论文部分内容阅读
目的比较多器官功能障碍综合征(MODS)诊断标准、病情严重度评分及预后评估系统(简称MODS诊断草案)与急性生理和慢性健康评分Ⅱ(APACHEⅡ)系统对MODS患者住院病死率的预测力。方法前瞻性搜集725例MODS患者的临床和实验室数据,应用MODS诊断草案判定该组患者器官系统功能状态并计算相应的MODS总分,另外计算该组患者的APACHEⅡ评分分值,应用受试者工作特征(ROC)曲线比较二者对MODS患者住院病死率的预测能力。结果总的住院病死率58．2%,ICU病死率55．3%。住院天数的中位数16 d,住ICU天数的中位数8 d。APACHEⅡ分值7～50分,中位数22分。725例MODS患者严重度评分分值为1～25分,平均9．7分,中位数9．0分。按照MODS诊断草案判断出障碍器官系统的数目与住院病死率、本草案病情严重度分值和APACHEⅡ分值呈正相关。上述三者均随着障碍器官数目的增加而升高,且差异有统计学意义。在预测住院病死率方面,MODS诊断草案总分ROC曲线下面积为0．720,标准误(SE)为0．019,P值为0．000,95%可信限为0．683～0．757；APACHEⅡROC曲线下面积为0．746,SE为0．018,P值为0．000,95%可信限为0．710～0．782。结论本课题组所建立的MODS诊断草案在预测MODS患者的住院转归方面(死亡或生存)有较好的辨别力。
Objective To compare the predictive value of multiple organ dysfunction syndrome (MODS) criteria, severity of illness score and prognosis evaluation system (MODS diagnosis draft) and acute physiology and chronic health score Ⅱ (APACHE Ⅱ) system in hospital mortality of MODS patients. Methods The clinical and laboratory data of 725 patients with MODS were prospectively collected. The MODS diagnosis was used to determine the functional status of organ system and to calculate the corresponding MODS score. In addition, the APACHEⅡscore score of the patients was calculated. (ROC) curve to compare their predictive ability of inpatient mortality in MODS patients. Results The total in-hospital mortality rate was 58.2% and the ICU mortality rate was 55.3%. The median length of hospital stay was 16 days and the median number of ICU days was 8 days. APACHE II score 7 to 50 points, the median 22 points. The severity score of 725 MODS patients was 1 to 25, with an average of 9.7 and a median of 9.0. In accordance with the MODS diagnostic draft to determine the number of obstructive organ systems and in-hospital mortality, the draft disease severity score and APACHE II score was positively correlated. All of the above three increased with the number of obstructive organs, and the difference was statistically significant. In predicting the in-hospital mortality rate, the area under the ROC curve for the MODS diagnosis draft was 0.720, the standard error (SE) was 0.019, the P value was 0.000, and the 95% confidence interval was 0.683-0. 757; APACHE IIROC area under the curve is 0.746, SE is 0.018, P value is 0.000, 95% confidence limits 0.710 ~ 0.782. Conclusion The DRS MODS established by our group have a good discriminating ability in predicting the hospitalization of patients with MODS (death or survival).