Objective:Our aim was to prospectively compare the Accuracy of Acute Physiology and Chronic Health Evaluation(APACHE)II,Bedside Index of Severity in Acute Pancreatitis(BISAP),Ranson’s score and modified Computed Tomo...Objective:Our aim was to prospectively compare the Accuracy of Acute Physiology and Chronic Health Evaluation(APACHE)II,Bedside Index of Severity in Acute Pancreatitis(BISAP),Ranson’s score and modified Computed Tomography Severity Index(CTSI)in predicting the severity of acute pancreatitis based on Atlanta 2012 definitions in a tertiary care hospital in northern India.Methods:Fifty patients with acute pancreatitis admitted to our hospital during the period of March 2015 to September 2016 were included in the study.APACHE II,BISAP and Ranson’s score were calculated for all the cases.Modified CTSI was also determined based on a pancreatic protocol contrast enhanced computerized tomography(CT).Optimal cut-offs for these scoring systems and the area under the curve(AUC)were evaluated based on the receiver operating characteristics(ROC)curve and these scoring systems were compared prospectively.Results:Of the 50 cases,14 were graded as severe acute pancreatitis.Pancreatic necrosis was present in 15 patients,while 14 developed persistent organ failure and 14 needed intensive care unit(ICU)admission.The AUC for modified CTSI was consistently the highest for predicting severe acute pancreatitis(0.919),pancreatic necrosis(0.993),organ failure(0.893)and ICU admission(0.993).APACHE II was the second most accurate in predicting severe acute pancreatitis(AUC 0.834)and organ failure(0.831).APACHE II had a high sensitivity for predicting pancreatic necrosis(93.33%),organ failure(92.86%)and ICU admission(92.31%),and also had a high negative predictive value for predicting pancreatic necrosis(96.15%),organ failure(96.15%)and ICU admission(95.83%).Conclusion:APACHE II is a useful prognostic scoring system for predicting the severity of acute pancreatitis and can be a crucial aid in determining the group of patients that have a high chance of need for tertiary care during the course of their illness and therefore need early resuscitation and prompt referral,especially in resource-limited developing countries.展开更多
目的分析急性生理和慢性健康状况评分(Acute Physiology and Chronic Health Evaluation,APACHE)Ⅱ、Ranson评分和序贯器官衰竭评分(Sequential Organ Failure Assessment,SOFA)3种评分系统对重症监护病房(intensive care unit,ICU)重...目的分析急性生理和慢性健康状况评分(Acute Physiology and Chronic Health Evaluation,APACHE)Ⅱ、Ranson评分和序贯器官衰竭评分(Sequential Organ Failure Assessment,SOFA)3种评分系统对重症监护病房(intensive care unit,ICU)重症急性胰腺炎(severe acute pancreatitis,SAP)患者病死率的预测价值,探索SAP患者病死率的独立危险因素。方法回顾性分析2014年7月-2019年7月入住四川大学华西医院ICU的SAP患者电子病历资料。搜集患者入ICU后的首次APACHEⅡ评分、Ranson评分、SOFA评分以及机械通气、血管活性药物使用、肾脏替代治疗和预后的临床资料。利用受试者工作特征(receiver operator characteristic,ROC)曲线评价APACHEⅡ评分、Ranson评分和SOFA评分对SAP患者预后的预测价值。使用logistic回归模型寻找SAP患者ICU死亡的独立危险因素。结果筛选了290例SAP患者,60例患者因无预后资料等被排除。最终纳入230例SAP患者,其中男162例,女68例,平均年龄(51.1±13.7)岁。230例SAP患者转出ICU时166例存活,64例死亡,ICU病死率为27.8%。APACHEⅡ评分、Ranson评分、APACHEⅡ联合Ranson评分、SOFA评分与ICU病死率绘制的ROC曲线下面积分别为0.769、0.741、0.802与0.625,提示APACHEⅡ联合Ranson评分对SAP患者ICU病死率预测价值较单一评分系统更高。Logistic回归分析显示APACHEⅡ评分[比值比(odds ratio,OR)=1.841,95%置信区间(confidence interval,CI)(1.022,2.651),P=0.002]、Ranson评分[OR=1.542,95%CI(1.152,2.053),P=0.004]、血糖不稳定指数[OR=1.321,95%CI(1.021,1.862),P=0.008]、有无升压药物使用[OR=15.572,95%CI(6.073,39.899),P<0.001]与有无肾脏替代治疗[OR=4.463,95%CI(1.901,10.512),P=0.001]是SAP患者ICU死亡的独立危险因素。结论与SOFA评分相比,APACHEⅡ评分联合Ranson评分对SAP患者ICU病死率的预测价值更高。APACHEⅡ评分、Ranson评分、血糖不稳定指数、有无升压药物使用和肾脏替代治疗是SAP患者ICU死亡的独立危险�展开更多
