危重症量化评分系统在MICU中的应用

目的探讨电子化APACHEⅡ、SOFA评分和TISS及MPMⅡ预计死亡率在MICU危重症评价中的应用价值。方法216例住MICU患者根据预后分为存活组与死亡组，比较分析两组患者APACHEⅡ、SOFA评分和TISS及MPMⅡ预计死亡率分值、预测病死危险度之间的差异。以接受者操作特征曲线下面积（AUROCC）大小及HosmerLemeshow拟合优度检验衡量各种评分系统区别有可能病死或存活患者的能力。结果存活组APACHEⅡ、MPMⅡ预计死亡率、SOFA及TISS-28分值分别为：19．7±7．5、28．6±21．4％、5．4±3．7及18．2±7．6；死亡组分别为：32．4±8．9、71．2±26．7％、7．5±2．6及为32．3±12．1；各参数两组之间相比均存在明显差异（P〈0．000）。APACHEⅡ、MPMⅡ预计死亡率、SOFA及TISS-28的AUROCC分别为：0．875、0．879、0．769及0．846，均明显高于相应曲线下面积为50％的数值（P〈0．000）。Hosmer-Lemeshow拟合优度检验：APACHEⅡ、MPMⅡ死亡率及’nSS_28评分的H值分别为6．222、8．197及9．054；P值分别为0．51、0．41及0．338，均与患者实际病死率之间差异无显著性，而SOFA评分（H=8．820，P=0．032）与患者实际病死率之间差异有显著性。结论APACHEⅡ、MPMⅡ预计死亡率、SOFA及TISS48评分系统预测危重病患者预后的能力均较好且接近一致；APACHEⅡ、MPMⅡ死亡率、及TISS-28评分的整体校准度良好；而SOFA评分整体校准度不良。

The application of computerized critical score systems in MICU

Objective To evaluate the application of computerized score for critical patients in MICU. Methods 216 patients in MICU were enrolled in the study and divided into survival group and death group according to the prognosis. The scores of APACHE Ⅱ, mortality probability model （MPMⅡ）, sepsis-related organ failure assessment（SOFA） and therapeutic intervention scoring system（TISS） of each group were counted respectively. The area under receiver operating characteristic（AUROCC） and Lemeshow-Hosmer ehi square statistics were used to test accuracy of prediction. Results The scores of APACHE Ⅱ , MPM Ⅱ , SOFA and TISS in the survival group were 19.7 ± 7.5,28.6 ± 21.4% ,5.4 ± 3.7 and 18.2 ± 7.6 ; the above scores of the death group were 32. 4 ± 8.9,71.2 ± 26.7%, 7. 5±2. 6 and 32. 3 ±12. 1 ; There were significantly different in two groups （ P 〈 0. 000）. The AUROCC of APACHE Ⅱ, MPM Ⅱ, SOFA and TISS in the survival group were 0. 875,0. 879,0. 769 and 0. 846, there were significantly higher than that of the value of 50% AUROCC （P 〈 0. 000）. The χ2 value in Lemesshow-Hosmer statistic of APACHE Ⅱ ,MPM Ⅱ and TISS were 0. 51,0. 41 and 0. 338 respectively,there were not significantly different with actual fatality rate. But the χ2 value in Lemesshow-Hosmer statistic of SOFA was 0. 032 （P 〈 0. 05 ）. Conclusion The prognostic value of discrimination about APACHE II, MPM Ⅱ, SOFA and TISS is good and basically equivalent. The calibration of acuity of APACHEⅡ, MPM Ⅱ and TISS is much better than that of SOFA.