중환자실에 입원하는 혈액종양 환자의 예후 예측에 있어 Simplified Acute Physiology Score 2 (SAPS 2)와 Sequential Organ Failure Assessment (SOFA) Score의 유용성
The Prognostic Utility of the Simplified Acute Physiology Score 2 (SAPS 2) and the Sequential Organ Failure Assessment (SOFA) Score for Hemato-Oncology Patients Admitted to the Intensive Care Unit
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Background: The prognosis of hemato-oncology (HMO) patients admitted to the intensive care unit (ICU) is poor and predicting the mortality is important for decision making at the time of ICU admission and for administering aggressive treatment. Methods: We retrospectively reviewed 309 patients who were admitted to the medical ICU (MICU) at Samsung Medical Center from July in 2005 to June in 2006. We calculated their Simplified Acute Physiology Score II (SAPS II) and the Sequential Organ Failure Assessment (SOFA) score at the time of ICU admission and we investigated the relationship between the two scoring systems and the hospital mortality. Results: Among the 309 patients, the hospital mortality was 41.2%, and the mean SAPS II/SOFA score at ICU admission was 45.4±19.5/8.1±4.6. Seventy-nine (25.6%) patients had hemato-oncological diseases. Their hospital mortality was 65.8%, and the mean SAPS II/SOFA score at the time of ICU admission was 53.9±18.6/9.7±4.4, which was higher than that of the non-HMO patients (p=0.00). The area under the receiver operating characteristic (ROC) curves for the SAPS II/SOFA score for predicting the mortality was 0.794±0.05/0.785±0.051 (p=0.00/p=0.00) for the HMO patients. There was no significant difference in discrimination ability between the two scoring systems (p>0.05). None of the HMO patients with a SAPS II/SOFA score of 70/14 or higher survived. Conclusions: Both the SAPS II and SOFA scores at the time of ICU admission were similarly effective for predicting the hospital mortality. The two scoring systems could be useful tools for decision making at the time of ICU admission and for administering aggressive treatment.
Abstract
Background: The prognosis of hemato-oncology (HMO) patients admitted to the intensive care unit (ICU) is poor and predicting the mortality is important for decision making at the time of ICU admission and for administering aggressive treatment. Methods: We retrospectively reviewed 309 patients who were admitted to the medical ICU (MICU) at Samsung Medical Center from July in 2005 to June in 2006. We calculated their Simplified Acute Physiology Score II (SAPS II) and the Sequential Organ Failure Assessment (SOFA) score at the time of ICU admission and we investigated the relationship between the two scoring systems and the hospital mortality. Results: Among the 309 patients, the hospital mortality was 41.2%, and the mean SAPS II/SOFA score at ICU admission was 45.4±19.5/8.1±4.6. Seventy-nine (25.6%) patients had hemato-oncological diseases. Their hospital mortality was 65.8%, and the mean SAPS II/SOFA score at the time of ICU admission was 53.9±18.6/9.7±4.4, which was higher than that of the non-HMO patients (p=0.00). The area under the receiver operating characteristic (ROC) curves for the SAPS II/SOFA score for predicting the mortality was 0.794±0.05/0.785±0.051 (p=0.00/p=0.00) for the HMO patients. There was no significant difference in discrimination ability between the two scoring systems (p>0.05). None of the HMO patients with a SAPS II/SOFA score of 70/14 or higher survived. Conclusions: Both the SAPS II and SOFA scores at the time of ICU admission were similarly effective for predicting the hospital mortality. The two scoring systems could be useful tools for decision making at the time of ICU admission and for administering aggressive treatment.
