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预测肺栓塞患者入院ICU的患者的医院生存率
Martin J Ryll1, Aurelia Zodl1, Toby N Weingarten2
1Faculty of Medicine, Ludwig Maximilian University of Munich, Munich, Germany.
Journal of intensive care medicine
|November 15, 2023
概括
新的ICU-sPESI得分与简化的PESI (sPESI) 相比,在重症监护室 (ICU) 改善了肺栓塞 (PE) 死亡率预测. 这一新得分为重症PE患者提供了更好的风险歧视.
科学领域:
- 肺部医学 肺部医学
- 关键护理医学 关键护理医学
- 健康 结果 研究 研究 结果
背景情况:
- 肺栓塞严重性指数 (PESI) 和简化PESI (sPESI) 是预测肺栓塞患者死亡率的已知工具.
- 在重症监护室 (ICU) 设置中,这些评分的有效性需要进一步评估,因为患者经常出现更严重的疾病.
- 需要改进风险分层工具,以考虑重症患者PE呈现的尖性.
研究的目的:
- 为了比较PESEI,sPESI和急性生理和慢性健康评估IV (APACHE-IV) 的预测性表现,对PE的ICU患者的住院死亡率进行比较.
- 评估一种新的ICU专用简化的PESI (ICU-sPESI) 评分,其中包括表明PE严重程度的临床变量 (输管,精神状态变化,血管活性输液).
- 在这个患者群体中评估ICU-sPESI得分的辨别能力和负预测值.
主要方法:
- 使用eICU协作研究数据库 (2014-2015) 的回顾性队列研究.
- 包括被诊断为PE的初级诊断进入ICU的成年患者 (n=1424).
- 计算和比较APACHE-IV,PESI,sPESI和新型ICU-sPESI得分的接收器操作特征 (AUROC) 曲线下的面积,以预测住院死亡率.
主要成果:
- 在研究PE患者中,住院死亡率为6.3%.
- 与sPESI (AUROC=0.777) 相比,APACHE-IV (AUROC=0.870) 和PESI (AUROC=0.848) 的表现更为出色.
- ICU-sPESI得分显示了与APACHE-IV和PESI (AUROC=0.847) 相似的表现,明显超过了最初的sPESI.
结论:
- 新的ICU-sPESI得分有效预测重症PE患者的死亡率,比标准sPESI提供更好的风险分层.
- ICU-sPESI得分提供了极好的死亡风险歧视,与APACHE-IV和PESI等既定得分相美.
- 这种修改后的得分提高了在ICU环境中识别高风险PE患者的能力.
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