STUDY OBJECTIVE:To assess the prognostic performance of general severity systems (APACHE II [acute physiology and chronic health evaluation], simplified acute physiology score [SAPS II], and mortality probability models [MPM II]) in coronary patients and to derive new customized indexes for coronary patients using a reduced number of variables.

DESIGN:Inception cohort.

SETTING:Adult medical and surgical ICUs in 17 hospitals in Catalonia and the Balearic Islands.

PATIENTS:Four hundred fifty-six patients with acute myocardial infarction.

MEASUREMENTS AND RESULTS:The APACHE II, SAPS II, and MPM II variables and survival status at hospital discharge have been collected. Performance of the severity systems was assessed by evaluating calibration and discrimination. Logistic regression was used to customize the MPM II(24) and SAPS II indexes. Discrimination was high enough for all of the models. However, calibration of the MPM II(24) was not as satisfactory as for the other models. The MPM II(24) and SAPS II were both reduced to five variables (MPM II(24 cor:) age, PaO2, continuous vasoactive drugs, urinary output, and mechanical ventilation; SAPS II(cor:) age, PaO2/FI(O2) ratio, systolic BP, Glasgow coma score, and urinary output). Both models showed better calibration and discrimination than the original ones.

CONCLUSIONS:Prognostic indexes developed for multidisciplinary patients show good performance when applied to patients with acute myocardial infarction, but customization can reduce the number of variables necessary to compute them without a loss of, and a possible improvement in, prognostic accuracy.

译文

研究目标 : 评估一般严重程度系统 (APACHE II [急性生理学和慢性健康评估],简化的急性生理学评分 [SAPS II],和冠心病患者的死亡率概率模型 [MPM II]),并使用减少的变量数量为冠心病患者推导新的定制指标。
设计 : 初始队列。
设置 : 加泰罗尼亚和巴利阿里群岛17家医院的成人医疗和外科重症监护医师。
患者 : 456例急性心肌梗死患者。
测量和结果 : 已收集APACHE II,SAPS II和MPM II变量以及出院时的生存状态。通过评估校准和判别来评估严重性系统的性能。Logistic回归用于定制MPM II(24) 和SAPS II指数。歧视对于所有模型来说都足够高。但是,MPM II(24) 的校准不如其他模型令人满意。MPM II(24) 和SAPS II均降低为五个变量 (MPM II(24 cor :) 年龄,PaO2,持续血管活性药物,尿量和机械通气; SAPS II(cor :) 年龄,PaO2/FI(O2) 比,收缩压,格拉斯哥昏迷评分,和尿量)。两种模型均显示出比原始模型更好的校准和区分度。
结论 : 为多学科患者开发的预后指标在应用于急性心肌梗死患者时显示出良好的表现,但是,自定义可以减少计算它们所需的变量数量,而不会损失预后准确性,并可能提高预后准确性。

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