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題 名 | Development of a New Prognostic System and Validation of APACHEⅡ for Surgical ICU Mortality: A Multicenter Study in Taiwan=為外科加護病房開發預後系統並與APACHEⅡ比較之多中心研究 |
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作 者 | 郭旭崧; 莊人祥; 唐高駿; 侯清正; 周幸生; 雷永耀; 彭芳谷; | 書刊名 | 中華醫學雜誌 |
卷 期 | 62:10 1999.10[民88.10] |
頁 次 | 頁673-681 |
分類號 | 419.21 |
關鍵詞 | 院內死亡; 加護病房; 預測能力; 疾病嚴重度; Hospital mortality; Intensive care unit; Outcome prediction; Severity of illness index; |
語 文 | 英文(English) |
中文摘要 | 背景 為台灣外科加護病患開發及驗證一本土性的預後系統,並針對其預測能力 與APACHE II作比較。 方法 收集每位病患的人口學變項、診斷、APACHE II變項及出院存活狀態的資料, 然後將整個資料庫以隨機的方法分成發展組與驗證組。在發展組資料庫中,用多變項對數迴 歸模式開發出一新預後系統,再將驗證組的資料填入,並加以驗證。利用receiver operating characteristic(ROC)curve及適合度檢定,分別評估預後系統的準確性及預測能力的穩定性。 結果 在研究期間,3家醫院的加護病房共收入1,248位病患。以APACHE II score為 預後系統,則在ROC curve下的面積為0.712。新預後系統共有18個變項。檢定發展組與 驗證組資料庫的適合度顯示,新系統預測能力相當穩定(發展組與驗證組的p值各為0.235 及0.297),發展組與驗證組在ROC curve下的面積則分別為0.840及0.763。如將APACHE II score用於驗證組,則其在ROC curve下的面積為0.686。APACHE II score與新預後系統用 於驗證組,兩者在ROC curve下的面積經檢定後發現有顯著差異(p<0.0001)。 結論 雖然APACHE II score與台灣外科加護病房病患的死亡率有相關性,然而其準確 性則不如原始研究的結果。所發展的新的本土預後系統,確能改善預測的準確性。 |
英文摘要 | Background. To develop and to validate a new prognostic prediction system for patients admitted to the surgical intensive care unit (ICU), and to compare its performance with the Acute Physiology and Chronic Health Evaluation (APACHE) II system. Method. The database was derived from three surgical ICUs in three hospitals. For each patients, demographic data, diagnosis, APACHE II score and hospital survival data were collected. The accuracy in outcome prediction of the APACHE II was assessed by means of receiver operating characteristic (ROC) analysis. The new prognostic system was developed by using a multicple logistic regression in the developmental data set and validated with the validation data set. Results. A total of 1,248 patients were included from three ICUs. The area under the ROC curve was 0.74 for the APACHE II score. The new prognostic system includes 18 variables. Goodness-of- fit tests indicated that the model performed well in the developmental and validation samples (p=0.235 in the developmental data set and p=0.297 in the validation set). The area under the ROC curve was 0.84 in the developmental sample and 0.77 in the validation sample for the new prognostic score. The area under the ROC curve was 0.71 in the validation sample for the APACHE II score. Conclusions. Although APACHE II correlated with mortality for surgical ICU patients in Taiwan, its accuracy is not as good as in the original study. Mortality prediction performance improved with the use of the new, local scoring system. |
本系統中英文摘要資訊取自各篇刊載內容。