急诊脓毒症死亡风险评分、降钙素原对脓毒血症预后评估的价值

Prognostic Value of Mortality in Emergency Department Sepsis and Procalcitonin in Patients with Sepsis

目的:探讨急诊脓毒症死亡风险(MEDS)评分、血清降钙素原(PCT)对脓毒血症预后评估的临床意义。方法:102例脓毒血症患者按预后分为存活组和死亡组,比较治疗早期MEDS评分、PCT及急性生理与慢性健康状况(APACHEⅡ)评分,并建立ROC曲线观察三者对预后评估的临床价值。结果:两组MEDS评分、PCT和APACHEⅡ评分均有明显差异,且MEDS评分、PCT与APACHEⅡ评分存在明显相关;MEDS评分和PCT预测死亡的ROC曲线下面积分别为0.85和0.78,MEDS的敏感性和特异性分别为80.6%和86.7%,PCT的敏感性和特异性分别为82.3%和78.4%,MEDS评分对脓毒血症预后的评估特异性优于PCT、敏感性逊于PCT;两种联合应用敏感性及特异性更高(86.3%、89.9%)。结论:MEDS评分和PCT对脓毒血症患者预后有较好的预测作用,联合使用可提高敏感性及特异性。

Objective： To explore the prognostic value of mortality in emergency department sepsis （MEDS） score and procalcitonin （PCT）. Methods： 102 patients with sepsis were divided into survival group and death group according to their outcome. The score of MEDS and levels of PCT were measured in the early stage of treatment, and APACHE II were scored. ROC was constructed to observe the prognostic value of the items. Results： There were significant differences in levels of both items and APACHE II score between the two groups, and the both items were obviously correlated with APACHE II score, all P〈0.01. The area under the curve （AUC） of MEDS and PCT were 0.85 and 0.78 respectively. The sensibility and specificity of MEDS were 80.6% and 86.7% ,while the sensibility and specificity of PCT were 82.3% and 78.4%. MEDS was better than PCT in evaluating prognosis of sepsis. The specificity was higher when MEDS and PCT were combined to evaluate the sensitive and specificity （86.3%,89.9%）. Conclusions： MEDS and PCT are both good for evaluating prognosis of patients with sepsi, and combined evaluation can increase the sensitive and specificity.