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Journal Information-measuring and Control Systems №12 for 2011 г.
Article in number:
Estimation efficiency and comparison of several prognostic scoring systems in several diagnostic groups for ICU patients of surgical profile
Keywords: APACHE II APACHE IV SAPS II MPM II 0 POSSUM prognostic scoring systems aortic aneurysm
Authors:
О. K. Potanina, A. G. Dorfman, E. V. Ogurtsova, S. L. Shvirev, T. V. Zarubina
Abstract:
The aim of the study was the estimation efficiency and the comparison several prognostic scoring systems for severity conditions estimation (APACHE II, APACHE IV, SAPS II, MPM II 0 and POSSUM) for several diagnosis groups among ICU patients of surgical profile in a Russian hospital. The analysis was constructed on the prospective study that was conducted on the Intensive Care Unit for Postoperative patients of N. V. Sklifosovsky Research Institute of Emergency Medicine. Clinical and physiological data required for the calculation of predictive models were collected on the status of 300 patients on admission to ICU and during the first 24 hours of sojourn time in the department. All patients were divided on 4 nosological groups: 36 patients with aortic aneurysm, 39 patients with gastrointestinal hemorrhage, 74 patients with different site traumas, 34 patients with thrombosis and different site vascular embolism. The analysis was conducted in each diagnostic group. The discriminatory ability of models were compared by constructing of ROC-curves, as well as their calibration were analyzed by applying Hosmer-Lemeshow's test and the construction of calibration curves. The results showed that all scales had a good discriminatory ability (area under the ROC-curve is significantly more than 0.5). The Hosmer-Lemeshow's test demonstrated that in the group of patients with aorta aneurysm all scales (APACHE II, APACHE IV, SAPS II, MPM II 0, POSSUM) had poor calibration. We can conclude that using listed scales for patients with such pathology is not advisable. Scales APACHE II, SAPS II, MPM II 0 had satisfactory calibration in groups with traumas, vascular pathology and gastrointestinal bleeding. When patients with aorta aneurysm were excluded from analysis, scales APACHE II, SAPS II, MPM II 0 had better calibration and discriminatory ability. Thus, according our results the scales APACHE II, SAPS II and MPM II 0 have the satisfactory calibration and high discriminatory power and can be recommended to estimate the probability of death in ICU of surgical profile for all patients with the exception of patients for whom aneurysm patients were diagnosed.
Pages: 75-81
References
  1. Гельфанд Б. Р., Ярошецкий А. И., Проценко Д. Н., Романовский Ю. Я. Интегральные системы оценки тяжести состояния больных при политравме // Вестник интенсивной терапии. 2004. № 1. С. 1-10.
  2. Зарубина Т. В., Швырев С. Л., Сидоров К. В. ИНТЕРИС - информационная система отделения реанимации и интенсивной терапии // Врач и информационные технологии. 2006. № 3. С. 27-40.
  3. Knaus, W. A., Wagner, D. P., Draper, E. A., Zimmerman, J. E., Bergner, M., Bastos, P.G., Sirio, C.A., Murphy, D. J., Lotring, T.,Damiano, A., The APACHE III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized adults // Chest. 1991. V. 100. P. 1619-1636.
  4. Le Gall, J. R., Lemeshow, S., Saulnier, F., A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multicenter study //JAMA. 1993. V. 270. P. 2957-2963.
  5. Lemeshow, S., Teres, D., Klar, J., Avrunin, J. S., Gehlbach, S. H., Rapoport, J., Mortality Probability Models (MPM II) based on an international cohort of intensive care unit patients // JAMA. 1993. 270. P. 2478 - 2486.
  6. Fagon, J. Y., Chastre, J., Novara, A., Medioni, P., Gibert, С., Characterization of intensive care unit patients using a model based on the presence or absence of organ dysfunctions and/or infection: the ODIN model // Intensive Care Med. 1993. 19. P.137-144.
  7. Groeger, J. S., Lemeshow, S., Price, K., Nierman, D. M., White, P., Klar, J., Granovsky, S., Horak, D., Kish, S. K., Multicenter outcome study of cancer patients admitted to the Intensive Care Unit: a probability of mortality Model // J Clin Oncol. 1998.
    V. 16. P. 761-70.
  8. Metz CE. Basic principles of ROC analysis // Seminars in Nuclear Medicine. 1978. 8. P. 283 - 298.
  9. The GNU project: a language and environment for statistical computing and graphics. 10. http://www.r-project.org/
  10. Nashef, S. A., Roques, F., Michel, P., Gauducheau, E., Lemeshow, S., Salamon, R., European system for cardiac operative risk evaluation (EuroSCORE). // Eur J Cardiothorac Surg. 1999. V. 16. P. 9 - 13.
  11. Tu, J. V., Jaglal, S. B., Naylor CD. Multicenter validation of a risk index for mortality, intensive care unit stay, and overall hospital length of stay after cardiac surgery //Circulation. 1995. V. 91. P. 677 - 684.
  12. Hosmer, D. W., Lemeshow, S.,Applied Logistic Regression, New York: Wiley. 2000.