四种评分系统对呼吸重症监护室病人预后评估的比较

目的　研究APACHEⅢ、SAPSⅡ、MPMⅡ 0和APACHEⅡ评分系统对呼吸重症监护室病人预后评估中的适用性和可行性 ,同时比较其优劣。方法　回顾性分析 2 16例呼吸重症监护室病人临床资料 ,进行APACHEⅢ、SAPSⅡ和APACHEⅡ评分 ,计算SAPSⅡ、APACHEⅡ和MPMⅡ 0的预计病死危险度。比较由SAPSⅡ、APACHEⅡ和MPMⅡ 0计算的病人院内病死概率和病人实际病死率之间的差异 ;同时用Hosmer-Lemeshow拟合优度检验和ROC曲线比较APACHEⅢ、SAPSⅡ和APACHEⅡ评分之间校准度和精确度的差异。结果　 2 16例病人中死亡 77例 ,存活 139例 ,实际病死率 35 6 5 %。死亡组与存活组病人的APACHEⅡ、APACHEⅢ及SAPSⅡ评分在存活组与死亡组之间差异均有统计学意义 (P <0 0 5 )。APACHEⅡ、APACHEⅢ和SAPSⅡ的AUROCC分别为 0 74 4、0 74 1和 0 75 4 ,APACHEⅡ -PHM与实际病死率无显著性差异 (P >0 0 5 ) ,而SAPSⅡ -PHM和MPMⅡ 0与实际病死率有显著性差异 (P <0 0 5 )。结论　各种病情评价系统均可用于评价呼吸重症监护室病人的预后 ,4种病情评价系统中以APACHEⅡ最适于RICU病人。     

急诊脓毒症病死率评分在急诊脓毒症患者中的应用

目的 验证急诊脓毒症病死率评分(mortality in emergency department sepsis score,MEDS)对于急诊脓毒症患者病情评估的应用价值,并将其对患者28 d病死率的预测效果进行比较。方法 对2009年9月至2010年9月首都医科大学附属北京朝阳医院急诊抢救室救治的613例脓毒症患者进行前瞻性研究。记录患者的证急诊脓毒症病死率评分(MEDS)、急性生理学与慢性健康情况评价系统Ⅱ（acute physiology and chronic health evaluation,APACHEⅡ）、简化急性生理学评分Ⅱ（simplified acute physiology score,SAPSⅡ）和改良早期预警评分(modified early warning score,MEWS)。随访28 d转归。根据患者MEDS评分分值将死亡风险分级：极低危险组(0 ～4分)、低度危险组（5～7分）、中度危险组（8～12分）、高度危险组（13 ～ 15分）、极高危险组（大于15分）,各组间实际病死率采用X2检验比较。再对生存组和死亡组进行比较,通过logistic 回归分析确定预测死亡的独立因素,应用受试者工作特征曲线（ROC曲线）比较MEDS与APACHEⅡ,SAPSⅡ和MEWS评分对预后的预测能力。结果 失访10例,完整记录603例。MEDS评分患者各组实际病死率分别为0％,7.7％,18.5％,46.7％,63％,各组间实际病死率有显著区别。生存组（440例）与死亡组（163例）之间年龄和四种评分差异均具有统计学意义(P＜0.01)。MEDS,APACHEⅡ,SAPSⅡ、MEWS评分均是预测死亡的独立因素,ROC曲线下的面积(AUC)分别为0.767,0.743,0.741和0.636。结论 MEDS评分可以对脓毒症患者死亡风险进行分级,在患者28 d病死率方面有较好的预测能力,适用于急诊脓毒症患者。     

血小板计数和APACHEⅡ评分对脓毒症预后的影响

目的 探讨血小板计数、急性生理和慢性健康状况评分Ⅱ (APACHEⅡ)在评定和预测脓毒症中的意义.方法 对151例脓毒症患者于入院第1天进行血小板计数测定和APACHEⅡ评分,并按APACHEⅡ评分分为A组(＜15分)、B组(15~20分)、C组(＞20分),分析各组患者的血小板计数和预后.根据预后分为生存组和死亡组,比较两组血小板计数和APACHEⅡ评分.结果 A组血小板计数明显高于B、C组(P<0.01),B组明显高于C组(P<0.01).A组死亡率明显低于B、C组(P<0.05),B组明显低于C组(P<0.05).生存组APACHEⅡ评分明显低于死亡组(P<0.01),血小板计数明显高于死亡组(P<0.01).结论 血小板计数和APACHEⅡ评分能准确反映脓毒症患者的病情和预后.     

