨别力（受试者工作特征曲线下面积 > 0.86）。简化急性生理学评分 2、简化急性生理学评分 3 和死亡率概率模型 III 不准确地估计死亡率。通过死亡率和 Hosmer-Lemeshow 检验显示出良好校准的唯一死亡率预测分数是死亡率概率模型 II。死亡概率模型 II 的死亡率为 0.88 (95% CI, 0.60-1.25)。 Hosmer-Lemeshow 检验不显着 (p = 0.571)。结论：简化急性生理学评分 2 和简化急性生理学评分 3 高估了产科重症监护患者的死亡率。死亡率概率模型 III 校准不充分。死亡率模型 II 非常适合预测发展中国家的死亡率。未来需要在发达国家和发展中国家进行研究来进一步证实我们的研究结果。
Objective:The purpose of this research was to evaluate the discrimination and calibration of mortality prediction of Simplified Acute Physiology Score 2, Simplified Acute Physiology Score 3, Mortality Probability Model II, and Mortality Probability Model III in peripartum women.Design:A retrospective cohort study.Setting:Rafael Calvo Maternity Hospital, a large teaching hospital in Cartagena (Colombia).Patients:All obstetric patients admitted to the ICU from 2006 to 2011.Interventions:None.Measurements and Main Results:Seven hundred twenty-six obstetric critical care patients were included. All scores showed good discrimination (area under the receiver operator characteristic curve > 0.86). Simplified Acute Physiology Score 2, Simplified Acute Physiology Score 3, and Mortality Probability Model III inaccurately estimated mortality. The only mortality prediction score that showed good calibration through mortality ratio and Hosmer-Lemeshow test was Mortality Probability Model II. Mortality ratio for Mortality Probability Model II was 0.88 (95% CI, 0.60-1.25). Hosmer-Lemeshow test was not significant (p = 0.571).Conclusions:Simplified Acute Physiology Score 2 and Simplified Acute Physiology Score 3 overestimate mortality in obstetric critical care patients. Mortality Probability Model III was inadequately calibrated. Mortality Probability Model II showed good fit to predict mortality in a developing country setting. Future studies in developed and developing countries are needed to further confirm our findings.