Validation of the modified multisystem organ failure score as a predictor of mortality in patients with AIDS-related Pneumocystis carinii pneumonia and respiratory failure.
Validation of the modified multisystem organ failure score as a predictor of mortality in patients with AIDS-related Pneumocystis carinii pneumonia and respiratory failure.
复制标题
验证修改后的多系统器官衰竭评分作为艾滋病相关卡氏肺孢子虫肺炎和呼吸衰竭患者死亡率的预测因子。
DOI：
10.1378/chest.114.1.199
复制
发表时间：
1998
期刊：
影响因子：
9.6
通讯作者：
J. Montaner
中科院分区：
文献类型：
--
作者：
D. Forrest;O. Djurdjev;C. Zala;J. Singer;L. Lawson;J. Russell;J. Montaner
研究目的
验证先前开发的多系统器官衰竭（MSOF）评分（添加和不添加乳酸脱氢酶（LDH）水平）作为艾滋病相关卡氏肺孢子虫肺炎（PCP）和急性呼吸衰竭（ARF）患者出院时生存率的预测因子。
设计
1991年4月1日至1996年9月30日期间的回顾性病历审查。
设置
加拿大不列颠哥伦比亚省温哥华市中心的大学附属三级护理中心。
患者
所有PCP相关ARF患者在研究期间入住圣保罗医院ICU。
干预措施
作为假定的预后工具，在进入ICU时提取关于APACHE II（急性生理学和慢性健康评价II）、急性肺损伤（ALI）、AIDS和改良MSOF评分以及LDH水平的数据。根据LDH水平< or >≥ 2，000 U/L对患者进行分层，并在将该阈值与上述每个评分相加时评估其结局的可预测性。对于APACHE II，将评分分为6组，并在纳入和不纳入LDH的情况下进行评价。为LDH和有和没有LDH水平的每个评分构建受试者工作特征曲线，以评估预测的准确性。计算并比较每条曲线下的面积，以估计观察到的差异的统计学显著性。
测量和结果
38例患者中有40例入住ICU，死亡率为52.5%。ALI和AIDS评分不能预测预后。改良的MSOF和APACHE II评分是生存率的重要预测因子，LDH的加入增强了两者的表现。
结论
在研究的患者人群中，APACHE II和改良的MSOF评分都是显著的预后预测因子。这些结果验证了改良的MSOF评分作为发展为ARF的艾滋病相关PCP患者出院生存率的有效预测因子，并且通过添加LDH水平增强了评分的性能。
STUDY OBJECTIVES
To validate a previously developed multisystem organ failure (MSOF) score with and without the addition of the lactate dehydrogenase (LDH) level as a predictor of survival to hospital discharge in patients with AIDS-related Pneumocystis carinii pneumonia (PCP) and acute respiratory failure (ARF).
DESIGN
Retrospective chart review between April 1, 1991, and September 30, 1996.
SETTING
University-affiliated tertiary care center in downtown Vancouver, British Columbia, Canada.
PATIENTS
All patients with PCP-related ARF admitted to the ICU of St. Paul's Hospital during the study period.
INTERVENTIONS
As putative prognostic instruments, data were extracted regarding the APACHE II (acute physiology and chronic health evaluation II), acute lung injury (ALI), AIDS, and modified MSOF scores, as well as LDH levels, at entry to the ICU. Patients were stratified based on an LDH level of < or > or = 2,000 U/L and this threshold was assessed in its predictability of outcome when added to each of the above scores. For APACHE II, the score was categorized in six groups and evaluated with and without inclusion of the LDH. Receiver operating characteristic curves were constructed for LDH and for each score with and without the LDH level to assess accuracy of prediction. The area under each curve was calculated and compared to estimate the statistical significance of observed differences.
MEASUREMENTS AND RESULTS
There were 40 admissions to the ICU of 38 patients with 52.5% mortality. The ALI and AIDS scores were not predictive of outcome. The modified MSOF and APACHE II scores were significant predictors of survival and the performance of both was enhanced by the addition of LDH.
CONCLUSIONS
Both the APACHE II and the modified MSOF scores were significant predictors of outcome in the patient population studied. These results validate the modified MSOF score as an effective predictor of survival to hospital discharge among patients with AIDS-related PCP who develop ARF and the performance of the score is enhanced by the addition of the LDH level.
影响因子：
9.6
作者：
HEBERT, PC;DRUMMOND, AJ;RUSSELL, JA
通讯作者：
RUSSELL, JA