Serum osmolality and outcome in intensive care unit patients
Serum osmolality and outcome in intensive care unit patients
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DOI：
10.1111/j.1399-6576.2006.01096.x
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发表时间：
2006-09-01
影响因子：
2.1
通讯作者：
Gruendling, M.
中科院分区：
文献类型：
--
作者：
Holtfreter, B.;Bandt, C.;Gruendling, M.
背景资料：本研究的目的是比较16个常规的临床和实验室参数，急性生理和慢性健康状况评价（APACHE）和序贯器官衰竭评估（SOFA）评分的价值，在住院期间的患者入住综合重症监护室（ICU）的死亡率预测。方法：进行了一项回顾性观察性临床研究，在一所大学医院的15床ICU。观察到933例ICU停留时间> 24小时的连续患者（36.2%手术，29.1%医疗和34.7%创伤）。进行血液采样、患者监测和数据收集。主要结局是住院期间的死亡率。结果：933例患者中死亡233例，死亡率25.0%。一个实验室参数血清渗透压[曲线下面积（AUC）0.732]对死亡率具有预测值，其介于APACHE II（AUC 0.784）和SOFA（AUC 0.720）评分之间。当结果预测仅限于长期患者（ICU停留> 5天）时，血清渗透压（AUC 0.711）优于任一标准评分（APACHE AUC 0.655，SOFA AUC 0.636）。使用Logistic回归分析，临床参数，年龄和诊断组与mortality determined.Conclusions：血清渗透压升高，在ICU入院与危重患者的死亡风险增加。血清渗透压比评分系统更便宜，更快速。然而，需要进一步的研究来评估血清渗透压在不同患者人群中的预测价值。
Background: The aim of the present study was to compare 16 routine clinical and laboratory parameters, acute physiologic and chronic health evaluation (APACHE) and sequential organ failure assessment (SOFA) score for their value in predicting mortality during hospital stay in patients admitted to a general intensive care unit (ICU).Methods: A retrospective observational clinical study was carried out in a 15-bed ICU in a university hospital. Nine hundred and thirty-three consecutive patients with ICU stay > 24 h (36.2% surgical, 29.1% medical and 34.7% trauma) were observed. Blood sampling, patient surveillance and data collection were performed. The primary outcome was mortality in the hospital. We used receiver operating characteristic (ROC) analyses and logistic regression to compare the 16 relevant parameters, APACHE II and SOFA scores.Results: Two hundred and thirty-three out of the 933 patients died (mortality 25.0%). One laboratory parameter, serum osmolality [area under the curve (AUC) 0.732] had a predictive value for mortality which lay between that of APACHE II (AUC 0.784) and SOFA (AUC 0.720) scores. When outcome prediction was restricted to long-term patients (ICU stay > 5 days), serum osmolality (AUC 0.711) performed better than either of the standard scores (APACHE AUC 0.655, SOFA AUC 0.636). Using logistic regression analysis, the association of clinical parameters, age and diagnosis group with mortality was determined.Conclusions: Elevated serum osmolality at ICU admission is associated with an increased mortality risk in critically ill patients. Serum osmolality is cheaper and more rapid to determine than the scoring systems. However, further studies are needed to evaluate the predictive value of serum osmolality in different patient populations.