摘要目的 研究查尔森合并症指数(Charlson's weighted index of comorbidities,WIC)评价基础疾病对急诊内科患者留院观察时间的预测价值.方法 回顾性分析北京朝阳医院急诊科2013年1月1日至2013年6月30日观察室内科留院观察患者2836例的临床资料,包括患者年龄、性别、留观疾病诊断、基础疾病、是否居住老年公寓,留观24h内的WIC评分和急性生理与慢性健康状况(APACHE)Ⅱ评分,并且记录患者留观转归情况和留院观察时间.2836例患者按照留观时间进行分组:留观时间≥72 h的1908例(A组),＜72 h的928例(不含死亡患者,B组).用Logistic回归方法分析影响患者留院观察的因素,并且绘制受试者工作特征曲线(ROC),评价WIC评分对留院观察时间≥72 h的预测作用.结果 2836例留观患者中,因呼吸系统疾病留观者1176例(41.5％),心脑血管系统疾病709例(25.0％),消化系统疾病423例(14.9％),肾脏和内分泌系统疾病251例(8.8％),理化等因素致病以及其他277例(9.8％).A组患者的WIC分值(3.1±1.2)和APACHEⅡ分值(18.5±8.3)较B组WIC分值(1.8±1.4)和APACHEⅡ分值(12.5 ±6.1)均高(P＜0.05).高龄、居住老年公寓、WIC分值和APACHEⅡ分值均为留院观察时间≥72 h相关因素.WIC评分和APACHEⅡ评分以及二者联合预测留观时间≥72 h的ROC曲线下面积依次为0.701、0.788和0.853.结论 WIC评分系统可以较好的通过基础疾病评价急诊内科患者的留院观察时间.

abstractsObjective To investigate the role of underlying diseases in predicting the length of stay for observation in emergency department of internal medicine by the Charlson weighted index of comorbidities (WIC).Methods A single-center retrospective analysis of clinical data of 2 836 patients admitted in emergency observation room of the Beijing Chaoyang Hospital from January 1 to June 30 in 2013 was carried out.The patients were divided into two groups according to the length of observation time:Group A (time of observation ≥72 h,n =1908) and Group B (time of observation ＜ 72 h,n =928).The data of the length of observation time were recorded,and the WIC and the APACHE Ⅱ score were calculated.Logistic regression analysis was used to determine the independent predictors for 72-hour observation.Receiver operating characteristics (ROC) curve was used to evaluate the value of WIC in predicting 72-hour observation.Results Of 2836 patients,1176 (41.5％) suffered from respiratory disease,709 (25.0％) had cardiovascular and cerebrovascular diseases,423 (14.9％) were contracted digestive system disease,251 (8.8％) had renal and endocrinology system diseases and 277 (9.8％) had diseases arisen from physicochemical factor and miscellaneous causes.Compared with patients in Group B,the average age,the number of elderly patients residing in apartment exclusively for elderly,the WIC and the APACHE Ⅱ score were higher in patients in Group A.The one-variable and multi-variable Logistic regression analyses showed that age,the WIC score,the APACHE Ⅱ score and residing in apartment for elderly people were related with 72-hour observation in emergency observation room.The area under the ROC curve in predicting 72-hour observation was 0.701 for the WIC score,0.788 for APACHE Ⅱ score and 0.853 for their combination.Conclusions The WIC scoring system can be a good predicting method for 72-hour observation in patients in emergency observation room.