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目的评价入院时急性生理与慢性健康评估Ⅱ(APACHEⅡ)评分在重症急性胰腺炎(SAP)发生深部真菌感染(DFI)中的判断价值。方法回顾性分析2006年1月至2011年6月期间我院收治的132例SAP患者的临床资料,采用受试者操作特征曲线(ROC)评价APACHEⅡ评分预测DFI的价值。结果 132例SAP患者中39例发生DFI(29.5%),其中白色念珠菌感染36例(92.3%),合并热带念珠菌2例(5.1%),合并近平滑仿珠菌1例(2.6%);单部位感染27例(69.2%),多部位感染12例(30.8%)。39例发生DFI患者入院时APACHEⅡ评分为(17.1±3.8)分,而93例未发生DFI患者入院时APACHEⅡ评分为(9.7±2.1)分,前者明显高于后者(t=14.316,P=0.000)。APACHEⅡ评分对SAP患者发生DFI预测的ROC曲线下面积为0.745(P=0.000),95%CI为0.641～0.849。当截断值为15分时,预测效能最佳,其特异度为0.81,灵敏度为0.72,约登指数为0.53。结论入院时APACHEⅡ评分能较好地预测SAP患者DFI的发生,尤其当APACHEⅡ评分大于15分时,高度提示发生DFI的可能,必要时可行预防性抗真菌治疗。
Objective To evaluate the value of acute physiology and chronic health assessment Ⅱ (APACHEⅡ) score on admission to deep fungal infection (DFI) in severe acute pancreatitis (SAP). Methods The clinical data of 132 patients with SAP admitted in our hospital from January 2006 to June 2011 were retrospectively analyzed. The value of APACHE Ⅱ score in predicting DFI was evaluated by using receiver operating characteristic curve (ROC). Results The DFI was found in 39 out of 132 patients (29.5%), of which 36 (92.3%) were Candida albicans, 2 (5.1%) were Candida tropicalis, and 1 (2.6% ; Single-site infection in 27 cases (69.2%), multi-site infection in 12 cases (30.8%). The APACHE II score was (17.1 ± 3.8) at admission in 39 patients with DFI, and APACHEⅡ score was (9.7 ± 2.1) at admission in 93 patients without DFI, the former was significantly higher than the latter (t = 14.316, P = 0.000 ). The area under the ROC curve of APACHE II score for DFI prediction of SAP patients was 0.745 (P = 0.000) and the 95% CI was 0.641-0.849. When the cut-off value is 15, the prediction efficiency is the best, with a specificity of 0.81, a sensitivity of 0.72 and a Youden index of 0.53. Conclusions APACHEⅡscores on admission can predict the occurrence of DFI in patients with SAP. Especially when the APACHEⅡscore is greater than 15 points, it is highly suggestive of the possibility of DFI. If necessary, prophylactic antifungal therapy is feasible.