NEWS评分对急诊抢救室患者7d全因死亡率预警能力的评价

Assessment of 7-day all-cause mortality warning ability of resuscitation room patients by NEWS score

目的:评价国家早期预警评分(NEWS)对急诊抢救室患者7 d全因死亡率的预警能力。方法:回顾性分析2020年8月—12月期间首都医科大学附属北京天坛医院急诊抢救室内收治的542例患者,排除资料不全、拒绝治疗及失访的患者,选取13项可能影响抢救室内危重患者7 d全因死亡率的因素:性别、年龄、血白细胞、血红蛋白、血白蛋白、凝血酶原时间、肿瘤病史、肺部疾病史、肝病病史、神经系统疾病病史、肾病病史、心血管疾病病史,计算入组患者的NEWS评分。将上述危险因素进行单因素、多因素回归分析找出影响抢救室内危重患者7 d全因死亡率的独立危险因素,采用受试者工作特征曲线(ROC)和Hosmer-Lemeshow Test拟合优度检验评价独立危险因素对急诊科危重患者7 d全因死亡率的预测能力。结果:本研究最终纳入293例患者,其中男194例,女99例;年龄16~96岁;随访患者7 d预后,死亡108例,生存185例。单因素分析结果显示,可能影响急诊抢救室患者7 d全因死亡率的因素为年龄、NEWS评分及肿瘤病史,差异有统计学意义(P<0.05)。多因素回归分析结果显示:NEWS评分、年龄分别为影响急诊抢救室患者7 d全因死亡率的独立影响因子(P<0.05,OR>1)。NEWS评分、年龄及NEWS联合年龄的ROC曲线下面积(AUC)分别是0.700、0.749、0.826。NEWS评分与年龄联合NEWS评分的AUC比较差异具有统计学意义(Z=2.03,P<0.05)。NEWS评分最佳截断点为7分,年龄最佳截断点为65岁。病情NEWS评分和年龄联合NEWS评分的Hosmer-Lemeshow Test拟合优度检验显示,年龄联合NEWS评分的拟合优度(P=0.161)好于NEWS评分的拟合优度(P=0.111)。结论:年龄联合NEWS评分对急诊抢救室患者7 d全因死亡率预警能力优于单独使用NEWS评分。增加年龄参数前后NEWS评分在对对象进行预后评估时均表现出较好的校准度,并且年龄联合NEWS评分的拟合优度好于NEWS评分的拟合优度。

Objective:To evaluate the predictive ability of NEWS score of 7-day all-cause mortality in resuscitation rooms.Methods:A retrospective analysis was performed on 542 patients admitted to the resuscitation room of Beijing Tiantan Hospital,Capital Medical University from August 2020 to December 2020.Patients with incomplete data,refusal of treatment and loss of follow-up were excluded.Thirteen possible influencing factors that may affect the 7-day all-cause mortality of critical patients in the resuscitation room were selected as follows:Gender,age,blood leukocyte,hemoglobin,albumin,prothrombin time,history of cancer,lung disease,liver disease,neurological disease,kidney disease,cardiovascular disease,and calculate the NEWS score of the enrolled patients.Single factor and multiple factors regression analysis were used to investigate the independent risk factors for 7-day all-cause mortality.The receiver-operating characteristic curve(ROC)and the Hosmer-Lemeshow Test were applied to evaluate the prediction of independent risk factors for 7-day all-cause mortality in critically ill patients in the resuscitation room.Results:A total of 293 patients,including 194 males and 99 females,aged 16 to 96 years,were included in this study.The prognosis of the patients was followed up for 7 days,108 of them died and 185 survived.Univariate analysis showed that age,NEWS score,history of tumor were the factors that might affect the 7-day all-cause mortality of patients in the resuscitation room(P<0.05).Multivariate regression analysis showed that NEWS score and age were independent influencing factors for 7-day all-cause mortality of patients in resuscitation room(P<0.05,OR>1).The area under the ROC curve(AUC)of NEWS score,age and NEWS combined age were 0.700,0.749 and 0.826,respectively.The AUC was significantly different between NEWS score and NEWS score combined age(Z=2.03,P<0.05).NEWS had a cutoff point of 7 and an age cutoff point of 65.Hosmer-Lemeshow Test showed that the goodness of fit of age combined with NEWS score(P=0.161)was better than that of NEWS score(P=0.111).Conclusion:NEWS score combined with age is better than NEWS score alone in predicting 7-day all-cause mortality in resuscitation room patients.Before and after the age parameter was added,the NEWS score showed better calibration in the prognostic evaluation of the subjects,and the goodness of fit of the combination of NEWS score and age was better than that of NEWS score.