Outcome prediction in intensive care: Results of a prospective, multicentre, Portuguese study
Outcome prediction in intensive care: Results of a prospective, multicentre, Portuguese study
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DOI：
10.1007/s001340050313
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发表时间：
1997-02-01
影响因子：
38.9
通讯作者：
Morais, P
中科院分区：
文献类型：
--
作者：
Moreno, R;Morais, P
目的：使用正式的统计评估，比较新简化急性生理学评分 (SAPS II) 和急性生理学和慢性健康评估 (APACHE) II 在独立数据库中的表现。设计：对一项多中心、前瞻性研究的数据库进行分析。地点：葡萄牙 19 个重症监护病房 (ICU)。患者：收集了 4 个月内连续入住 ICU 的 1094 名患者的数据。遵循最初的 SAPS II 和 APACHE II 标准，分析排除了年龄小于 18 岁的患者、再入院、急性心肌梗死、烧伤、冠状动脉搭桥手术后的术后患者以及在 ICU 住院时间少于 24 小时的患者。分析组包括 982 名患者。 干预措施：收集计算 SAPS II、APACHE II、治疗干预评分系统 (TISS)、简化 TISS、器官系统衰竭和基本人口统计所需的前 24 小时入院数据。记录出院时的生命状况。 测量和结果：在该队列中，SAPS II 的区分度优于 APACHE II（SAPS II：受试者工作特征曲线下面积 0.817，标准误差 0.015；APACHE II：0.787、0.015；p < 0.001）；然而，这两个模型的校准效果都很差，观察到的死亡率与预测的死亡率之间存在显着差异（Hosmer-Lemeshow 拟合优度检验 H 和 C，p < 0.001）。在分层分析中，本研究无法证明模型的不良表现与除病情最严重的患者外的特定患者亚组之间有任何明确的关联模式，这两种模型都高估了死亡率。结论：SAPS II 在这个独立数据库中的表现优于 APACHE II，但结果不允许使用它（至少在没有定制的情况下）来分析目标人群中 ICU 的护理质量或表现。
Objective: To compare the performance of the New Simplified Acute Physiology Score (SAPS II) and Acute Physiology and Chronic Health Evaluation (APACHE) II in an independent database, using formal statistical assessment.Design: Analysis of the database of a multicentre, prospective study.Setting: 19 intensive care units (ICUs) in Portugal.Patients: Data for 1094 patients consecutively admitted to the ICUs were collected over a period of 4 months. Following the original SAPS II and APACHE II criteria, the analysis excluded patients younger than 18 years of age, readmissions, acute myocardial infarction, burns, patients in the post-operative period after coronary artery bypass surgery, and patients with a length of stay in the ICU of less than 24 h. The group analysed comprised 982 patients.Interventions: Collection of the first 24 h admission data necessary for the calculation of SAPS II, APACHE II, Therapeutic Intervention Scoring System (TISS), Simplified TISS, organ system failure and basic demographic statistics. Vital status at discharge from the hospital was registered.Measurements and results: In this cohort, discrimination was better for SAPS II than for APACHE II (SAPS II: area under the receiver operating characteristic curve 0.817, standard error 0.015; APACHE II: 0.787, 0.015;p < 0.001); however, both models presented a poor calibration, with significant differences between observed and predicted mortality (Hosmer-Lemeshow goodness-of-fit tests H and C, p < 0.001). In a stratified analysis, this study was unable to demonstrate any definite pattern of association between the poor performance of the models and specific subgroups of patients except for the most severely ill patients, where both models overestimated mortality.Conclusions: SAPS II performed better than APACHE II in this independent database, but the results do not allow its use, at least without being customised, to analyse quality of care or performance among ICUs in the target population.