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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)(APACHE Ⅳ和APACHE Ⅱ)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APACHE Ⅳ和APACHE Ⅱ评分,并计算其各自预测病死率,通过标准化死亡率(StandardizedMortality 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%。APACHE Ⅱ得分为25±8分,预测死亡率为53.31%;APACHE Ⅳ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%CI 0.614～0.972);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:APACHE Ⅱ和APACHE Ⅳ对于危重症患者死亡率预测准确性高;与APACHE Ⅱ相比,APACHE Ⅳ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。
OBJECTIVE: To compare the value of different versions of Acute Physiology And Chronic Health Evaluation (APACHE) (APACHE Ⅳ and APACHE Ⅱ) in the prognosis assessment of adult critically ill patients. Methods: The clinical data of patients admitted to intensive care unit in our hospital from January to October 2011 were collected. The scores of APACHE Ⅳ and APACHE Ⅱ within 24 hours after ICU admission were calculated and their respective predicted mortality rates were calculated. The standardized mortality (Standardized Mortality) Ratios, SMR) to compare the accuracy of these two scoring systems in assessing the prognosis of critically ill patients. Results: A total of 184 patients were enrolled in this study, with a mortality rate of 41.8%. APACHE Ⅱ score of 25 ± 8 points, the predicted mortality rate was 53.31%; APACHE Ⅳ score of 93 ± 24 points, the predicted mortality rate was 30.76%. APACHE II predicted mortality higher than the actual mortality (SMR 0.78,95% CI 0.614 ~ 0.972); APACHE IV predicted mortality rate lower than the actual mortality (SMR = 1.35,95% CI1.066 ~ 1.688). However, there was no significant difference between the two in predicting the mortality of critically ill patients (P> 0.05). CONCLUSION: APACHE Ⅱ and APACHE Ⅳ are highly accurate in predicting the mortality of critically ill patients. Compared with APACHE Ⅱ, APACHE Ⅳ showed no superior performance, and there was no significant difference between them.