国家早期预警评分联合动脉血乳酸对急诊老年危重患者死亡预测的研究

Prognostic value of National Early Warning Scores combined with arterial lactate level in critical elderly ill patients

目的评价国家早期预警评分（NEWS）联合动脉血乳酸在急诊老年危重症患者死亡预测中的意义。方法随机（随机数字法）选取2013年9月至2015年7月入北京医院急诊科抢救室的413例老年危重症患者。计算NEWS评分并检测动脉血乳酸，电话随访30d转归并分为存活组和死亡组，采用多因素回归分析和受试者工作特征曲线（ROC）评价NEWS评分、动脉血乳酸以及两者联合对患者死亡的预测价值。结果死亡组与存活组NEWS评分、动脉血乳酸值存在差异。多因素回归分析结果显示NEWS评分、动脉血乳酸以及两者联合均为30d死亡风险的独立预测因子（均P〈0．05，OR〉1）。三者的ROC曲线下面积分别是0．721、0．746、0．762。NEWS评分和NEWS评分联合动脉血乳酸的ROC曲线下面积比较差异具有统计学意义，NEWS评分最佳截断点为7分，动脉血乳酸水平最佳截断点为2．7mmol／L。结论NEWS评分、动脉血乳酸、NEWS评分联合动脉血乳酸均为急诊老年危重症患者30d死亡风险的独立预测因子。三者均有中等预测价值，NEWS评分联合动脉血乳酸在急诊老年危重症患者30d死亡预后评估方面较单纯NEWS评分预测能力更强。

Objective To investigate the prognostic value of National Early Warning Scores （NEWS） combined with arterial lactate level in elderly patients with critical illness in emergency department. Methods A total of 413 elderly patients with critical illness randomly （random number） selected from resuscitation room in emergency department from September 2013 to July 2015 were enrolled in this study. NEWS system was employed to determine the patients＇ condition. Arterial lactate level was detected. The patients were followed for the 30-day death by telephone calls and patients were divided into survival group and death group. Multivariate logistic regression analysis and receiver operating characteristic curve （ROC） were used to evaluate the prognostic values of NEWS score, arterial lactate level, and NEWS score combined with arterial lactate level in patients without survival. Results There were significant differences in NEWS score and arterial lactate level between the death group and the survival group. The results of multiple factor regression showed that NEWS score, arterial lactate level, and NEWS score combined with arterial lactate level were all independent predictors of 30-day death （ P 〈 O. 05, OR 〉 1 ）. The AUCs of the three evaluation modalities were O. 721, 0. 746 and 0. 762, respectively. There was a significant difference in the area under the ROC curve between NEWS score and NEWS score combined with arterial lactate level. The optimal cut-off point of NEWS score was 7, and arterial lactate level was 2. 7 mmol/L. Conclusions NEWS score, arterial lactate level, and NEWS score combined with arterial lactate level were independent predictors of 30-day death in elderly patients with critical illness in emergency department. They all had some predictive value, and NEWS score combined with arterial lactate level had higher capability to predict 30-day death in elderly patients with critical illness in emergency department than NEWS score alone.