APACHEⅡ与SAPSⅡ评分系统对急诊内科危重患者病情评估价值的比较

目的评价急性生理与慢性健康状况评分Ⅱ(APACHEⅡ)评分系统和简化急性生理学评分Ⅱ(SAPSⅡ)评分系统在急诊内科危重患者病情评估中的适用性和可行性;比较二者评价效力的优劣.方法对207例急诊内科危重患者分别进行APACHEⅡ、SAPSⅡ评分和计算预计死亡危险度,以校准度及分辨度评价其预测效力.结果存活组(178例)与死亡组(29例)之间的APACHEⅡ和SAPSⅡ分值差异有统计学意义(P<0.01),死亡组患者分值[(22.66±7.30)分,(52.48±11.59)分]明显高于存活组患者[(11.26±6.32)分,(33.12±11.67)分].随着分值增加,病死率也增加.APACHEⅡ的预计死亡危险度(18.81%)与实际病死率(14.01%)之间差异无统计学意义(P>0.05),即APACHEⅡ能准确预测病死率.而SAPSⅡ则不能,SAPSⅡ的预计死亡危险度(23.51%)高于实际病死率(P<0.05).APACHEⅡ和SAPSⅡ都有较大的ROC曲线下面积(>0.85),其分辨度好,能较好区分可能死亡的患者和可能存活的患者.结论APACHEⅡ和SAPSⅡ评分系统均有较好的分辨度;APACHEⅡ的校准度优于SAPSⅡ.临床上对急诊内科危重患者病情的评价及预测预后宜以APACHEⅡ为首选.     

脓毒症患者血清降钙素原水平与APACHE Ⅱ评分相关性的临床研究

目的 观察脓毒症患者血清降钙素原(PCT)作为判断脓毒血症的发展和预后在临床中的价值及其与急性生理和慢性健康状况(APACHE Ⅱ)评分之间的相关性.方法 脓毒症患者56例,入ICU后给予重症监护治疗(包括病因治疗,充分的液体复苏,抗生素治疗,呼吸机治疗等).于入ICU后24 h内进行APACHE Ⅱ评分,同时采集入ICU治疗前及入ICU后1、3、5、7、10d各时点的静脉血(死亡患者记录到死亡前),检测PCT.追踪患者的转归,并根据28d病死率将患者分为存活组与死亡组.结果 随着治疗的进程,患者PCT水平逐渐下降,从治疗第3天[存活组/死亡组:(2.98±0.48)μg/L/(4.98±0.66)μg/L]开始,与入ICU时[存活组/死亡组:(4.04±0.50)μg/L/(6.02±0.50)μg/L]相比有明显下降(均P<0.05).存活组PCT随病情好转迅速下降,至病程第10天,PCT已基本恢复至正常水平[(0.48 ±0.18)μg/L],而死亡组虽有下降趋势,仍持续高于正常水平[(4.04±0.45)μg/L].APACHE Ⅱ评分死亡组显著高于存活组(死亡组/存活组:25.86±8.73/12.07±6.20)(P<0.05).PCT与APACHEⅡ评分的相关系数是0.656(P<0.05).结论 PCT作为单一的血清学指标,具有简便、快速的特点,而APACHE Ⅱ评分与其具有较强的相关性.结合PCT与APACHE Ⅱ评分综合分析,对脓毒血症的诊断、治疗效果及预后的判断具有很好的临床实用性.     

危重病评分系统对急诊内科危重病人预后预测的对比研究

目的 研究危重病评分系统对急诊内科危重病人预后预测的对比结果.方法 选取2005年10月～2006年8月的急诊内科危重病人103例,应用APACHEI Ⅱ、APACHE Ⅲ、SAPS Ⅱ、MPM0、MPM 24评分系统计算入急诊抢救室当时及24 h最差值时分值及预测病死率,分析比较入急诊抢救室当时及24 h最差值时对预测预后的差异有无统计学意义.结果 各种评分系统在入院当时及24 h最差值时取值对预后预测均无明显差异(P＞0.05).各种评分系统的分值和预计死亡率在存活组和死亡组之间差异显著,且入院时分数越高,病情越重,死亡率越高.结论 各种评分系统均可用于预测急诊内科危重病人的预后.选取入院当时的参数进行评分,对预测预后无明显影响,但仍以入院时APACHE Ⅱ评分系统为首选.     

