急性生理和慢性健康状况Ⅳ评分模型在老年重症医学科中的验证  

Validation of the acute physiology and chronic health evaluation Ⅳ model for the prediction of hospital mortality in a geriatric intensive care unit

作　　者：董家辉[1] 莫泽珣[1] 孙照琨[1] 孙杰[1] 曾安[2] 郭振辉[1] DONG Jia-Hua MO Ze-Xun SUN Zhao-Kun SUN Jie ZENG An GUO Zhen-Hui(Geriatric Intensive Care Unit, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou 510010, China College of Computing, Guangdong University of Technology, Guangzhou 510000, China)

机构地区：[1]广州军区广州总医院老年重症医学科,广州510010 [2]广东工业大学计算机学院,广州510000

出　　处：《中华老年多器官疾病杂志》2017年第6期410-413,共4页Chinese Journal of Multiple Organ Diseases in the Elderly

基　　金：国家自然科学基金(6130010);广东省科技计划项目(2012A061400010);广州市创新重大专项(201508020253)~~

摘　　要：目的研究急性生理和慢性健康状况(APACHE)Ⅳ评分模型的精确度以及是否适用于老年重症患者。方法前瞻性观察2011年7月至2015年7月广州军区广州总医院老年重症医学科收治的421例重症老年患者,计算入住ICU 24 h内的APACHEⅣ评分,通过受试者工作曲线下面积(ROC AUC)和Hosmer-Lemeshow(HL)检验分别检验模型的辨别力和校准,标准化死亡比值(SMR)检验模型预测群体死亡率的准确性,并计算模型的Brier评分(BS)。结果 421例老年重症患者,住院死亡率为33.3%(140/421)。APACHEⅣ模型辨别力为良好到优秀(AUC=0.82,95%CI:0.78~0.86),模型的HL检验显示校准不适(χ~2=20.49,P=0.009)。BS显示模型良好的精确度(BS=0.18),但APACHEⅣ模型可能低估老年重症患者住院死亡率(SMR=1.50,95%CI:1.30~1.70)。结论在老年重症患者中,APACHEⅣ模型显示优秀的辨别力,但模型校准不良同时低估住院死亡率。老年专科患者使用危险预测模型前应验证模型并使用定制化模型拟合预测群体。Objective To validate the accuracy and feasibility of acute physiology and chronic health evaluation （APACHE） Ⅳ model in critically ill elderly patients.Methods A total of 421 elderly critically ill patients admitted in our hospital from July 2011 to July 2015 were prospectively recruited in this study.Their APACHE Ⅳ scores were calculated within 24 h in ICU.Discrimination and calibration were respectively assessed by using area under the receiver operating characteristic curve （ROC AUC） and Hosmer-Lemeshow （HL） test.Standardized mortality ratio （SMR） was reported to quantify the mortality variation between observation and prediction and the brier score （BS） to represent the overall performance.Results The mortality rate of the 421 subjects was 33.3%（140/421）.The discrimination of the APACHE Ⅳ model was good to excellent （AUC=0.82, 95%CI： 0.78-0.86）, but the calibration was inadequacy according to the results of HL test （Chi square=20.49, P=0.009）.The BS showed good accuracy of APACHE Ⅳ model （BS=0.18）, but it may underestimate the in-hospital mortality （SMR=1.50, 95%CI： 1.30-1.70） in elderly critically ill patients.ConclusionThe APACHE Ⅳ model shows good discrimination in critically ill elderly patients, but has poor calibration and underestimated in-hospital mortality.Therefore, before we use the risk prediction models for geriatric patients, we should validate it and employ customized models to fit the population to be predicted.

关 键 词：急性生理与慢性健康状况评分 老年 住院病死率 预后评估 验证 

分 类 号：R541.4[医药卫生—心血管疾病]