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目的:探讨多时点急性生理学与慢性健康状况评分Ⅱ（APACHEⅡ）对重症脑卒中患者14 d死亡风险的影响，为临床诊疗提供参考。方法:收集美国重症监护医学信息数据库Ⅲ（MIMIC-Ⅲ）中3 229例重症脑卒中患者的相关信息。根据患者主要脑卒中类型分为蛛网膜下腔出血（SAH）、脑出血（ICH）、缺血性脑卒中（IS）及其他类型组；根据年龄分为>60岁和≤60岁组；根据序贯器官衰竭评分（SOFA）基线值分为>3分和≤3分组。计算患者APACHEⅡ评分的每日测量值，以患者入重症监护病房（ICU）14 d内全因死亡为结局指标，获取患者的生存状态和生存时间。建立纵向数据与生存数据的联合模型，评估多时点测量的APACHEⅡ评分对患者死亡风险的影响，并进行亚组分析。结果:在构建的多种联合模型中，仅纳入APACHEⅡ评分并考虑APACHEⅡ评分与年龄交互项的模型拟合效果较好。进一步分析显示，APACHEⅡ评分的变化受到年龄、性别、入院方式、SOFA评分基线值以及吸烟史的影响。控制上述混杂因素后，APACHEⅡ评分与重症脑卒中患者14 d全因死亡具有显著的相关性〔风险比（n HR）＝1.48，95%可信区间（95%n CI）为1.31~1.66，n P60岁和≤60岁患者14 d死亡风险的影响差异不大〔n HR（95%n CI）：1.37（1.08~1.72）比1.35（1.07~1.70）〕；与SOFA评分>3分患者相比，APACHEⅡ评分对SOFA评分≤3分患者14 d死亡风险的影响较大〔n HR（95%n CI）：1.40（1.16~1.70）比1.34（1.16~1.55）〕。n 结论:多时点APACHEⅡ评分是评价重症脑卒中患者死亡风险的重要指标。“,”Objective:To study the influence of time-dependent acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score on 14-day death risk in patients with severe stroke, and to provide reference for clinical diagnosis and treatment.Methods:Data of 3 229 patients with severe stroke were enrolled from Medical Information Mart for Intensive Care-Ⅲ (MIMIC-Ⅲ). According to the main types of stroke, the patients were divided into subarachnoid hemorrhage (SAH), intracerebral hemorrhage (ICH), ischemic stroke (IS) and other groups. According to age, patients were divided into > 60 years old and ≤ 60 years old subgroups. According to the baseline of sequential organ failure assessment (SOFA) score, they were divided into subgroups of > 3 and ≤ 3. The daily measured values of APACHE Ⅱ scores in each patient were recorded. And all-cause death within 14 days after admission to intensive care unit (ICU) was used as the outcome index to obtain the survival status and survival time of patients. Joint models for longitudinal and time-to-event data were established to evaluate the effect of APACHE Ⅱ score measured at multiple time points on the death risk of patients, and a subgroup analysis was performed.Results:Among the joint models, the one which include APACHE Ⅱ score, and the interaction items between APACHE Ⅱ and age showed the better fitting. Further analysis showed that APACHE Ⅱ score was affected by age, gender, hospital admission, baseline SOFA score and smoking history. After controlling for these confounding factors, APACHE Ⅱ score was significantly associated with 14-day all-cause death in patients with severe stroke [hazard ratio (n HR) = 1.48, 95% confidence interval (95%n CI) was 1.31-1.66, n P 60 years old and those aged ≤ 60 years old [ n HR (95%n CI): 1.37 (1.08-1.72) vs. 1.35 (1.07-1.70), respectively]. Compared with patients with SOFA score > 3, APACHE Ⅱ score had a greater impact on the risk of 14-day death in patients with SOFA score ≤ 3 [ n HR (95%n CI): 1.40 (1.16-1.70) vs. 1.34 (1.16-1.55)].n Conclusion:Time-dependent APACHE Ⅱ score is an important indicator to evaluate the risk of death in patients with severe stroke.