A comparison of APACHE II and CPIS scores for the prediction of 30-day mortality in patients with ventilator-associated pneumonia
A comparison of APACHE II and CPIS scores for the prediction of 30-day mortality in patients with ventilator-associated pneumonia
复制标题
DOI：
10.1016/j.ijid.2014.11.005
复制
发表时间：
2015-01-01
影响因子：
8.4
通讯作者：
Ni, Song-Shi
中科院分区：
文献类型：
--
作者：
Zhou, Xiao-Yu;Ben, Su-Qin;Ni, Song-Shi
目的：本研究的目的是比较急性生理学和慢性健康评估II（APACHE II）评分和临床肺部感染评分（CPIS）对呼吸机相关性肺炎（VAP）患者30天死亡率的预测。方法：2010年1月1日至2014年1月1日采用单中心前瞻性队列研究设计。在诊断VAP当天进行APACHE II和CPIS评分。使用受试者工作特征（ROC）曲线和曲线下面积（AUC）测试辨别力。校准使用Hosmer-Lemeshow statistics.Results：135例VAP患者中，39例死亡，30天死亡率为28.9%。非幸存者的APACHE II和CPIS评分显著高于幸存者（23.1 +/- 4.8 vs. 16.7 +/- 4.6，p < 0.001; 6.8 +/- 1.3 vs. 6.2 +/- 1.3，p = 0.016）。APACHE II在预测VAP患者30天死亡率方面具有良好的区分度，AUC为0.808（95%置信区间（CI）为0.704-0.912，p < 0.001）。然而，CPIS评分对预测死亡率没有区分力，AUC为0.612（95% CI 0.485-0.739，p = 0.083）。Hosmer-Lemeshow统计量显示观察到的30天死亡率和APACHE II预期死亡率的拟合优度良好（卡方= 1.099，p = 0.785）。然而，CPIS预期的30天死亡率并不适合观察到的死亡率（卡方= 6.72，p = 0.004）。结论：这些数据表明，APACHE II是有用的预测VAP患者的30天死亡率，但CPIS没有很好的区分和校准预测死亡率。(C)2014作者由爱思唯尔有限公司代表国际传染病学会出版。
Objective: The aim of this study was to compare the Acute Physiology and Chronic Health Evaluation II (APACHE II) score and the Clinical Pulmonary Infection Score (CPIS) for the prediction of 30-day mortality in patients with ventilator-associated pneumonia (VAP).Methods: A single-center, prospective cohort study design was employed between January 1, 2010 and January 1, 2014. APACHE II and CPIS scores were determined on the day of VAP diagnosis. Discrimination was tested using receiver-operating characteristic (ROC) curves and the areas under the curve (AUC). Calibration was tested using the Hosmer-Lemeshow statistic.Results: Of 135 patients with VAP, 39 died; the 30-day mortality was 28.9%. APACHE II and CPIS scores were significantly higher in non-survivors compared to survivors (23.1 +/- 4.8 vs. 16.7 +/- 4.6, p < 0.001; 6.8 +/- 1.3 vs. 6.2 +/- 1.3, p = 0.016). APACHE II had excellent discrimination for predicting 30-day mortality in patients with VAP, with AUC 0.808 (95% confidence interval (CI) 0.704-0.912, p < 0.001). However, the CPIS score did not have discrimination power for predicting mortality, with AUC 0.612 (95% CI 0.485-0.739, p = 0.083). The Hosmer-Lemeshow statistic showed good goodness-of-fit for observed 30-day mortality and APACHE II expected mortality (Chi-square = 1.099, p = 0.785). However, CPIS expected 30-day mortality did not fit the observed mortality (Chi-square = 6.72, p = 0.004).Conclusions: These data suggest that APACHE II is useful for predicting 30-day mortality in patients with VAP, but that the CPIS does not have good discrimination and calibration for predicting mortality. (C) 2014 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.