【摘要】 目的 对比分析APACHEⅡ、APACHEⅢ评分及PSI评分评估老年重症肺炎患者预后的临床价值。方法 研究纳入2014-05~2015-09人住天津市第一中心医院的老年重症肺炎患者102例,根据28 d生存情况分为生存组与死亡组,分析比较两组患者APACHEⅡ、APACHEⅢ评分及PSI评分差异,通过ROC曲线下的面积评估各评分系统的预测能力。结果 APACHEⅢ、PSI评分与APACHEⅡ评分呈显著正相关(r值分别为0.579、0.218,P<0.01);APACHEⅡ、APACHEⅢ评分及PSI评分ROC曲线下面积分别为0.930(P=0.000,95%CI 0.861~1.000)、0.795(P=0.001,95%C1 0.661~0.929)及0.677(P=0.047,95%C1 0.515~0.839)。结论 在三种评分系统中,APACHEⅡ、APACHEⅢ评分系统预测老年重症肺炎预后的准确性高,且APACHEⅡ评分优于APACHEⅢ评分,PSI评分预测预后的临床价值有限,评估老年重症肺炎预后首选APACHEⅡ评分。更多还原

【Abstract】 Objective The aim of this study was to compare the effects of Acute Physiology and Chronic Health Evaluation Ⅱ score(APACHE Ⅱ score),Acute Physiology and Chronic Health Evaluation Ⅲ score(APACHE Ⅲ score) and pneumonia severity index(PSI score) for the prediction of28- day mortality in the elderly patients with severe pneumonia.Methods A total of 102 critical patients during May 2014 and September 2015,undertook APACHE TJ,score APACHE Ⅲ score and PSI score.Correlations between the scores from the three methods and prognoses were compared according to the survival and death conditions during a 28- day observation period;the accuracy of evaluating the prognoses with three scoring systems was compared by areas under the ROC curve.Results APACHE Ⅱ / Ⅲ score had good discrimination for predicting 28- day mortality in elderly patients with severe pneumonia,and with AUC 0.930(P = 0.000,95%CI 0.861 ~ 1.000),0.795(P = 0.001,95%CI 0.661 ~ 0.929).However,the PSI score did not have discrimination power for predicting mortality,with AUC 0.677(P =0.047,95%CI 0.515 ~0.839).Conclusion These data suggest that APACHE Ⅱ,as well as APACHE Ⅲ score,is effective for predicting 28- day mortality in elderly patients with severe pneumonia,but that the PSI score does not have good discrimination and calibration for predicting mortality.APACHE Ⅱ score is excellent in the prediction of 28- day mortality.更多还原