急诊可疑脓毒症危险分层评分对脓毒症患者预后的预测价值

Predictive value of emergency suspected sepsis risk stratification score for prognosis of patients with sepsis

目的探讨急诊可疑脓毒症危险分层(risk-stratifcation of emergency department suspected sepsis,REDS)评分在脓毒症患者预后判断中的价值。方法收集2018年1月至2020年2月间在黄山首康医院住院的脓毒症患者的临床资料进行回顾性病例对照研究。计算REDS评分、急性生理学与慢性健康状况评分系统Ⅱ(acute physiology and chronic health evaluationⅡ,APACHEⅡ)评分和急诊脓毒症病死率评分(mortality in emergency department sepsis,MEDS)。通过REDS评分与APACHEⅡ和MEDS比较,评价REDS评分在脓毒症患者预后判断中的价值。结果103例患者最终被纳入研究,其中男65例(63.11%),女38例(36.89%);年龄范围42~93岁,中位数(四分位数)74(65,82)岁;72例(69.91%)存活(存活组),31例死亡(30.09%)(死亡组)。存活组和死亡组的REDS评分[(5.28±2.10)分与(7.87±2.53)分]、MEDS评分[(6.64±3.32)分与(9.06±3.36)分]、APACHEⅡ评分[(18.96±6.72)分与(21.87±6.15)分],差异均有统计学意义(t=5.404,P<0.001;t=3.381,P=0.001;t=2.067,P=0.041)。REDS评分7.5时Youden指数最大(0.381),受试者工作特征曲线下面积0.777(95%可信区间:0.678~0.876,P<0.001)。APACHEⅡ评分19.5时Youden指数最大(0.177),受试者工作特征曲线下面积0.614(95%可信区间:0.499~0.729,P=0.068)。MEDS评分10.5时Youden指数最大(0.341),受试者工作特征曲线下面积0.696(95%可信区间:0.590~0.802,P=0.002)。REDS评分的受试者工作特征曲线下面积大于APACHEⅡ评分(Z=1.987,P=0.046)。结论REDS评分对脓毒症患者病情和预后判断有较好的效果,与MEDS评分相当,但优于APACHEⅡ评分。

Objective To explore the value of using risk-stratifcation of mergency department suspected sepsis score(REDS)score in the prognosis of patients with sepsis.Methods The clinical data of sepsis patients hospitalized in Huangshan Shoukang hospital from January 2018 to February 2020 were collected for retrospective case-control study.The REDS,acute physiology and chronic health evaluationⅡ(APACHEⅡ)score and mortality in emergency department(MEDS)of all cases were calculated.To evaluate the value of REDS in prognosis of patients with sepsis by comparing REDS with APACHEⅡand MEDS.Results Finally 103 patients were enrolled in the study,including 65 males(63.11%)and 38 females(36.89%);the age ranged from 42 to 93 years old,the median(quartile)was 74(65,82)years old;72 patients(69.91%)survived(survival group),31 patients(30.09%)died(death group).There were significant differences between survival group and death group in REDS((5.28±2.10)score vs.(7.87±2.53)score),MEDS score((6.64±3.32)score vs.(9.06±3.3)score),APACHEⅡscore((18.96±6.72)score vs.(21.87±6.15)score)(t value were5.404,3.381 and 2.067,respectively;P value were<0.001,0.001 and 0.041,respectively).Youden index was biggest(0.381),when REDS was 7.5.The area under the receiver operating characteristic curve was 0.777(95%CI:0.678-0.876,P<0.001).When APACHEⅡscore was 19.5,Youden index was the largest(0.177),and the area under the ROC of APACHEⅡwas 0.614(95%CI:0.499-0.729,P=0.068).When the MEDS score was 10.5,Youden index was the largest(0.341),and the area under the receiver operating characteristic curve was 0.696(95%CI:0.590-0.802,P=0.002).The area under the curve of working characteristics of the subjects with red score was larger than that of APACHEⅡscore(Z=1.987,P=0.046).Conclusion REDS has a good effect in judging the condition and prognosis of patients with sepsis,which is equivalent to MEDS score,but better than APACHEⅡ.