重症监护护理评分与急性生理和慢性健康状况评分配置ICU护理资源效果的比较

目的比较重症监护护理评分系统（ICNSS）与急性生理和慢性健康状况（APACHE11）评分在ICU护理资源配置中的应用价值。方法将108例ICU患者随机分为观察组（n=55）和对照组（n=53）。观察组应用ICNSS评分量表计算ICU护理工作量并进行人力资源的配置。对照组依据APACHEⅡ评分结果配置护理资源。观察组住ICU时间、医疗费用、住ICU期间并发症的发生率以及护士对护理资源配置和患者／家属对护理工作的满意度。结果观察组住ICU时间（4．6±2．9）d、医疗费用（15678．2±6115．3）元、住ICU期间并发症的发生率7．3％,均低于对照组,差异有统计学意义（P〈0．05）;护士对护理资源配置以及患者／家属对护理工作的满意度高于对照组（P〈0．05）。结论应用ICNSS配置护理人力资源比基于APACHEⅡ评分的护理资源配置模式能更有效提高护理质量以及护士和患者／家属的满意度。     

重症监护室患者的焦虑状况与急性生理和慢性健康状况评估Ⅱ评分的相关性

目的:探讨重症监护室(ICU)患者的焦虑状况与急性生理和慢性健康状况评估(APACHE)Ⅱ评分的相关性。方法:纳入ICU患者150例,采用医院焦虑抑郁量表(HADS)对患者进行测评。分别根据性别、年龄、住院费用报销方式、病房类型、是否机械通气及APACHEⅡ评分分组,比较不同组别患者的HADS评分,并分析HADS焦虑总分与APACHEⅡ评分的相关性。结果:性别、年龄、报销方式、机械通气、APACHEⅡ评分均与患者焦虑状态有关,APACHEⅡ评分与ICU患者焦虑程度成正相关。结论:ICU患者焦虑情绪与多因素有关,其焦虑情绪可以加重患者病情及影响患者预后。     

碱剩余早期动态变化与严重脓毒症和脓毒症休克患者预后的关系

目的 探讨碱剩余早期动态变化对严重脓毒症和脓毒症休克患者预后的早期评估作用.方法 采用回顾性分析方法,记录严重脓毒症和脓毒症休克患者入院后碱剩余及急性生理和慢性健康状况评分Ⅲ(APACHEⅢ),分析碱剩余与APACHEⅢ 评分及脓毒症预后的关系,并比较不同碱剩余组预后的情况.结果 死亡组和存活组碱剩余值及早期变化趋势明显不同(P＜0.05,P＜0.01),不同碱剩余组间预后比较差异有统计学意义(P＜0.05,P＜0.01),碱剩余与APACHEⅢ评分间有较好的一致性.早期碱剩余越高,预后越好,治疗后碱剩余恢复较快组预后良好.结论 碱剩余是评估严重脓毒症和脓毒症休克严重性及预后较好的指标,其应用价值可与APACHEⅢ评分媲美,而且两者联合预测效果更好.     

Elevated plasma levels of heparin-binding protein in intensive care unit patients with severe sepsis and septic shock

ABSTRACT: INTRODUCTION: Rapid detection of, and optimized treatment for, severe sepsis and septic shock is crucial for successful outcome. Heparin-binding protein (HBP), a potent inducer of increased vascular permeability, is a potentially useful biomarker for predicting outcome in patients with severe infections. Our aim was to study the systemic release and dynamics of HBP in the plasma of patients with severe sepsis and septic shock in the ICU. METHODS: A prospective study was conducted of two patient cohorts treated in the ICU at Karolinska University Hospital Huddinge in Sweden. A total of 179 patients was included, of whom 151 had sepsis (126 with septic shock and 25 patients with severe sepsis) and 28 a non-septic critical condition. Blood samples were collected at five time points during six days after admission. RESULTS: HBP levels were significantly higher in the sepsis group as compared to the control group. At admission to the ICU, a plasma HBP concentration of ≥15 ng/mL and/or a HBP (ng/mL)/white blood cell count (109/L) ratio of >2 was found in 87.2% and 50.0% of critically ill patients with sepsis and non-septic illness, respectively. A lactate level of >2.5 mmol/L was detected in 64.9% and 56.0% of the same patient groups. Both in the sepsis group (n = 151) and in the whole group (n = 179), plasma HBP concentrations at admission and in the last measured sample within the 144 hour study period were significantly higher among 28-day non-survivors as compared to survivors and in the sepsis group, an elevated HBP-level at baseline was associated with an increased case-fatality rate at 28 days. CONCLUSIONS: Plasma HBP levels were significantly higher in patients with severe sepsis or septic shock compared to patients with a non-septic illness in the ICU. HBP was associated with severity of disease and an elevated HBP at admission was associated with an increased risk of death. HBP that rises over time may identify patients with a deteriorating prognosis. Thus, repeated HBP measurement in the ICU may help monitor treatment and predict outcome in patients with severe infections.     

