急诊全身炎症反应综合征患者3日死亡的预测因素

The independent predictors of 3-day mortality in patients with systemic inflammatory response syndrome in emergency department

目的研究急诊抢救室全身炎症反应综合征（systemic inflammatory response syndrome，SIRS）患者3d内死亡的独立预测因素。方法此研究为前瞻性，选取2006年12月至2007年9月在北京朝阳医院急诊抢救室救治的符合SIRS诊断的患者640例，排除1h内死亡的病例，检测血浆B型钠尿肽（B-type natriuretic peptide，BNP）和血清肌钙蛋白I（cardiac troponinI，cTNI）水平，并进行早期预警评分（early warningscore，EWS），使用秩和检验比较3d内死亡组与存活组BNP，cTNI，EWS的差异，用logistic回归分析确定3d内死亡的独立预测因素，采用受试者工作特征（ROC）曲线确定预测因素的界值。结果急诊抢救室3d内死亡的SIRS患者的平均年龄为73．5岁（65～80）岁，BNP水平为468．5pg／mL（161．5～1862．5pg／mL），cTNI水平为0．37ng／mL（0．07～2．61ng／mL），EWS评分为6分（5—9）。存活组SIRS患者平均年龄为71岁（60—77），BNP水平239pg／mL（56．3～783．8pg／mL），cTNI水平0．07ng/mL（0．03～0．26ng／mL），EWS评分4分（3～6）分。两组间年龄，BNP水平，cTNI水平以及EWS评分差异均具有统计学意义（P〈0．05）。3d内死亡的独立预测因素有年龄≥76岁，BNP≥115pg／mL，cTNI≥0．135ng／mL，EWS≥6。结论早期检测BNP、cTNI水平并进行EWS评分对于急诊室SIRS患者3日内死亡具有预后价值。

Objective To study the independent predictors of 3-day mortality of patients with systemic inflammatory response syndrome（SIRS） in emergency department. Method From Dec 2006 to Sep 2007, 640 patients with SIRS admitted to emergency department were enrolled. Those died within one hour were excluded. Every patient was examined on plasma B-type natriuretic peptide （BNP） level and serum cardiac Troponin I （cTNI） level. Early warning score （EWS） was calculated. Rank test was used to compare the difference of BNP, cTNI and EWS between survivors and non-survivors. Logistic regression analysis was used to determine the independent predictors for death and receiver operator characteristic curve was used to determine the cutoff values. Results The mean levels of age, BNP, cTNI and EWS of patients died in 3 days were 73.5（65 - 80）,468.5 pg/mL（161.5 - 1862.5 pg/mL） ,0.37 ng/mL（0.07 - 2.61 ng/mL） and 6（5 - 9）, respectively. In survivors, the mean levels of age, BNP, cTNI and EWS were 71（60- 77）, 239 pg/mL（56.3 - 783.8 pg/mL）, 0.07 ng/mL（0.03 - 0.26 ng/mL）and 4（3 - 6）, respectively. There were significant difference in age, BNP, cTNI and EWS between two groups （ P 〈 0.05 ）. Age ≥ 76, BNP ≥115 pg/mL, cTNI ≥0.135 ng/mL and EWS ≥ 6 were independent predictors of death. Conclusions Levels of BNP, cTNI and EWS were predictors of death in SIRS patients during emergency department stay.