APACHEⅡ评分和TRISS评分预测ICU创伤患者预后的Meta分析  

A comparison of the acute physiology and chronic health evaluation Ⅱ score and the trauma-injury severity score for outcome assessment in intensive care unit trauma patients:a meta-analysis

作　　者：余倩 江利冰[2] 高建波 Yu Qian;Jiang Libing;Gao Jianbo(Department of Emergency,the First People's Hospital of Fuyang,Hangzhou 311400,Zhejiang,China;Department of Emergency,the Second Affiliated Hospital,School of Medicine,Zhejiang University,Hangzhou 310009,Zhejiang,China)

机构地区：[1]杭州市富阳区第一人民医院急诊医学科,浙江杭州311400 [2]浙江大学医学院附属第二医院急诊医学科,杭州310009

出　　处：《中华危重病急救医学》2022年第1期59-63,共5页Chinese Critical Care Medicine

基　　金：浙江省医药卫生科技计划项目(2017KY372);浙江省杭州市卫生计生科技计划项目(2018B053)。

摘　　要：目的比较急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)和创伤严重度评分(TRISS)对重症监护病房(ICU)创伤患者预后的预测能力。方法应用计算机系统性检索美国国立医学图书馆PubMed数据库、Cochrane图书馆数据库、中国生物医学文献服务系统(SinoMed)、中国知网(CNKI)1980年1月至2020年12月发表的比较TRISS与APACHEⅡ两种评分法对创伤患者预后预测能力的研究。由2位研究者独立完成文献筛选、数据提取及质量评价。采用MetaDiSc 1.4软件检验各研究间的异质性,对诊断准确度指标进行Meta分析并拟合综合受试者工作特征曲线(SROC曲线),比较两种评分的SROC曲线下面积(AUC)。采用Deek检验法分析文献发表偏倚。结果最终共纳入6篇文献,包括4054例患者,文献质量中等偏上。Meta分析结果显示,TRISS评分和APACHEⅡ评分预测ICU创伤患者预后的敏感度较低〔合并敏感度及95%可信区间(95%CI)分别为0.48(0.41~0.55)、0.51(0.41~0.62)〕,特异度较高〔合并特异度及95%CI分别为0.96(0.93~0.97)、0.98(0.95~0.99)〕,诊断优势比(DOR)及95%CI分别为20(14~28)、46(18~120),总体AUC尚可〔AUC及95%CI分别为0.79(0.75~0.82)、0.80(0.76~0.83)〕,两种评分AUC比较差异无统计学意义(Z=1.542,P>0.05)。Deek检验显示,纳入文献不存在发表偏倚。结论APACHEⅡ评分和TRISS评分在预测ICU创伤患者死亡风险准确性方面没有明显区别。Objective To assess the ability of the acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)and trauma-injury severity score(TRISS)in predicting mortality in intensive care unit(ICU)trauma patients.Methods Databases of PubMed,Cochrane Library,SinoMed,CNKI were retrieved from January 1980 to December 2020.The ability of the APACHE Ⅱ and the TRISS to predict mortality in the ICU trauma patients was compared in the retrieval literatures.The relevant literatures were screened by two researchers independently.The data of the included literatures were extracted,and the quality of the included literatures was evaluated.MetaDiSc 1.4 software was used to test the heterogeneity among studies.Meta-analysis was performed on diagnostic accuracy indicators and the summary receiver operator characteristics curve(SROC curve)was fitted.The area under SROC curve(AUC)of the two scores was compared.Deek test was used to analyze literature publication bias.Results Six studies were selected with 4054 patients involved with medium and high quality.Meta-analysis results showed that APACHE Ⅱ and TRISS had low sensitivity[the pooled sensitivity and 95%confidence interval(95%CI)was 0.48(0.41-0.55)and 0.51(0.41-0.62)],high specificity[the pooled specificity and 95%CI was 0.96(0.93-0.97)and 0.98(0.95-0.99)],the pooled diagnostic odds ratio(DOR)and 95%CI was 20(14-28)and 46(18-120),and overall good performance in terms of AUC[the AUC and 95%CI was 0.79(0.75-0.82)and 0.80(0.76-0.83)]in predicting the prognosis of ICU trauma patients.There was no statistical difference in AUC between the two scores(Z=1.542,P>0.05).Deek funnel plot showed little publication bias.Conclusion Both APACHE Ⅱ and TRISS scores could accurately predict mortality in ICU trauma patients.

关 键 词：急性生理学与慢性健康状况评分Ⅱ 创伤严重度评分 病死率 重症监护病房 META分析 受试者工作特征曲线 

分 类 号：R641[医药卫生—外科学]