APACHE II score validation in emergency abdominal surgery. A post hoc analysis of the InCare trial
APACHE II score validation in emergency abdominal surgery. A post hoc analysis of the InCare trial
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DOI：
10.1111/aas.13476
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发表时间：
2019-10-14
影响因子：
2.1
通讯作者：
Vester-Andersen, Morten
中科院分区：
文献类型：
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作者：
Hansted, Anna K.;Moller, Morten H.;Vester-Andersen, Morten
急诊腹部手术的病人有很高的发病率和死亡率。准确识别高危患者非常重要。急性生理学和慢性健康评估（APACHE）II评分需要在实施前在更大的异质性人群中进行验证。我们的目的是评估APACHE II评分在急诊腹部手术患者中的预测价值。此外，我们比较了APACHE II评分与美国麻醉医师协会（阿萨）的身体状况评分和Charlson Comorbance指数（CCI）。方法我们纳入了2010年10月至2012年11月期间接受急诊腹部手术筛选入组InCare试验的成人患者。APACHE II评分采用受试者工作特征曲线下面积（AUROC）统计。主要结局为30天死亡率。次要结局包括90天死亡率和入住重症监护室。结果共纳入885例患者。全因30天死亡率为5.0%，90天死亡率为8.9%，共有7.9%的患者入住重症监护室。APACHE II评分的AUROC（95%置信区间）为30天死亡率0.72（0.65-0.80），90天死亡率0.70（0.64-0.76），入住重症监护室0.65（0.59-0.71）。CCI在预测90天死亡率方面表现更好（P = 0.04）。阿萨评分和CCI的所有其他结果与APACHE II评分相当。结论APACHE Ⅱ评分对急诊腹部手术患者的死亡率有中等预测作用，对进入重症监护病房的预测作用较差。
Background Patients undergoing emergency abdominal surgery are at high risk of morbidity and mortality. Accurate identification of high-risk patients is important. The Acute Physiology and Chronic Health Evaluation (APACHE) II score needs to be validated in a larger heterogeneous population before implementation. We aimed to assess the predictive value of the APACHE II score in emergency abdominal surgical patients. Furthermore, we compared the APACHE II score with the American Society of Anesthesiologists (ASA) physical status score and the Charlson Comorbidity Index (CCI). Methods We included adult patients undergoing emergency abdominal surgery screened for enrolment in the InCare trial from October 2010 to November 2012. The APACHE II score was evaluated with area under the receiver operating characteristics curve (AUROC) statistics. The primary outcome was 30-day mortality. Secondary outcomes included 90-day mortality and admission to the intensive care unit. Results We included a total of 885 patients. All-cause 30-day mortality was 5.0%, 90-day mortality was 8.9%, and a total of 7.9% of the patients were admitted to the intensive care unit. The AUROC (95% confidence interval) of the APACHE II score was 0.72 (0.65-0.80) for 30-day mortality, 0.70 (0.64-0.76) for 90-day mortality and 0.65 (0.59-0.71) for admission to the intensive care unit. The CCI performed better in prediction of 90-day mortality (P = .04). All other results for the ASA score and CCI were comparable with the APACHE II score. Conclusion The APACHE II score predicted mortality moderately and admission to intensive care unit poorly in emergency abdominal surgical patients.