摘要
目的应用查尔森合并症指数（Charlson’s weighted index of comorbidities，WIC）评价基础疾病对ICU肺部感染患者28d死亡风险的影响。方法回顾性分析上海长征医院2010年10月至2012年2月的160例肺部感染患者，临床资料包括年龄、性别、社区获得性肺炎（CAP）或者院内获得性肺炎（HAP）、基础疾病、是否发生急性呼吸窘迫综合征（ARDS）、是否严重脓毒症和28d病死率；入院24h内计算WIC评分、急性生理与慢性健康状况（APACHE）II评分和脓毒症相关性器官功能衰竭评分（sepsis related organ failure assessment，SOFA）评分。用Logistic回归分析影响患者预后的因素，绘制受试者工作曲线（ROC）比较各评分对预后的判断。结果在160例入组患者中，CAP患者76例（48．8％），HAP患者82例（51．2％），男性106例（66．3％），女性54例（33．7％），存活99例（61．9％），死亡61例（38．1％）。年龄（62．4±17．3）岁。与存活组比较，死亡组的WIC分值、APACHE11分值和SOFA评分较高（P〈0．05）。多因素Logistic回归分析提示，年龄（OR=1．049，95％C／：1．011—1．088，P=0．011）、WIC评分（OR=1．725，95％ CI：1．194—2．492，P=0．004）、APACHEII评分（OR=1．175，95％CI：1．058—1．305，P=0．003）、SOFA评分（OR=1．277，95％ CI：1．048～1．556，P=0．015）、是否ARDS（OR=0．081，95％C／：0．008—0．829，P=0．034）、是否严重脓毒症（OR=0．149，95％CI：0．232—0．622，P=0．004）与肺部感染患者28d预后相关。WIC评分、APACHElI评分、SOFA评分及三者合并后预测概率的受试者工作曲线（ROC）曲线下面积（95％C／）依次为0．639（0．547—0．730）、0．782（0．709—0．856）、0．79（0．714～0．866）、0．842（0．777～0．907）。结论WIC评分系统可以较好的评价基础疾病对ICU肺部感染患者28d预后的影响。
Objective To estimate the validity of Charlson＇ s weighted index of comorbidities （WIC） used to predicting 28-day mortality among ICU pneumonia patients with underlying diseases. Methods A retrospective analysis of 160 adult patients with pneumonia admitted to a multi-discipline ICU of Shanghai Changzheng hospital between October 2010 and February 2012 was carried out. Clinical data were collected including age, gender, community acquired pneumonia （CAP） or hospital acquired pneumonia （ HAP）, underlying diseases, severity-of-sepsis, and 28-day mortality. WIC scores, acute physiology and chronic health evaluation （APACHE） 1T , and sepsis related organ failure assessment （SOFA） were assessed within the first 24 hours after admission. Logistic regression analyses were used to evaluate the predictors for outcome. The receiver operating characteristic curve （ROC） was used to compare the performance of these scores between different methods. Re.suits Of 160 enrolled patients, 76 （48.8%） were CAP, 82 （51.2%） HAP, and 106 （66. 3% ） male, 54 （33.7%） female, and 99 （61.9%） patients survived and 61 （38. 1%） died. The average age was （62.4 _＋ 17.3） years old. Compared with survivors, WIC, APACHE II and SOFA scores were significantly higher in death group （ P 〈 O. 05）. The multivariate logistic regression revealed that risk of death depends predominantly on age （ OR = 1. 049, 95% CI： 1. 011-1. 088, P = O. 011 ） , WIC （ OR = 1. 725, 95% CI： 1. 194-2. 492, P = 0. 004）, APACHE II score （ OR = 1. 175, 95%CI： 1.058-1.305, P=0.003）, SOFA score （0R=1.277, 95%CI： 1.048-1.556, P=0.015）, presence of ARDS （ OR = 0. 081, 95% CI： 0. 008-0. 829, P = 0. 034 ） , and complicated with severe sepsis （OR = 0. 149, 95% CI： 0. 232-0. 622, P = 0. 004 ）. The area under the receiver operating characteristics curve in predicting mortality was 0. 639 （0. 547-0. 730） for the WIC, 0. 782 （0. 709-0. 856） for APACHE II score, 0.79 （0.714-0.866） for SOFA score and 0.842 （0.777-0.907） for the merger of three. Conehmions In pneumonia patients of ICU, WIC is a useful approach to predicting 28-day mortality, and the risk of death significantly depends on co-morbidities.
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2013年第7期744-748,共5页
Chinese Journal of Emergency Medicine
基金
国家自然科学基金（81173402）
