WIC评分预测心肺复苏后自主循环恢复患者预后的价值

摘要

Objective To explore the predictive value of Charlson's weighted index of comorbidities (WIC) in predicting the prognosis of patients with restoration of spontaneous circulation (ROSC) after cardiopulmonary resuscitation (CPR).Methods A retrospective review was performed for the patients with ROSC after CPR.In 182 enrolled patients,139 patients died and 43 patients survived.The clinical data were recorded including general information (gender,age),original diseases (myocardial infarction,congestive heart failure,peripheral vascular disease,cerebrovascular accident,dementia,chronic lung diseases,connective tissue disease,ulcers,mild liver damage,diabetes,hemiplegia,moderately severe kidney disease,diabetes accompanied with organ damage,tumors,and moderately severe liver diseases,etc.),complications [sepsis and multiple organ failure (MODS)] and WIC score,acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score.The logistic regression was used and the receiver operating characteristic curve (ROC curve) was drawn to calculate the prognosis of ROSC patients.Results Univariate analysis showed that age,complications (sepsis and MODS),WIC score and APACHE Ⅱ score were independently associated with the prognosis of patients with CRP after ROSC (all P ＜ 0.05);gender and original diseases had nothing to do with the prognosis of ROSC patients (all P ＞ 0.05).Multivariate logistic regression analysis showed that age (OR =1.050,95％ CI:1.008-1.094),WIC score (OR =0.544,95 ％ CI:1.058-2.254),APACHE Ⅱ score (OR =1.471,95％ CI:1.204-1.796) and having MODS or not (OR =3.207,95％ CI:1.321-7.789) were independently associated with the prognosis of ROSC patients (all P ＜ 0.05).ROC curve areas of WIC score,APACHE Ⅱ score and the combination of the two in predicting the prognosis of patients were 0.723 (95％ CI:0.648-0.817),0.806 (95％ CI:0.727-0.885),0.822 (95％ CI:0.749-0.895).The predictive value of the combination of the two and APACHE Ⅱ score were greater than that of WIC score in predicting prognosis (Z =2.659,2.125,all P ＜0.05).But there was no significant difference between the combination of the two and APACHE Ⅱ score (P ＞ 0.05).Conclusion WCI score can be used for predicting the prognosis of patients with ROSC after CPR,which is more convenient and easy to carry out.%目的 探讨查尔森合并症指数(WIC)评分预测心肺复苏后自主循环恢复患者预后的价值.方法 选择实施心肺复苏后自主循环恢复的成年心脏骤停患者182例,入院72 h死亡139例(死亡组)、存活43例(存活组).收集两组临床资料,包括一般资料(性别、年龄)、基础疾病(心肌梗死、充血性心力衰竭、周围血管疾病、脑血管意外、痴呆、慢性肺部疾病、结缔组织病、溃疡病、轻度肝损害、糖尿病、偏瘫、中重度肾脏疾病、糖尿病伴器官损害、肿瘤、中重度肝脏疾病)、并发症[脓毒症、多器官功能衰竭(MODS)]以及WIC评分、急性生理与慢性健康状况评分Ⅱ(APACHEⅡ评分).采用单因素和多因素Logistic回归分析分析患者预后的影响因素.绘制受试者工作特征(ROC)曲线,评估WIC评分预测患者预后的效能.结果 单因素分析显示,年龄、并发症(脓毒症、MODS)、WIC评分、APACHEⅡ评分可能与患者预后有关(P均＜0.05),性别、基础疾病与患者预后无关(P均＞0.05).多因素Logistic回归分析显示,年龄(OR=1.050,95％ CI:1.008 ～1.094)、WIC评分(OR=1.544,95％ CI:1.058～2.254)、APACHEⅡ评分(OR=1.471,95％CI:1.204～1.796)、合并MODS(OR=3.207,95％ CI:1.321～7.789)是患者预后的独立影响因素(P均＜0.05).ROC曲线分析显示,WIC评分、APACHE Ⅱ评分及二者联合对患者预后预测概率的曲线下面积分别为0.723(95％ CI:0.648～0.817)、0.806(95％ CI:0.727～0.885)、0.822(95％ CI:0.749～0.895);二者联合和单独APACHE Ⅱ评分预测患者预后的ROC曲线下面积明显大于单独WIC评分(Z分别为2.659、2.125,P均＜0.05),但二者联合与单独APACHE Ⅱ评分预测患者预后的ROC曲线下面积比较P＞0.05.结论 WIC评分可用于预测心肺复苏后自主循环恢复患者预后,联合APACHE Ⅱ评分效果更佳.