改良早期预警评分与简明急性生理功能评分Ⅱ在恶性肿瘤急诊患者近期死亡中的预测价值

Value of Modified Early Warning Score and Simplified Acute Physiology Score Ⅱ in Predicting Short-term Mortality of Emergent Patients with Malignant Tumor

[目的]探讨改良早期预警评分（MEWS）与简明急性生理功能评分Ⅱ（SAPSⅡ）在恶性肿瘤急诊患者近期死亡中的预测价值。[方法]采用回顾性研究方法,选取2015年1月1日至2016年12月31日中国医学科学院肿瘤医院综合科急诊就诊的200例恶性肿瘤患者,按转归分为死亡组（14天内死亡）100例和存活组（14天内未死亡）100例。绘制MEWS评分与SAPSⅡ评分对所有患者近期死亡预测的工作特征曲线（ROC曲线）,计算约登指数,以最大约登指数时的评分为临界值。通过对比两种评分ROC曲线下面积评估两种评分方法对恶性肿瘤急诊患者近期死亡的预测价值。[结果]KPS评分在死亡组显著低于存活组,MEWS、SAPSⅡ评分在死亡组均显著高于存活组。三种评分均对患者14天内死亡具有一定的预测价值（P均为0.00）。其中以SAPSⅡ评分的ROC曲线下面积最大,为0.874。[结论 ]SAPSⅡ评分能够更好地预测恶性肿瘤急诊患者的14天内死亡,而MEWS、KPS评分系统虽然对于预测恶性肿瘤急诊患者14天内死亡的价值相对较低,但由于其方法简便快速,亦对评估患者病情具有重要意义。

[Purpose] To evaluate the application of modified early warning score（MEWS） and simplified acute physiology score Ⅱ（SAPS Ⅱ） in predicting short-term mortality of emergent patients with malignant tumor. [Methods] Clinical data of 200 emergency patients admitted to General Department of National Cancer Center/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College from January 2015 to December 2016 were retrospectively reviewed. The patients died with 14 days after admission were classified as fatal group（n=100） and those survived in 14 days after admission were classi-fied as survival group（n=100）. The receiver operator characteristic curve（ROC） and the areas under the curve（AUC） were applied to analyze the value of MEWS and SAPS Ⅱ in predicting short-term mortality of patients. Youden index were calculated to get the best cut off values. [Results] KPS in the fatal group was significantly lower than that in the survival group. MEWS and SAPS Ⅱ in the fatal group were significantly higher than those in the survival group. The 3 scores were all of value in predicting short-term mortality of emergency patients with malignant tumor（P=0.00）. AUC of SAPS Ⅱ（0.874） was larger than that of KPS and MEWS（0.737 and 0.742）. [Conclusion] SAPS Ⅱ can better predict short-term mortality of emergency patients with malignant tumor than MEWS and KPS,but MEWS and KPS are more convenient and easy to be used.