Evaluation of the Severity of Patients Admitted to ICU in Japan

本研究的目的是建立一个评分系统来评估日本ICU患者的严重程度。首先，我们采用了APACHE-II评分系统，该评分系统在国外已被广泛应用于评估ICU患者的严重程度和预测其后续预后。本研究的对象是我们icu收治的患者。采用APACEH-II评分系统评估其严重程度和预测死亡率。整体而言，APACHE-II评分与实际观察死亡率（OM）成比例相关，总体计算预测死亡率（PM）也与OM相符。然而，APACHE-II评分与OM之间以及PM与OM之间存在差异，特别是在脓毒症合并多器官衰竭（MOF）的患者中。脓毒症患者出现差异的原因认为，APACHE-II评分系统中没有对脓毒症患者常见的肝功能障碍进行评分，而肝功能障碍是脓毒症患者死亡的重要原因。接下来，我们修改了APACHE-II评分系统，设计了apache - liver评分系统（APACHE-H），该评分系统通过动脉血酮体比（AKBR）、渗透压间隙、凝血酶原时间和肝活素时间来评估肝功能。在MOF患者中，APACHE-H的准确性和预测能力优于APACHE-II。然而，由于添加的项目（如AKBR）并不总是容易检查，因此APACHE-H被认为有必要改进其简单性。综上所述，APACHE-II评分系统似乎是一个有用的指标来划分ICU患者的严重程度，除了一些亚组的患者，如脓毒症合并MOF。APACHE-H评分系统在评价MOF患者严重程度方面优于APACHE-II评分系统。

The purpose of this study is to establish a scoring system by which we can evaluate the severity of ICU patients in Japan.First, we used the APACHE-II scoring system which has been widely used in many foreign countries for evaluating the severity of ICU patients and for predicting their subsequent prognosis. The subjects of the study were patients admitted to our ICUs. Their severity and predicted mortality were evaluated by using the APACEH-II scoring system. As a whole, APACHE-II scores were proportionally correlated with actual observed mortality (OM), and the overall calculated predicted mortality (PM) also fit with the OM. However, discrepancies were found between the APACHE-II scores and the OM and between the PM and the OM especially in septic patients with multiple organ failure (MOF). The reason why the discrepancies were found in septic patients was considered that the APACHE-II scoring system does not have scores evaluating liver dysfunction which was frequently observed in septic patients and was an important cause of death of the patients.Next, we modified the APACHE-II scoring system and designed the APACHE-HEPATIC scoring system (APACHE-H), which included the scores to evaluate the liver function by using an arterial blood ketone body ratio (AKBR), an osmolality gap, a prothrombin time and a hepaplastin time. The accuracy and predictive power of the APACHE-H were superior to the APACHE-II in MOF patients. However, because the added items such as AKBR were not always easy to examine, the APACHE-H was considered necessary to be improved its simplicity.In conclusion, the APACHE-II scoring system seemed to be a useful index to classify the severity of ICU patients except for some subgroups of patients such as septic ones with MOF. The APACHE-H scoring system was superior to the APACHE-II for evaluating the severity of MOF patients.