THE APACHE-III PROGNOSTIC SYSTEM - RISK PREDICTION OF HOSPITAL MORTALITY FOR CRITICALLY ILL HOSPITALIZED ADULTS
THE APACHE-III PROGNOSTIC SYSTEM - RISK PREDICTION OF HOSPITAL MORTALITY FOR CRITICALLY ILL HOSPITALIZED ADULTS
复制标题
DOI：
10.1378/chest.100.6.1619
复制
发表时间：
1991-12-01
期刊：
影响因子：
9.6
通讯作者：
HARRELL, FE
中科院分区：
文献类型：
--
作者：
KNAUS, WA;WAGNER, DP;HARRELL, FE
本研究的目的是完善 APACHE（急性生理学、年龄、慢性健康评估）方法，以便更准确地预测危重住院成人的医院死亡风险。我们前瞻性地收集了 40 家美国医院（14 家志愿三级护理机构和随机选择的 26 家医院代表全国重症监护服务）的 17,440 名未经选择的成人内科/外科重症监护病房 (ICU) 入院数据。我们分析了患者出院后存活的可能性与以下预测变量之间的关系：主要内科和外科疾病类别、急性生理异常、年龄、先前存在的功能限制、主要合并症以及入住 ICU 前的治疗地点。 APACHE III预后系统由两个选项组成：（1）APACHE III评分，可以为独立定义的患者组内的重症住院患者提供初步风险分层； (2) APACHE III 预测方程，使用 APACHE III 评分以及 ICU 入院前主要疾病类别和治疗地点的参考数据，为个别 ICU 患者的医院死亡率提供风险估计。 APACHE III 评分增加 5 分（范围，0 至 299）与 78 种主要内科和外科疾病类别中每一种的医院死亡相对风险（比值比，1.10 至 1.78）统计显着增加独立相关。第一天 APACHE III 方程的总体预测准确性是这样的：在 ICU 入院的 24 小时内，95% 的 ICU 入院患者可以得到院内死亡风险估计，与实际观察到的风险估计在 3% 以内（r2 = 0.41；接受者操作特征 = 0.90）。记录 ICU 治疗后每一天 APACHE III 评分的变化可以提供这些风险估计的每日更新。当应用于各个 ICU 时，第一天的 APACHE III 方程解释了观察到的死亡率的大部分变化（r2 = 0.90，p < 0.0001）。
The objective of this study was to refine the APACHE (Acute Physiology, Age, Chronic Health Evaluation) methodology in order to more accurately predict hospital mortality risk for critically ill hospitalized adults. We prospectively collected data on 17,440 unselected adult medical/surgical intensive care unit (ICU) admissions at 40 US hospitals (14 volunteer tertiary-care institutions and 26 hospitals randomly chosen to represent intensive care services nationwide). We analyzed the relationship between the patient's likelihood of surviving to hospital discharge and the following predictive variables: major medical and surgical disease categories, acute physiologic abnormalities, age, preexisting functional limitations, major comorbidities, and treatment location immediately prior to ICU admission. The APACHE III prognostic system consists of two options: (1) an APACHE III score, which can provide initial risk stratification for severely ill hospitalized patients within independently defined patient groups; and (2) an APACHE III predictive equation, which uses APACHE III score and reference data on major disease categories and treatment location immediately prior to ICU admission to provide risk estimates for hospital mortality for individual ICU patients. A five-point increase in APACHE III score (range, 0 to 299) is independently associated with a statistically significant increase in the relative risk of hospital death (odds ratio, 1.10 to 1.78) within each of 78 major medical and surgical disease categories. The overall predictive accuracy of the first-day APACHE III equation was such that, within 24 h of ICU admission, 95 percent of ICU admissions could be given a risk estimate for hospital death that was within 3 percent of that actually observed (r2 = 0.41; receiver operating characteristic = 0.90). Recording changes in the APACHE III score on each subsequent day of ICU therapy provided daily updates in these risk estimates. When applied across the individual ICUs, the first-day APACHE III equation accounted for the majority of variation in observed death rates (r2 = 0.90, p < 0.0001).