Шкала APACHE II точнее прогнозирует госпитальную летальность, чем показатели воспаления, у пациентов с острым коронарным синдромом

Цель    В этом исследовании оценивалось прогностическое значение шкалы APACHE II и осуществлялось его сравнение с показателями воспаления у пациентов с острым коронарным синдромом (ОКС).
Материал и методы    В исследование было ретроспективно включено 525 пациентов с ОКС. Рассчитывали баллы по шкале APACHE II и определяли уровень С-реактивного белка (СРБ), соотношение нейтрофилов и лимфоцитов (NLR) и индекс системного иммунного воспаления (SII). Шкала APACHE II сравнивалась с воспалительными индексами для прогнозирования внутрибольничной летальности.
Результаты    Однофакторный логистический регрессионный анализ показал, что уровень СРБ, значения SII и NLR, фракция выброса, хроническая болезнь почек, пол и оценка по шкале APACHE II были значимыми предикторами госпитальной летальности. При проведении многофакторного логистического регрессионного анализа оценка по шкале APACHE II оказалась единственным значимым предиктором госпитальной летальности (ОШ: 1,201, 95% ДИ: 1,122–1,285; р<0,001). По результатам ROC-анализа при использование точки отсечения 16,5 шкала APACHE II предсказывает госпитальную летальность с чувствительностью 70,4% и специфичностью 92,9%.
Заключение    Шкала APACHE II может использоваться в качестве предиктора госпитальной летальности с большей точностью, чем маркеры воспаления у пациентов с ОКС.

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