改良早期预警评分系统对急性胸痛危险分层及近期预后的评估价值

Value of modified early warning score and HEART score in evaluating short-term prognosis of acute chest pain

目的探讨改良早期预警评分(MEWS)、HEART评分对急性胸痛近期预后的预测价值。方法采用前瞻性研究方法,选择2016年7月-2017年7月我院急诊科就诊的311例急性胸痛患者作为研究对象,患者入院时分别进行HEART评分和MEWS评分,按照HEART评分对患者进行危险分层(高危、中危和低危),记录随访患者发病30 d内急性冠脉综合征(ACS)、心肌梗死(MI)或死亡发生情况;利用受试者工作曲线(ROC)分析MEWS评分对患者危险分层和预后的预测价值。结果本组急性胸痛患者中高危组MEWS评分、空腹血糖、低密度脂蛋白胆固醇(LDL-C)、C-反应蛋白(CRP)明显高于中、低危组,预后不良组高血压、高血脂发生率以及MEWS评分、HEART评分、空腹血糖、总胆固醇(TC)、甘油三酯(TG)、LDL-C、CRP均明显高于预后良好组,差异有统计学意义(P<0.05)。Logistic回归分析显示高血脂、MEWS评分、HEART评分、LDL-C、CRP是急性胸痛不良预后的独立危险因素(P<0.05)。最佳临界值为3.17分时,MEWS评分预测高危胸痛的曲线下面积为0.825,特异性为79.4%,敏感性为77.9%;最佳临界值为3.88分时,MEWS评分预测不良预后的AUC为0.921,明显高于HEART评分(AUC=0.843,Z=3.004,P=0.003),特异性为87.2%,敏感性为87.8%。结论 MEWS评分可以为预测急性胸痛近期预后提供参考,但其临床价值仍需进一步证实。

Objective To investigate the predictive value of modified early warning score for risk stratification and recent outcomes of acute chest pain patients. Methods Prospective research methods was carried in the present study,311patients with acute chest pain in emergency department were enrolled from July 2016 to July 2017.The HEART score and MEWS score was assessed,respectively.The risk stratification were classified using HEART score,after 30 days of follow-up,outcomes such as acute coronary syndrome (ACS) and myocardial infarction (MI) or death were recorded.Predictive value of MEWS score for risk stratification and recent outcome was assessed by using receiver operating characteristic curve (ROC). Results MEWS scores,fasting blood glucose,LDL-C,CRP was significantly higher in high risk group than that of the low and middle group.Additional,MEWS scores,HERAT scores,fasting blood glucose,TC,TG,LDL-C,CRP was markedly higher in good prognosis group than in poor prognosis group,there were statistically significant difference between groups( P <0.05).Logistic results showed that hyperlipidemia,MEWS scores,HERAT scores,LDL-C,CRP was independent factors for the poor prognosis of patients with chest pain ( P <0.05).ROC curve showed that the optimal cut-off value were 3.17 when MEWS score predicted high risk chest pain with AUC was 0.825,which yield sensitivity and specificity was 77.9% and 79.4% respectively.Moreover,MEWS score predicted poor prognosis of chest pain patients with AUC was 0.921,and cut-off value were 3.88 scores,significantly higher than HERAT score ( AUC =0.843, Z =3.004, P =0.003),the sensitivity and specificity was 87.2% and 87.8%,respectively. Conclusion MEWS score is a applicable index for risk stratification and outcome prediction of chest pain patients.