The application value of traditional Chinese medicine symptom score in evaluation of prognosis of patients with acute exacerbation of chronic cardiac insufficiency and establishment of mortality probability model / 中国中西医结合急救杂志

ABSTRACT

Objective To explore the application value of traditional Chinese medicine (TCM) symptom score in the evaluation of the prognosis of patients with acute exacerbation of chronic cardiac insufficiency and establish a mortality probability model to assess the patients' consistency between the risk of death and actual death. Methods A retrospective observational study was conducted. Three hundred and twenty patients with acute exacerbation of chronic cardiac insufficiency admitted to Zhuji Hospital of TCM from January 2015 to June 2017 were divided into survival and death groups according to 28-day prognosis. The TCM symptom score and acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) score were recorded on admission, then Spearman correlation analysis was used to determine the correlation between the two types of evaluating score; the differences in APACHE Ⅱ score and TCM symptom score between the two groups of patients were compared; the receiver operating characteristic curve (ROC) was drawn, and the area under ROC curve (AUC) was calculated to evaluate the values of APACHE Ⅱ score and TCM symptom score in predicting the prognosis of patients. Whether the patients being dead or not and the TCM symptom score were used to carry out the logistic regression analysis and establish the regression model, then the relationship between the risk of death and actual death was verified. Results A total of 320 patients were enrolled, of whom 279 survived and 41 died.① The APACHE Ⅱ score and TCM symptom score in the dead group were significantly higher than those in survival group [APACHE Ⅱ score 30.0 (22.5, 33.5) vs. 14.0 (8.0, 21.0); TCM symptom score 28 (25, 33) vs. 15 (10, 20); both P < 0.01]. ② The APACHE Ⅱ score of patients with acute exacerbation of chronic cardiac insufficiency was positively correlated with their TCM symptom score obviously (r = 0.814, P < 0.01). ③ The AUC for predicting the prognosis of patients with acute exacerbation of chronic cardiac insufficiency by APACHE Ⅱ score and TCM symptom score were 0.816 and 0.920 respectively, when the best critical value of APACHE Ⅱ score was 21, the sensitivity of predicting death in the patients was 82.9%, and specificity was 74.1%, and the 95% confidence interval (95%CI) was 0.739-0.893;when the best critical value of TCM symptom score was 25, the sensitivity of predicting death in patients was 82.7%, specificity was 91.0% and 95%CI was 0.876-0.964. ④ Whether the patient being dead or not and TCM symptom score were brought into logistic regression analysis to obtain the death risk model ln [R/(1-R)] = -8.131+0.283×TCM symptom score, after the TCM symptom score was substituted into the death risk model, the result revealed that the death risk was consistent with the actual death situation, that is with the rising of TCM symptom score, the death risk rate increases, and the actual fatality rate also increases gradually. Conclusions The application of TCM symptom score is helpful to realize the degree of disease severity and early judgement of prognosis in patients with chronic cardiac insufficiency.