NEWS、REMS和APACHEⅡ评分对急诊危重患者预后评估的对比研究

Comparison of national early warning score, rapid emergency medicine score and acute physiology and chronic health evaluation Ⅱ score for predicting outcome among emergency severe patients

目的对比分析英国早期预警评分（NEWS）、快速急诊内科评分（REMS）和急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分评估急诊危重患者预后的价值。方法回顾性分析2016年1月至2017年6月南华大学附属南华医院急诊科收治的年龄〉16岁、住院时间〉24 h的危重患者资料，根据患者入住急诊监护室或抢救室后24 h内各指标最差值计算NEWS、REMS和APACHEⅡ评分。主要研究终点为28 d病死率。分析3种评分与患者预后的关系；通过受试者工作特征曲线（ROC）分析3种评分对急诊危重患者预后的预测价值。结果共有119例急诊危重患者入选，28 d病死率为21.0%。死亡组NEWS、REMS和APACHEⅡ评分明显高于存活组〔NEWS（分）：9.40±3.19比5.72±2.35，REMS（分）：12.64±4.46比7.97±3.28，APACHEⅡ（分）：26.64±6.92比16.19±5.48，均P〈0.01〕。随着NEWS、REMS和APACHEⅡ评分的增高，患者28 d病死率逐渐升高〔NEWS〈5分、5-6分、≥7分的病死率分别为3.03%（1/34）、13.33%（4/34）、64.25%（20/51），REMS〈12分、12-16分、≥17分的病死率分别为10.99%（10/91）、50.00%（11/22）、66.67%（4/6）；APACHEⅡ〈15分、15-24分、≥25分的病死率分别为2.33%（1/43）、15.09%（8/53）、69.57%（16/23），均P〈0.01〕。ROC曲线分析显示，NEWS、REMS、APACHEⅡ评分对急诊危重患者预后预测的ROC曲线下面积（AUC）分别为0.830〔95%可信区间（95%CI）=0.737-0.923〕、0.782（95%CI=0.671-0.892）和0.878（95%CI=0.800-0.956），均P=0.000；其预测准确性分别为57.4%、48.6%、65.4%。结论NEWS、REMS和APACHEⅡ评分在预测急诊危重患者预后方面均有效，APACHEⅡ预测准确性最高，NEWS次之，REMS最低；综合考虑成本效益等因素，急诊危重患者更适合用NEWS评分进行早期预后评估。

ObjectiveTo analyze the comparation of national early warning score （NEWS）, rapid emergency medicine score （REMS） and acute physiology and chronic health evaluation Ⅱ（APACHE Ⅱ） score in predicting prognosis of critically ill patients in emergency department （ED）.MethodsA retrospective study was conducted. Critically ill patients, aged 〉 16 years, hospitalized 〉 24 hours, and admitted to the ED of Nanhua Hospital Affiliated to South China University from January 2016 to June 2017 were enrolled. NEWS, REMS and APACHE Ⅱ score were calculated based on the worst value of each index within 24 hours after emergency admission. The primary endpoint was 28-day mortality. The relationship between the three scoring systems and the prognosis of patients was analyzed. The predictive value of three scoring systems for the prognosis of critically ill patients in ED was analyzed by receiver operating characteristic curve （ROC）.ResultsA total of 119 emergency severe patients were enrolled in the study, and the 28-day mortality was 21.0%. The scores of NEWS, REMS and APACHE Ⅱ in the death group were significantly higher than those in the survival group （NEWS score： 9.40±3.19 vs. 5.72±2.35, REMS score： 12.64±4.46 vs. 7.97±3.28, APACHE Ⅱscore： 26.64±6.92 vs. 16.19±5.48, all P 〈 0.01）. With the increase of NEWS, REMS and APACHE Ⅱ score, the 28-day mortality of patients gradually increased [28-day mortality of NEWS 〈 5, 5-6, ≥ 7 was 3.03% （1/34）, 13.33% （4/34）, 64.25% （20/51）; 28-day mortality of REMS 〈 12, 12-16, ≥ 17 was 10.99% （10/91）, 50.00% （11/22）, 66.67% （4/6）; 28-day mortality of APACHE Ⅱ 〈 15, 15-24, ≥ 25 was 2.33% （1/43）, 15.09% （8/59）, 69.57% （16/23）, respectively, all P 〈 0.01]. The ROC curve analysis showed that the areas under the ROC curve （AUC） of NEWS, REMS and APACHE Ⅱ score for predicting the prognosis of emergency critically ill patients were 0.830 [95% confidence interval （95%CI） = 0.737-0.923], 0.782 （95%CI = 0.671-0.892） and 0.878 （95%CI = 0.800-0.956）, respectively （all P = 0.000）, and the accuracy of prediction was 57.4%, 48.6%, 65.4%, respectively.ConclusionsThe scores of NEWS, REMS and APACHE Ⅱ were useful in predicting prognosis of critically ill patients, with the highest accuracy of APACHE Ⅱ forecast, followed by NEWS, and the lowest of REMS. After comprehensive consideration of cost-effectiveness, NEWS is more reliable in ED.