急诊脓毒症死亡风险评分对急诊脓毒症患者危险分层的价值研究

Value of mortality in emergency department sepsis （MEDS） score in the risk stratification of septic patients in the emergency department

目的探讨急诊脓毒症死亡风险（MEDS）评分对急诊脓毒症患者危险分层的价值。方法选取2010—03～2010—10就诊于苏北医院急诊室、拟诊为脓毒症并住院的586例患者，进行MEDS评分、急性生理学与慢性健康状况评分Ⅱ（APACHEⅡ）和动脉血乳酸测定，记录28d转归情况。通过Logistic回归分析评价各预测因子分值与预后的关系，通过受试者工作特征（ROC）曲线对三种独立预测因子的预后能力进行比较。结果586例患者28d死亡54例，死亡组三个预测因子均明显高于存活组（MEDS评分11．5分比4．2分，APACHEⅡ评分24．9分比19．2分，乳酸4．8mmol／L比3．3mmol／L，P均〈0．01）。MEDS评分≤4分患者病死率为2．7％，5～7分为4．7％，8～12分为13．8％，13～15分为30．0％，〉15分达60．0％，趋势检验P〈0．001。MEDS评分、APACHEⅡ评分及血乳酸的ROC曲线下面积（AUC）分别为0．86、0．72、0．76，MEDS评分对28d病死率预测能力优于血乳酸（P=0．017）及APACHEⅡ评分（P=0．008）。结论MEDS评分对急诊脓毒症患者是良好的危险分层工具，预测预后能力优于APACHEⅡ评分和血乳酸。

Objective To evaluate the value of mortality in emergency department sepsis （MEDS） score in the risk stratification of septic patients in the emergency department. Methods 586 adult patients with sepsis admitted to Subei People＇s Hospital of Jiangsu province from March 2010 to October 2010 were eligible for the study. MEDS score, Acute Physiology and Chronic Health Evaluation Ⅱ （APACHE Ⅱ ） score and arterial blood lactate were collected and the outcomes in 28 days were recorded. Logistic regression analysis was used to evaluate the relationship between each predictive factor score and prognosis. Discrimination of each predictive factor was compared with the areas under the receiver operating characteristics （ROC） curve （AUC）. Results ①54 patients died in 28 days in a total of 586 patients. The levels of 3 predictive factors were obviously higher in nonsurvivors than survivors（ 11.5 vs 4.2 for MEDS score; 24.9 vs 19.2 for APACHE Ⅱ score; 4.8 mmol/L vs 3.3 mmol/ L for lactate; P 〈 0.01 ）. ②The mortality of patients whose MEDS ≤4, 5 - 7, 8 - 12, 13 -15, and 〉 15 was 2.7%, 4.7%, 13.8%, 30.0%, 60.0% respectively, P〈0.001 in the trend test. ③The AUC was 0. 86, 0.72 and 0. 76 for MEDS score, APACHE Ⅱ score and blood lactate respectively. The predictive ability of MEDS for 28 - day mortality was better than that of blood lactate （ P = 0. 017 ） and APACHE Ⅱ score （ P = 0. 008 ）. Conclusion MEDS is a good risk stratification tool for emergency patients with sepsis, it＇s prognostic capability is better than APACHE Ⅱ score and blood lactate.