Mortality predictions using current physiologic scoring systems in patients meeting criteria for early goal-directed therapy and the severe sepsis resuscitation bundle
Mortality predictions using current physiologic scoring systems in patients meeting criteria for early goal-directed therapy and the severe sepsis resuscitation bundle
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DOI：
10.1097/shk.0b013e3181673826
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发表时间：
2008-07-01
期刊：
影响因子：
3.1
通讯作者：
Corbett, Stephen W.
中科院分区：
文献类型：
--
作者：
Nguyen, H. Bryant;Banta, Jim E.;Corbett, Stephen W.
生理评分系统常用于预测危重病人的死亡率。本研究考察了急性生理和慢性健康评估（APACHE） II、简化急性生理评分（SAPS） II、急诊科脓毒症死亡率（MEDS）和死亡率概率模型（MPM） II0在预测急诊科满足早期目标导向治疗和严重脓毒症复苏包标准的患者住院死亡率方面的表现。对APACHE II、SAPS II、MEDS评分和MPM II0的鉴别和校准特性进行了评价。数据以中位数和四分位数表示（25、75）。对246例年龄为68岁（52,81）岁的患者进行了前瞻性脓毒症登记分析，其中76.0%的患者发生脓毒症休克，45.5%的患者血培养阳性，35.0%的患者住院死亡率。急性生理和慢性健康评估II、SAPS II和MEDS评分分别为29（21,37）、54（40,70）和13(11,16)，预测死亡率分别为64%（40%,85%）、58%（25%,84%）和16%（9%,39%）。死亡率概率模型II0显示预测死亡率为60%（27%,80%）。APACHEⅱ组、SAPSⅱ组、MEDS组和MPMⅱ组的受试者工作特征曲线下面积分别为0.73、0.71、0.60和0.72。标准化死亡率分别为0.59、0.63、1.68和0.64。因此，APACHE II、SAPS II、MEDS评分和MPM II0在早期鉴别和估计急诊科需要重症脓毒症复苏包的患者的住院死亡率方面具有不同的能力。在这种情况下采用这些预测工具可能会影响这些患者的治疗和资源使用。
Physiologic scoring systems are often used to prognosticate mortality in critically ill patients. This study examined the performance of Acute Physiology and Chronic Health Evaluation (APACHE) II, Simplified Acute Physiology Score (SAPS) II, Mortality in Emergency Department Sepsis (MEDS), and Mortality Probability Models (MPM) II0 in predicting in-hospital mortality of patients in the emergency department meeting criteria for early goal-directed therapy and the severe sepsis resuscitation bundle. The discrimination and calibration characteristics of APACHE II, SAPS II, MEDS, and MPM II0 were evaluated. Data are presented as median and quartiles (25th, 75th). Two-hundred forty-six patients aged 68 (52, 81) years were analyzed from a prospectively maintained sepsis registry, with 76.0% of patients in septic shock, 45.5% blood culture positive, and 35.0% in-hospital mortality. Acute Physiology and Chronic Health Evaluation II, SAPS II, and MEDS scores were 29 (21, 37), 54 (40, 70), and 13 (11, 16), with predicted mortalities of 64% (40%, 85%'), 58% (25%, 84%), and 16% (9%, 39%), respectively. Mortality Probability Models II0 showed a predicted mortality of 60% (27%, 80%). The area under the receiver operating characteristic curves was 0.73 for APACHE II, 0.71 for SAPS II, 0.60 for MEDS, and 0.72 for MPM II0. The standardized mortality ratios were 0.59, 0.63, 1.68, and 0.64, respectively. Thus, APACHE II, SAPS II, MEDS, and MPM II0 have variable abilities to discriminate early and estimate in-hospital mortality of patients presenting to the emergency department requiring the severe sepsis resuscitation bundle. Adoption of these prognostication tools in this setting may influence therapy and resource use for these patients.