| ObjectiveTo evaluate the predictive value of NISS(new injury severity score),APACHE ?(acute physiology and chronic health evaluation ?),GCS(glasgow coma scale),a combination of NISS and GCS,a combination of APACHE? and GCS,a combination of NISS and APACHE? for the prognosis of ICU patients with severe trauma in retrospective and prospective study.MethodsThe clinical data of 614 patients with severe trauma hospitalized in ICU of the First Affiliated Hospital of Chengdu Medical College,Daping Hospital of the Third Military Medical University and the Affiliated Hospital of Zunyi Medical College from January 2010 to December 2014,according with the study criteria,were retrospectively analyzed.The patients were divided into MODS group(n=420),non-MODS group(n=194),death group(n=150)and survival group(n=464).The data of NISS,APACHE?,NGCS(corrected GCS),NISS+NGCS,APACHE?+NGCS,NISS+APACHE? score of patients on the first day of ICU admission were calculated and compared between these groups.A prospective study was conducted from April2015 to August 2016,involving 238 cases,to evaluate the above six scoring systems for predicting prognosis of ICU patients with severe trauma in ICU of Daping Hospital of the Third Military Medical University and the Affiliated Hospital of Zunyi Medical College.The patients were divided into sepsis group(n=98),non-sepsis group(n=80),MODS group(n=162),non-MODS group(n=76),death group(n=65)and survival group(n=173).The data of NISS,APACHE?,NGCS,NISS+NGCS,APACHE?+NGCS,NISS+APACHE? score of patients on the first day of ICU admission were calculated and compared between these groups.Data were processed with t test,chi-square test,and receiver operating characteristic(ROC)curve of six scoring systems in 614 patients and 238 patients with severe trauma were plotted respectively.DeLong-DeLong non parametric test was used to analysis the predictive ability for prognosis of these six scoring systems.Results(1)Results based on the retrospective study: The scores of NISS,APACHE?,NGCS,NISS+NGCS,APACHE?+NGCS,NISS+APACHE? in MODS group and death group were significantly higher than those of patients in non-MODS group and survival group(P values below 0.001).The total area under ROC curve(AUC,95%confidence interval)of above six scoring systems in MODS with two or more affected organs prediction were respectively 0.693(0.655~0.731),0.701(0.663~0.737),0.681(0.642~0.701),0.689(0.650~0.725),0.709(0.670~0.743),0.732(0.695~0.767);the AUC of above six scoring systems in MODS with three or more affected organs prediction were respectively 0.710(0.672~0.746),0.727(0.691~0.761),0.693(0.655~0.730),0.723(0.685~0.758),0.737(0.701~0.770),0.779(0.744~0.811);the AUC of above six scoring systems in MODS with four or more affected organs prediction were respectively 0.714(0.675~0.751),0.732(0.701~0.770),0.683(0.645~0.720),0.698(0.660~0.734),0.738(0.703~0.771),0.798(0.756~0.825);the AUC of above six scoring systems in death prediction were respectively0.826(0.794~0.855),0.802(0.768~0.832),0.808(0.774~0.838),0.859(0.829~0.886),0.864(0.835~0.890),0.896(0.869~0.919).(2)Results based on the prospective study: The scores of NISS,APACHE?,NGCS,NISS+NGCS,APACHE?+NGCS,NISS+APACHE? in sepsis group,MODS group and death group were significantly higher than those of patients in non-sepsis group,non-MODS group and survival group(P values below 0.001).The AUC(95%confidence interval)of above six scoring systems in sepsis prediction were respectively0.687(0.651~0.722),0.710(0.673~0.747),0.663(0.624~0.701),0.695(0.653~0.731),0.716(0.678~0.752),0.747(0.710~0.781);the AUC of above six scoring systems in MODS with two or more affected organs prediction were respectively 0.715(0.653~0.771),0.637(0.572~0.698),0.721(0.668~0.787),0.739(0.680~0.791),0.729(0.664~0.783),0.777(0.718~0.828);the AUC of above six scoring systems in MODS with three or more affected organs prediction were respectively 0.704(0.642~0.761),0.668(0.605~0.728),0.714(0.655~0.767),0.742(0.682~0.796),0.739(0.678~0.793),0.774(0.715~0.827);the AUC of above six scoring systems in MODS with four or more affected organs prediction were respectively 0.690(0.627~0.748),0.719(0.658~0.775),0.739(0.682~0.791),0.740(0.679~0.795),0.743(0.685~0.796),0.782(0.725~0.833);the AUC of above six scoring systems in death prediction were respectively 0.696(0.630~0.747),0.687(0.630~0.748),0.701(0.638~0.758),0.712(0.650~0.767),0.672(0.609~0.731),0.748(0.688~0.802).ConclusionThe combination of NISS and APACHE? has better value than NISS,APACHE?,NGCS,NISS+NGCS,APACHE?+NGCS in prediction of prognosis in ICU patients with severe trauma. |
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