참고문헌 (26)
- Ferreira FL, "Serial evaluation of the SOFA score to predict outcome in critically ill patients", Jama, 286, pp.1754~1758 (2001)
- Kajdacsy-Balla Amaral AC, "Use of the sequential organ failure assessment score as a severity score", Intensive Care Med, 31, pp.243~249 (2005)
- Le Gall JR, "A new Simplified Acute Physiology Score (SAPS II) based on a European", North American multicenter study, 1993, pp.270, 2957~2963
- Cornet AD, "Sequential organ failure predicts mortality of patients with a haematological malignancy needing intensive care", Eur J Haematol, 74, pp.511~516 (2005)
- Kroschinsky F, "Outcome and prognostic features of intensive care unit treatment in patients with hematological malignancies", Intensive Care Med, 28, pp.1294~1300 (2002)
- Lamia B, "Changes in severity and organ failure scores as prognostic factors in onco-hematological malignancy patients admitted to the ICU", Intensive Care Med, 32, pp.1560~1568 (2006)
- Vincent JL, "The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction", failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine, 1996, pp.22, 707~710
- Vincent JL, "Use of the SOFA score to assess the incidence of organ dysfunction", failure in intensive care units: results of a multicenter, prospective study. Working group on "sepsis-related problems" of the European Society of Intensive Care Medicine, 1998, pp.26, 1793~1800
- Le Gall JR, "A simplified acute physiology score for ICU patients", Crit Care Med, 12, pp.975~977 (1984)
- Moreno R, "Outcome prediction in intensive care: results of a prospective, multicentre, portuguese study", Intensive Care Med, 23, pp.177~186 (1997)
- Moreno R, "The use of maximum SOFA score to quantify organ dysfunction", failure in intensive care. Results of a prospective, multicentre study, 1999, pp.25, 686~696[DOI]
- Afessa B, "Intensive care unit support and Acute Physiology and Chronic Health Evaluation III performance in hematopoietic stem cell transplant recipients", Crit Care Med, 31, pp.1715~1721 (2003)
- Benoit DD, "Outcome and early prognostic indicators in patients with a hematologic malignancy admitted to the intensive care unit for a life-threatening complication", Crit Care Med, 31, pp.104~112 (2003)
- Brunet F, "Is intensive care justified for patients with haematological malignancies?", Intensive Care Med, 16, pp.291~297 (1990)
- Epner DE, "Outcome of mechanical ventilation for adults with hematologic malignancy", J Investig Med, 44, pp.254~260 (1996)
- Evison J, "Intensive care unit admission in patients with haematological disease: incidence, outcome and prognostic factors", Swiss Med Wkly, 131, pp.681~686 (2001)
- Massion PB, "Prognosis of hematologic malignancies does not predict intensive care unit mortality", Crit Care Med, 30, pp.2260~2270 (2002)
- Schuster DP, "Precedents for meaningful recovery during treatment in a medical intensive care unit. Outcome in patients with hematologic malignancy", Am J Med, 75, pp.402~408 (1983)
- Silfvast T, "Multiple organ failure and outcome of critically ill patients with haematological malignancy", Acta Anaesthesiol Scand, 47, pp.301~306 (2003)
- Blot F, "Prognostic factors for neutropenic patients in an intensive care unit: respective roles of underlying malignancies and acute organ failures", Eur J Cancer, 33, pp.1031~1037 (1997)
- Darmon M, "Impact of neutropenia duration on short-term mortality in neutropenic critically ill cancer patients", Intensive Care Med, 28, pp.1775~1780 (2002)
- Khassawneh BY, "Outcome from mechanical ventilation after autologous peripheral blood stem cell transplantation", Chest, 121, pp.185~188 (2002)
- Price KJ, "Prognostic indicators for blood and marrow transplant patients admitted to an intensive care unit", Am J Respir Crit Care Med, 158, pp.876~884 (1998)
- Staudinger T, "Outcome and prognostic factors in critically ill cancer patients admitted to the intensive care unit", Crit Care Med, 28, pp.1322~1328 (2000)
- Guiguet M, "Severity-of-illness scores for neutropenic cancer patients in an intensive care unit: which is the best predictor? Do multiple assessment times improve the predictive value?", Crit Care Med, 26, pp.488~493 (1998)
- Cabre L, "Multicenter study of the multiple organ dysfunction syndrome in intensive care units: the usefulness of Sequential Organ Failure Assessment scores in decision making", Intensive Care Med, 31, pp.927~933 (2005)