Clinical Significance Of APACHEⅢ Score In Infection Diseases

Objective：1To investigate the clinical significance of Acute Physiology and Chronic HealthEvaluation score Ⅲ(APACHEⅢ) in infection disease patients.2To study the correlation between APACHEⅢ score and the demand of nursingwork load for infection disease patients.Methods：Two hundreds and thirteen infection disease patients admitted to the infectiondisease department in XiangYa Hospital of Central South University wereinvestigated from December2011to October2012. The APACHEⅢ score and theBarthel index were used to assess those patients severity of illness and ADLrespectively. The follow up observation was taken on Prognosis, the incidence ofMODS and the patients direct care time. The research tools include the generalinformation;APACHEⅢ scoring standard; Barthel index;patients direct care time wasmeasured and recorded according to a self-designed table. Descriptive analysis,one-way ANOVA, R×C Chi-square test, Pearson correlation analysis and AUROCCanalysis were used to analysis data with software SPSS15.0.Results：1There was significant difference in APACHEⅢ score between survival group anddeath group(P＜0.01); and the APACHEⅢ score of the death group(82.2±7.3)wassignificantly higher than that of the survival group(48.3±8.7).2There was difference mortality between6groups. The actual mortality increasedwith the increase score of APACHEⅢ(P<0.01). APACHEⅢ score of the patientswas related to the actual mortality positively. 3There was a significant difference of APACHEⅢ scores among the differentsystemic infection groups. There was no significant difference between the group ofthe urinary system infections and the group of infectious diarrhea (F=1.293, P>0.05).APACHEⅢ score of central nervous system infections group, bloodstream infectiongroup and respiratory system infections group all of which were higher than that ininfectious diarrhea group. There was a significant difference between central nervoussystem infections group and respiratory system infections group(F=8.693, P<0.05).However, no significant difference were found in patients with central nervous systeminfections and the group of bloodstream infection(F=1.298, P>0.05).4There was significant difference in APACHEⅢ score of infection diseases betweenMODS group and non-MODS group(P＜0.01）. APACHEⅢ score of the patients wasrelated to the incidence of MODS positively.5The MODS group patients were divided into survival group and death group. TheAPACHEⅢ scores of the death group were all higher than those of the survival group.Dynamic APACHEⅢ scoring of patients elevated steadily in group of death; Scoring issignificantly difference between survival group and death group in2and3days (P＜0.01).6The Area Under the Receiver Operating Characteristics Cure(AUROCC) ofAPACHEⅢ was0.795; The best dividing Point was60.7APACHEⅢ score of the patients was related to patients ADL negatively (r=-0.612,P=0.0005); and related to the direct care time of the patients positively (r=0.679,P=0.0005).Conclusions：1APACHEⅢscoring system can evaluated disease severity of infection diseasepatients, nurse can use APACHEⅢscoring system to assess disease and provideintervention for infection disease patients.2APACHEⅢ scoring system has good application value in predicting prognosis of agroup of infection disease patients. The best dividing point is60. When ARACHEⅢ score is more than60, the risk of death significantly increased. It is suggested thatclinical medical and nursing staff should emphasize the point and find disease changeto provide intervention earlier.3APACHEⅢ score of the patients was related to the incidence of MODS positively.As treatment continued, the APACHEⅢ score of survival group decreased while theAPACHEⅢscore of the death group increased. Dynamic APACHEⅢ scoring can beused for evaluation of the MODS patients’ prognosis.4The direct care time of the inpatients was related to patients ADL negatively, andrelated to the APACHEⅢ score positively, the direct care time of inpatients withdifferent levels of ADL and APACHEⅢscore were different. The nursing managerscan assign the nursing resource more scientifically based on the APACHEⅢ score ofinpatients. APACHEⅢ score can help to optimize the dispositionof nursing staff andexercise better nursing service so as to improve the quality of nursing care and thesatisfactory rate about the nursing service.