Prevalence and incidence of severe sepsis in Dutch intensive care units

Introduction  

Severe sepsis is a dreaded consequence of infection and necessitates intensive care treatment. Severe sepsis has a profound impact on mortality and on hospital costs, but recent incidence data from The Netherlands are not available. The purpose of the present study was to determine the prevalence and incidence of severe sepsis occurring during the first 24 hours of admission in Dutch intensive care units (ICUs).     

Open the intensive care unit doors to HIV-infected patients with sepsis

Severe sepsis is more and more frequent, especially because of an increased rate of immunocompromised patients. Despite the improvement in the overall prognosis of HIV/AIDS patients and the improvement of global ICU care, the prognosis of HIV/ADS patients hospitalized in ICU with severe sepsis remained poor. This situation is partly due to the increased proportion of HIV/AIDS patients with limited access to health care and to a reluctance of ICU physicians in admitting HIV infected patients. However, medical literature suggests that ICU prognosis of immunocompromised (especially cancer) patients should be largely improved by early ICU admission and by an early institution of supportive techniques. This strategy should be used in HIV/AIDS patients with severe sepsis.     

SAPS 3-PIRO与其他评分方法对严重脓毒症患者28天预后的比较

目的 探求SAPS 3-PIRO评分方法对急诊ICU严重脓毒症患者预后评价的适用性.方法 对2008年1月至2011年12月,在首都医科大学附属北京朝阳医院急诊ICU救治的677例脓毒症患者进行回顾性研究.患者入选标准:年龄≥18岁,在急诊ICU存活时间≥24 h,符合2001年华盛顿“国际脓毒症定义会议”推荐的严重脓毒症诊断标准、脏器损伤标准,亦参照该会议制定的标准,不符合上述入选标准的予以排除.在入选时间段内重复在ICU治疗的患者取第一次入院的数据.收集所有入选病例的姓名、年龄、性别、既往病史.第1天生命体征、血常规、血气、生化、凝血四项、尿量.根据24 h内最差的数据进行APACHEⅡ、SOFA、SAPSⅢ、SAPS-3PIRO、MEDS评分.以患者28 d转归情况为终点,记录存活和死亡例数.使用SPSS 13.0统计软件分析数据,正态分布的计量资料均采用均数±标准差(-x±s)表示.生存组与死亡组间,正态分布、方差齐的计量资料采用独立样本f检验,方差不齐采用t'检验,计数资料采用x2检验.按患者死亡或生存,进行二分类Logistic回归分析,建立回归方程;采用受试者工作特征曲线(ROC曲线)评价评分系统,对预后的判定能力并确定预后的界值,ROC曲线下面积(AUG)比较用Z检验.以P＜0.05为差异具有统计学意义.结果 APACHEⅡ、SOFA、SAPSⅢ、SAPS 3-PIRO和MEDS评分,是入选严重脓毒症患者28 d死亡的独立预测因素.通过SAPS 3-PIRO、APACHEⅡ、SOFA、SAPSⅢ和MEDS评分的ROC曲线及AUC比较:SAPS 3-PIRO评分与APACHEⅡ、SOFA和SAPSⅢ评分,预测预后的能力相当,MEDS评分预测预后的能力优于SAPS 3-PIRO、APACHEⅡ、SOFA和SAPSⅢ评分.结论 (1) MEDS评分预测预后的能力优于SAPS 3-PIRO、APACHEⅡ、SOFA和SAPSⅢ评分,MEDS具有良好的预测28 d死亡的能力,MEDS≥11分是此类患者病死率增加的标志.(2) SAPS 3-PIRO与APACHEⅡ、SOFA和SAPSⅢ评分预测能力相当,也可用于对急诊ICU严重脓毒症患者的预后进行预测.     

