查尔森合并症指数在急诊病人留院观察时间预测中的应用
The application of Charlson's weighted index of comorbidities in predicting the hospitalisation observation time of emergency patients
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摘要: 目的：研究查尔森合并症指数（Charlson's weighted index of comorbidities，WIC）评分系统在急诊病人留院观察时间预测中的应用。方法：回顾性分析3 353例急诊留院观察病人的相关资料。按照留院观察时间对3 353例病人（不包括死亡病人）进行分组，留院观察时间≥ 72 h为A组（2 239例），留院观察时间<72 h为B组（1 114例）。对影响病人留院观察的因素进行logistic回归分析，包括病人的年龄、性别、基础疾病、居住条件（是否居住养老院）、留院观察疾病诊断，以及急性生理与慢性健康状况（APACHE）Ⅱ评分和留院观察的WIC评分。同时，根据受试者工作特征曲线（ROC），评定WIC评分在病人留院观察时间中的预测作用。结果：3 353例急诊留院观察病人中，因泌尿和内分泌系统疾病留院病人299例（8.9%），消化系统疾病522例（15.6%），循环和神经系统疾病838例（25.0%），呼吸系统疾病1 356例（40.4%），其他原因疾病338例（10.1%）。A组急诊病人的APACHEⅡ评分和WIC评分均高于B组（P<0.01）。年龄、居住养老院、WIC评分和APACHEⅡ评分均可影响病人留院观察时间（P<0.01）。多因素logistic回归分析显示，年龄、居住养老院、APACHEⅡ评分、WIC评分无共线性关系，均为影响病人留院观察时间的独立相关因素（P<0.01），APACHEⅡ评分的ROC曲线下面积为0.796，WIC评分的为0.691，两者结合的ROC曲线下面积为0.892。结论：基于基础疾病评价的WIC评分系统能够较好地预测急诊病人留院观察时间。
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关键词:
- 急诊,医院 /
- 查尔森合并症指数 /
- 急性生理与慢性健康状况 /
- logistic回归分析 /
- 受试者工作特征曲线
Abstract: Objective: To investigate the application value of Charlson's weighted index of comorbidities(WIC) in predicting the hospitalisation observation time of emergency patients.Methods: The clinical data of 3 353 emergency hospitalisation patients were retrospectively analyzed,and divided into the group A(2 239 cases,hospitalisation time ≥ 72 h) and group B(1 114 cases,hospitalisation time <72 h).The factors influencing hospitalisation time of patients were analyzed using logistic regression,and the related factors included the patient's age,sex,living condition,underlying disease,disease diagnosis,APACHEⅡ score,and WIC score.The predictive value of WIC scores in the observation time of patients was assessed by receiver operating characteristics(ROC) curve.Results: Among 3 353 patients,299(8.9%) cases with urinary and endocrine system diseases,522(15.6%) cases with digestive system diseases,838(25.0%) with circulatory and nervous diseases,1 356(40.4%) cases with respiratory disease and 338(10.1%) cases with other causes disease were found.The scores of APACHEⅡand WIC in group A were higher than those in group B(P<0.01).The age,living nursing-home,APACHEⅡ score and WIC score could affect the hospitalisation time of patients(P<0.01).The multivariable logistic regression analysis showed that the age,living nursing-home,APACHEⅡ score and WIC score did not exist the collinearity relation,and were the independently related factors of influencing the hospitalisation time of patients(P<0.01).The area under the ROC curve of APACHEⅡ score was 0.796,the WIC score was 0.691,and the area under the ROC curve of APACHEⅡ score combined with WIC score was 0.892.Conclusions: The WIC scoring system based on the underlying disease can be used to predict the hospitalisation observation time in emergency patients. -
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