APACHEIV和APACHEII预测危重症患者预后的比较性研究

目的：比较不同版本的急性生理和慢性健康评分（Acute Physiology And Chronic Health Evaluation，APACHE）（APACHEⅣ和APACHEⅡ）对于成人危重症患者预后评估的应用价值。方法：收集2011年1月至10月入住我院重症监护病房患者的临床资料，分别计算其入ICU24小时内的APACHEⅣ和APACHEII评分，并计算其各自预测病死率，通过标准化死亡率（Standardized Mortality Ratios，SMR）来比较这两个评分系统对危重症患者预后评估的准确性。结果：本研究共纳入184例患者，死亡率为41．8％。APACHEII得分为25±8分，预测死亡率为53．31％；APACHEⅣ得分为93±24分，预测死亡率为30．76％。APACHEII预测死亡率比实际死亡率高（SMR为0．78，95％CI0．614-0．972）；APACHEIV预测死亡率比实际死亡率低（SMR=1.35，95％CI1．066-1．688）。但二者对于危重症患者死亡率的预测没有统计学差异（P〉0．05）。结论：APACHEII和APACHEIV对于危重症患者死亡率预测准确性高；与APACHEII相比，APACHEIV无表现出更为优越的性能，二者之间的差异不存在统计学意义。

Comparison of APACHE IV with APACHE II in Predicting Prognosis of Intensive Care Unit

Objective： To evaluate and compare the performance and valuation of different versions of Acute Physiology And Chronic Health Evaluation （APACHE） scores （APACHE II and APACHE IV） in Intensive Care Unit. Methods： Retrospectively we collected the medical records of 184 patients admitted to intensive care unit of Shantou Central Hospital between January to October in 2011. We calculated the APACHE II and APACHE IV scores when patients admitted in ICU in the first 24 hours, and calculated their Predicted Hospital Mortality. Their performance was compared by Standardized Mortality Ratios （SMR）. Results： A total of 184 patients consecutively admitted to the study. The overall mortality rates were 41.8%.APACHE II scores were 25± 8, predicted mortality rates were 53.31%. APACHE IV scores were 93± 24, predicted mortality rates were 30.76%. The predicted mortality rates of APACHE II was higher than observed （SMR 0.78, 95%CI 0.614-0.972）; and the predicted mortality rates of APACHE IV was lower than observed （SMR 1.35, 95%CI 1.066-1.688）. But there was no significant difference between them （P 〉0.05）. Conclusions： The APACHE II and APACHE IV both had high accuracy in predictting mortality rates of ICU patients. However, APACHE IV did not perform better than APACHE II. Nevertheless, there was no significant difference between them.