Sagittal abdominal diameter may effectively predict future complications and increased mortality in intensive care unit patients with severe sepsis

Purpose

To investigate whether increased visceral adipose tissue is a risk factor for increased morbidity and mortality in intensive care patients with severe sepsis.

Materials and Methods

In this prospective cohort study, body mass index (BMI) and sagittal abdominal diameter (SAD) were measured in all patients with severe sepsis immediately after admission in the intensive care unit (ICU). The patients were followed up until death or discharge from ICU. The study’s primary outcome measure was mortality until day 60 after admission, while secondary outcomes were morbidity, length of stay, and length of ventilation in ICU.

Results

Of the 30 patients, 24 (80%) developed septic shock, 6 (20%) multiple organ dysfunction syndrome, 13 (43.3%) necessitated continuous venovenous hemodiafiltration, while 6 (20%) of them died. BMI and SAD had a statistically significant positive linear correlation with ICU length of stay (P < .001) and length of ventilation (P ≤ .001). However, only SAD was significantly correlated with the development of multiple organ dysfunction syndrome (P = .033), the need for continuous venovenous hemodiafiltration (P = .004), and death (P = .033).

Conclusion

An increased SAD may effectively predict future complications and increased mortality in intensive care unit patients with severe sepsis.     

Long-term mortality and medical care charges in patients with severe sepsis

OBJECTIVE: To estimate long-term mortality and medical care charges among patients with severe sepsis. DESIGN: Retrospective cohort study. SETTING: Large, integrated, geographically diverse, U.S. health-insurance claims database covering three million lives annually. PATIENTS: All persons with bacterial or fungal infections and acute organ dysfunction (severe sepsis) who were hospitalized between January 1, 1991, and August 31, 2000. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: All patients were followed from the date of hospitalization with severe sepsis (index admission) to August 31, 2000, disenrollment from the health plan, or death, whichever occurred first. Measures of interest included mortality and medical care charges and were estimated for the index admission, the 90- and 180-day periods following the index admission, and annually thereafter (up to 5 yrs), using techniques of survival analysis. A total of 16,019 patients were identified who met study entrance criteria. Most patients (81.2%) were >/=65 yrs of age; 53.4% were men. Mortality was 21.2% for the index admission, 51.4% at 1 yr, and 74.2% at 5 yrs. Mean cumulative total medical care charges were 44,600 US dollars for the index admission, 78,500 US dollars at 1 yr, and 118,800 US dollars at 5 yrs. Hospitalization accounted for the largest component of total medical care charges. CONCLUSIONS: Mortality and economic costs are high in patients with severe sepsis, during the period of acute illness as well as subsequently.     

Adult-population incidence of severe sepsis in Australian and New Zealand intensive care units

Objective To determine the population incidence and outcome of severe sepsis occurring in adult patients treated in Australian and New Zealand intensive care units (ICUs), and compare with recent retrospective estimates from the USA and UK.Design Inception cohort study.Setting Twenty-three closed multi-disciplinary ICUs of 21 hospitals (16 tertiary and 5 university affiliated) in Australia and New Zealand.Patients A total of 5878 consecutive ICU admission episodes.Measurements and results Main outcome measures were population-based incidence of severe sepsis, mortality at ICU discharge, mortality at 28 days after onset of severe sepsis, and mortality at hospital discharge. A total of 691 patients, 11.8 (95% confidence intervals 10.9–12.6) per 100 ICU admissions, were diagnosed with 752 episodes of severe sepsis. Site of infection was pulmonary in 50.3% of episodes and abdominal in 19.3% of episodes. The calculated incidence of severe sepsis in adults treated in Australian and New Zealand ICUs is 0.77 (0.76–0.79) per 1000 of population. 26.5% of patients with severe sepsis died in ICU, 32.4% died within 28 days of the diagnosis of severe sepsis and 37.5% died in hospital.Conclusion In this prospective study, 11.8 patients per 100 ICU admissions were diagnosed with severe sepsis and the calculated annual incidence of severe sepsis in adult patients treated in Australian and New Zealand ICUs is 0.77 per 1000 of population. This figure for the population incidence falls in the lower range of recent estimates from retrospective studies in the U.S. and the U.K.Electronic Supplementary Material Supplementary material is available in the online version of this article at An editorial regarding this arcticle can be found in the same issue ()