CHEST 中文版.pdf

CHEST 中文版文摘
死亡概率模型Ⅲ和简化急性生理评分Ⅱ——评价其在预测
住院时间中的意义并与 APACHE Ⅳ进行比较
Eduard E. Vasilevskis, MD, Michael W. Kuzniewicz, MD, MPH, Brian A. Cason, MD, Rondall K. Lane, MD, MPH, Mitzi L.
Dean, MS, MHA, Ted Clay, MS, Deborah J. Rennie, BA, Eric Vittinghoff, PhD and R. Adams Dudley, MD, MBA
From the Philip R. Lee Institute for Health Policy Studies (Drs. Vasilevskis, Kuzniewicz, Lane, and Dudley, Ms. Dean, Mr. Clay,
and Ms. Rennie), the Divisions of General Internal Medicine (Dr. Vasilevskis), Hospital Medicine (Dr. Vasilevskis), Neonatology
(Dr. Kuzniewicz), and Pulmonary and Critical Care Medicine (Dr. Dudley), and the Departments of Anesthesiology and Perioperative
Medicine (Drs. Cason and Lane), and Epidemiology and Biostatistics (Dr. Vittinghoff), University of California at San Francisco,
San Francisco, CA; Veterans Affairs Medical Center (Dr. Cason), San Francisco, CA; the Department of Medicine (General
Internal Medicine and Public Health) [Dr. Vasilevskis], Vanderbilt University, Nashville, TN; and Geriatric Research Education
and Clinical Care (Dr. Vasilevskis), and the Clinical Research Training Center of Excellence (Dr. Vasilevskis), Department of
Veterans Affairs, Tennessee Valley Healthcare System, Nashville, TN.
Correspondence to: Eduard E. Vasilevskis, MD, Vanderbilt University Medical Center; 1215 Twenty-First Ave South, 6006
Medical Center East, NT, Nashville, TN 37232-8300; e-mail: eduard.******@
目的应用3个常用的死亡率或住院时间(LOS) 预测模型,来形成和比较这些ICU住院时间(LOS)
的风险调节模型。
方法在 2001 - 2004 年间, 我们利用“加利福尼亚重症监护结局项目”完成了一项包括 35 家医
院 ICU 中 11 295 例患者的回顾性观察研究。我们比较了下列 3 个 LOS 模型的准确性: 重新校准的
急性生理和慢性健康评价(APACHE) IV-LOS模型;利用危险因素在死亡概率模型Ⅲ中零时产生的模
型(MPM0); 以及简化急性生理评分(SAPS) Ⅱ死亡率预测模型。我们通过计算下列参数来评价模
型: (1) 成组的确定系数; (2) 亚组间观测的LOS和预测的LOS之间的差别; (3) 模型之间观测LOS
与预期 LOS 比率的组内相关性。
结果成组的确定系数分别为以研究队列LOS值重新校准的APACHE Ⅳ(APACHE Ⅳrecal) (R 2 =
2 2
)、在零时的死亡概率模型Ⅲ(MPM0 Ⅲ)(R = ) 以及简化急性生理评分(SAPS Ⅱ)(R =
)。应用APACHE Ivrecal、 MPM0 Ⅲ和 SAPS