Performance of three prognostic models in patients with cancer in need of intensive care in a medical center in China.
Performance of three prognostic models in patients with cancer in need of intensive care in a medical center in China.
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在中国一个医疗中心需要重症监护的癌症患者中，三种预后模型的表现。
DOI：
10.1371/journal.pone.0131329
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发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
Sun K
中科院分区：
文献类型：
--
作者：
Xing X;Gao Y;Wang H;Huang C;Qu S;Zhang H;Wang H;Sun K
本研究的目的是评估急性生理学和慢性健康评估II(APACHE II)、简化急性生理学评分3(SAPS3)和急性生理学和慢性健康评估IV(APACHE IV)在中国单一医学中心重症监护病房(ICU)癌症患者中的应用情况。这是一项回溯性观察性队列研究，包括两年内连续的981名患者。住院死亡率为4.5%。3种模型预测住院死亡率的受试者工作特征曲线下面积(AUROC，95%可信区间)分别为0.948(0.914~0.982)、0.863(0.804~0.923)、0.873(0.813~0.934)。SAPS3、APACHE II和APACHE IV模型的Hosmer-Lemesow统计量的p值分别为0.759、0.900和0.878。然而，SAPS 3和APACHE IV低估了住院死亡率，标准化死亡率比(SMR)分别为1.5和1.17，而APACHE II高估了住院死亡率，SMR为0.72。进一步分析表明，无论是对于急诊外科和内科患者(AUROC为0.912比0.866和0.857)，还是对于预定手术患者(AUROC为0.945比0.834和0.851)，SAPS3的辨别力都好于APACHE II和APACHE IV。校准适用于所有模型(所有p>；0.05)，无论是预定手术患者还是急诊手术和内科患者。然而，就SMR而言，SAPS 3在预测急诊外科和内科患者以及定期手术患者的住院死亡率方面都是准确的，而APACHE IV和APACHE II则不是。在这一队列中，我们发现APACHE II、APACHE IV和SAPS 3模型在预测需要重症监护的癌症危重患者的住院死亡率方面具有良好的区分和校准能力。在这三个严重程度评分中，无论是在辨别力和校准能力方面，还是在标准化死亡率方面，SAPS 3都优于APACHE II和APACHE IV。
The aim of this study was to evaluate the performance of Acute Physiology and Chronic Health Evaluation II (APACHE II), Simplified Acute Physiology Score 3 (SAPS 3), and Acute Physiology and Chronic Health Evaluation IV (APACHE IV) in patients with cancer admitted to intensive care unit (ICU) in a single medical center in China. This is a retrospective observational cohort study including nine hundred and eighty one consecutive patients over a 2-year period. The hospital mortality rate was 4.5%. When all 981 patients were evaluated, the area under the receiver operating characteristic curve (AUROC, 95% Confidential Intervals) of the three models in predicting hospital mortality were 0.948 (0.914–0.982), 0.863 (0.804–0.923), and 0.873 (0.813–0.934) for SAPS 3, APACHE II and APACHE IV respectively. The p values of Hosmer-Lemeshow statistics for the models were 0.759, 0.900 and 0.878 for SAPS 3, APACHE II and APACHE IV respectively. However, SAPS 3 and APACHE IV underestimated the in-hospital mortality with standardized mortality ratio (SMR) of 1.5 and 1.17 respectively, while APACHE II overestimated the in-hospital mortality with SMR of 0.72. Further analysis showed that discrimination power was better with SAPS 3 than with APACHE II and APACHE IV whether for emergency surgical and medical patients (AUROC of 0.912 vs 0.866 and 0.857) or for scheduled surgical patients (AUROC of 0.945 vs 0.834 and 0.851). Calibration was good for all models (all p > 0.05) whether for scheduled surgical patients or emergency surgical and medical patients. However, in terms of SMR, SAPS 3 was both accurate in predicting the in-hospital mortality for emergency surgical and medical patients and for scheduled surgical patients, while APACHE IV and APACHE II were not. In this cohort, we found that APACHE II, APACHE IV and SAPS 3 models had good discrimination and calibration ability in predicting in-hospital mortality of critically ill patients with cancer in need of intensive care. Of these three severity scores, SAPS 3 was superior to APACHE II and APACHE IV, whether in terms of discrimination and calibration power, or standardized mortality ratios.
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影响因子：
3.7
作者：
Nassar, Antonio Paulo, Jr.;Mocelin, Amilcar Oshiro;Dias, Carlos Augusto
通讯作者：
Dias, Carlos Augusto
影响因子：
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作者：
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Peek, N.;Arts, D. G. T.;de Keizer, N. F.
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de Keizer, N. F.