目的急诊分诊是急救工作的重要环节,合理的评分系统能使分诊更科学、高效。文中拟探讨改良早期预警评分(modified early warning score,MEWS)、快速急诊内科评分(rapid emergency medicine score,REMS)和急性生理和慢性健康状况评分(acu...目的急诊分诊是急救工作的重要环节,合理的评分系统能使分诊更科学、高效。文中拟探讨改良早期预警评分(modified early warning score,MEWS)、快速急诊内科评分(rapid emergency medicine score,REMS)和急性生理和慢性健康状况评分(acute physiology and chronic health evaluationsⅡ,APACHEⅡ)在评估急诊危重患者预后的性能,并进行对比研究。方法对急诊科412例患者进行MEWS评分、REMS评分和APACHEⅡ评分,追踪患者去向和预后,并根据其当次入院后死亡率,比较3种评分与急诊危重患者预后的相关性,同时通过ROC曲线下面积大小,比较3种评分系统预测预后的性能。结果 3种评分分值越高,死亡危险率越高;MEWS评分、REMS评分和APACHEⅡ评分的ROC曲线下面积及其95%CI分别为0.750(0.685～0.814)、0.763(0.702～0.825)和0.865(0.814～0.915)。结论 3种评分系统均能预测患者的预后,其预测性能为APACHEⅡ>REMS>MEWS;从成本效益方面综合考虑,MEWS评分更适用于急诊患者的早期预后评估。展开更多
文摘Objective:Our aim was to prospectively compare the Accuracy of Acute Physiology and Chronic Health Evaluation(APACHE)II,Bedside Index of Severity in Acute Pancreatitis(BISAP),Ranson’s score and modified Computed Tomography Severity Index(CTSI)in predicting the severity of acute pancreatitis based on Atlanta 2012 definitions in a tertiary care hospital in northern India.Methods:Fifty patients with acute pancreatitis admitted to our hospital during the period of March 2015 to September 2016 were included in the study.APACHE II,BISAP and Ranson’s score were calculated for all the cases.Modified CTSI was also determined based on a pancreatic protocol contrast enhanced computerized tomography(CT).Optimal cut-offs for these scoring systems and the area under the curve(AUC)were evaluated based on the receiver operating characteristics(ROC)curve and these scoring systems were compared prospectively.Results:Of the 50 cases,14 were graded as severe acute pancreatitis.Pancreatic necrosis was present in 15 patients,while 14 developed persistent organ failure and 14 needed intensive care unit(ICU)admission.The AUC for modified CTSI was consistently the highest for predicting severe acute pancreatitis(0.919),pancreatic necrosis(0.993),organ failure(0.893)and ICU admission(0.993).APACHE II was the second most accurate in predicting severe acute pancreatitis(AUC 0.834)and organ failure(0.831).APACHE II had a high sensitivity for predicting pancreatic necrosis(93.33%),organ failure(92.86%)and ICU admission(92.31%),and also had a high negative predictive value for predicting pancreatic necrosis(96.15%),organ failure(96.15%)and ICU admission(95.83%).Conclusion:APACHE II is a useful prognostic scoring system for predicting the severity of acute pancreatitis and can be a crucial aid in determining the group of patients that have a high chance of need for tertiary care during the course of their illness and therefore need early resuscitation and prompt referral,especially in resource-limited developing countries.
