RIFLE Classification Did Not Have Satisfactory Predictive Value for Septic Patients with High Severity Scores

在高嚴重程度分數的嚴重敗血症病人身上使用RIFLE classification沒有令人滿意的預測價值

黃志宇(Chih-Yu Huang) ； 許恆榮(Heng-Jung Hsu) ； 劉育志(Yu-Chih Liu) ； 花仲涇(Chung-Ching Hua) ； 吳黃平(Huang-Ping Wu)

《胸腔醫學》 25卷5期 (2010/10) Pp. 230-237

https://doi.org/10.29806/TM.201010.0001

摘要

前言：預測嚴重敗血症病人的結果是重要的。RIFLE classification已經被拿來評估預測病人死亡的能力。本研究的目標是使用3個評分系統包括APACHE(Acute Physiology and Chronic Health Evaluation)II score、MODS(Multiple Organ Dysfunction Score)、及RIFLE(Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease)classification來比較其預測結果的價值。
方法：這個研究收集了71個從急診部門直接住到加護病房的嚴重敗血症病人。他們的APACHE II score、MODS、及RIFLE classification在住院後的24小時內就計算好。我們也估算了ROC(receiver operating characteristic)的曲線下面積來分析這3個評分系統的辨識能力。
結果：非存活者的APACHE II score及MODS的數值皆顯著高於存活者的平均分數，但RIFLE classification在非存活者及存活者之間並沒有統計上的差異。APACHE II score、MODS、及RIFLE classification的ROC曲線下面積分別是0.801、0.715及、0.602。APACHE II score及MODS比起RIFLE classification而言，是用來預測結果比較好的工具。RIFLE classification的辨識能力在預測嚴重敗血症病人的結果上並沒有顯著意義(p=0.226)。
結論：APACHE II score及MODS對於嚴重敗血症病人而言是有用的工具。而RIFLE classification使用在相對嚴重的敗血症病人來預測28天的死亡率並沒有令人滿意的預測能力。

關鍵字

嚴重敗血症 ； 死亡率 ； RIFLE ； APACHE II ； MODS

並列摘要

Background: Predicting the outcome of patients with severe sepsis is important. The RIFLE classification has been evaluated for its ability to predict mortality. The aim of this study was to compare the predictive value of 3 scoring systems: the Acute Physiology and Chronic Health Evaluation (APACHE) II score, the Multiple Organ Dysfunction Score (MODS), and the Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease (RIFLE) classification.
Patients and methods: Seventy-one severe septic patients admitted to intensive care units (ICU) directly from the emergency department were enrolled into this study. The APACHE II score, MODS, and RIFLE classification were calculated within 24 hours after admission. Areas under the receiver operating characteristic (ROC) curves were computed in order to analyze the discriminatory power of these 3 scoring systems.
Results: The value of the APACHE II score and the MODS in the non-survivors was statistically significantly higher than that in the survivors. The RIFLE classification showed no significant difference between survivors and non-survivors. Areas under the ROC curves were 0.801, 0.715, and 0.602, respectively, for the APACHE II score, the MODS, and the RIFLE classification. The APACHE II score and the MODS were better tools for outcome prediction, compared with the RIFLE classification. The discriminatory power of the RIFLE classification did not have significance (p=0.226) for outcome prediction in severe septic patients.
Conclusions: The APACHE II score and the MODS were useful tools in patients with severe sepsis. The RIFLE classification did not show satisfactory power in predicting 28-day mortality in more severe septic patients.

並列關鍵字

severe sepsis ； mortality ； RIFLE ； APACHE II ； MODS