MEWS、ViEWS和NEWS评分预测急性冠状动脉综合征心脏骤停效能

Efficacy of MEWS,ViEWS and NEWS on predicting cardiac arrest in acute coronary syndrome patients

目的探讨改良早期预警评分(MEWS)、重要性早期预警评分(ViEWS)及英国国家早期预警评分(NEWS)预测急性冠状动脉综合征(ACS)患者发生院内心脏骤停(IHCA)的能力,及其最佳预测时间点。方法选取2015年1月至2018年12月诊治入院24 h发生IHCA的172例ACS患者为IHCA组,以1∶3的比例分层随机选取未发生IHCA的ACS患者516例为非IHCA组。记录IHCA组IHCA前1、2、4、8、16 h及非IHCA组对应时间点临床资料,比较两组MEWS、ViEWS、NEWS评分;ROC曲线评估MEWS、ViEWS、NEWS系统预测IHCA发生的效能。结果IHCA组IHCA前1、2、4、8、16 h MEWS、ViEWS、NEWS评分均高于非IHCA组(P<0. 01)。IHCA前1、2、4、8、16 h,ViEWS评分预测IHCA发生的曲线下面积(AUC)均高于MEWS评分和NEWS评分,提示ViEWS评分预测IHCA发生的效能最强。IHCA前1、2、4 h,ViEWS评分预测IHCA的AUC分别为0. 81、0. 79、0. 78,均大于0. 7,提示预测效能中等。IHCA前1、2、4 h,ViEWS评分预测IHCA的AUC比较差异无统计学意义(P>0. 05)。结论与MEWS、NEWS系统相比,ViEWS可提前4 h较好预测ACS患者是否会发生IHCA。

Objective To explore the efficacy and optimal time-point of modified early warning score(MEWS),vitalPACTM early warning score(ViEWS) and national early warning score(NEWS) on predicting the occurrence of inhospital cardiac arrest(IHCA) in patients with acute coronary syndrome(ACS). Methods A total of 172 patients with ACS occured IHCA within 24 hours treated from January 2015 to December 2018 were selected as IHCA group. While 516 patients with ACS who did not develop IHCA was randomly selected as non-IHCA group at a ratio of 1 ∶ 3. The clinical manifestations at 1-,2-,4-,8-and 16-h before IHCA in IHCA group and those at corresponding time points in non-IHCA group were recorded,and the scores of MEWS,ViEWS and NEWS were compared between two groups. The ROC curve was used to evaluate the efficacy of MEWS,ViEWS and NEWS systems in predicting the occurrence of IHCA. Results The scores of MEWS,ViEWS,and NEWS in IHCA group were significantly higher than those in non-IHCA group at each time point before IHCA(P< 0. 01). At 1-,2-,4-,8-and 16-h before IHCA,AUC of ViEWS in predicting IHCA was higher than those of MEWS and NEWS,suggesting that ViEWS was the most effective predictor of IHCA. At 1-,2-and 4-h before IHCA,AUC of ViEWS in predicting IHCA was 0. 81,0. 79 and 0. 78 respectively,and all of them were more than 0. 7,indicating that the prediction efficiency was moderate. There were no significant differences in AUC of ViEWS in predicting IHCA at 1-,2-and 4-h before IHCA(P >0. 05). Conclusion Compared with MEWS and NEWS systems,ViEWS can effectively predict the occurrence of IHCA in ACS patients 4 hours ahead of time.