文摘目的分析急性生理和慢性健康状况评分(Acute Physiology and Chronic Health Evaluation,APACHE)Ⅱ、Ranson评分和序贯器官衰竭评分(Sequential Organ Failure Assessment,SOFA)3种评分系统对重症监护病房(intensive care unit,ICU)重症急性胰腺炎(severe acute pancreatitis,SAP)患者病死率的预测价值,探索SAP患者病死率的独立危险因素。方法回顾性分析2014年7月-2019年7月入住四川大学华西医院ICU的SAP患者电子病历资料。搜集患者入ICU后的首次APACHEⅡ评分、Ranson评分、SOFA评分以及机械通气、血管活性药物使用、肾脏替代治疗和预后的临床资料。利用受试者工作特征(receiver operator characteristic,ROC)曲线评价APACHEⅡ评分、Ranson评分和SOFA评分对SAP患者预后的预测价值。使用logistic回归模型寻找SAP患者ICU死亡的独立危险因素。结果筛选了290例SAP患者,60例患者因无预后资料等被排除。最终纳入230例SAP患者,其中男162例,女68例,平均年龄(51.1±13.7)岁。230例SAP患者转出ICU时166例存活,64例死亡,ICU病死率为27.8%。APACHEⅡ评分、Ranson评分、APACHEⅡ联合Ranson评分、SOFA评分与ICU病死率绘制的ROC曲线下面积分别为0.769、0.741、0.802与0.625,提示APACHEⅡ联合Ranson评分对SAP患者ICU病死率预测价值较单一评分系统更高。Logistic回归分析显示APACHEⅡ评分[比值比(odds ratio,OR)=1.841,95%置信区间(confidence interval,CI)(1.022,2.651),P=0.002]、Ranson评分[OR=1.542,95%CI(1.152,2.053),P=0.004]、血糖不稳定指数[OR=1.321,95%CI(1.021,1.862),P=0.008]、有无升压药物使用[OR=15.572,95%CI(6.073,39.899),P<0.001]与有无肾脏替代治疗[OR=4.463,95%CI(1.901,10.512),P=0.001]是SAP患者ICU死亡的独立危险因素。结论与SOFA评分相比,APACHEⅡ评分联合Ranson评分对SAP患者ICU病死率的预测价值更高。APACHEⅡ评分、Ranson评分、血糖不稳定指数、有无升压药物使用和肾脏替代治疗是SAP患者ICU死亡的独立危险�
文摘目的急诊分诊是急救工作的重要环节,合理的评分系统能使分诊更科学、高效。文中拟探讨改良早期预警评分(modified early warning score,MEWS)、快速急诊内科评分(rapid emergency medicine score,REMS)和急性生理和慢性健康状况评分(acute physiology and chronic health evaluationsⅡ,APACHEⅡ)在评估急诊危重患者预后的性能,并进行对比研究。方法对急诊科412例患者进行MEWS评分、REMS评分和APACHEⅡ评分,追踪患者去向和预后,并根据其当次入院后死亡率,比较3种评分与急诊危重患者预后的相关性,同时通过ROC曲线下面积大小,比较3种评分系统预测预后的性能。结果 3种评分分值越高,死亡危险率越高;MEWS评分、REMS评分和APACHEⅡ评分的ROC曲线下面积及其95%CI分别为0.750(0.685～0.814)、0.763(0.702～0.825)和0.865(0.814～0.915)。结论 3种评分系统均能预测患者的预后,其预测性能为APACHEⅡ>REMS>MEWS;从成本效益方面综合考虑,MEWS评分更适用于急诊患者的早期预后评估。
