简化MISSED评分对急诊科脓毒症休克患者预后的评估价值

sMISSED score in assessment of prognostis of patients with septic shock in the emergency department

目的:探讨简化MISSED评分(sMISSED评分)在急诊科对脓毒症休克患者的应用价值。方法:回顾性分析我院急救创伤部2016-08—2018-06期间收治的110例脓毒症休克患者的临床资料,以入院后28 d患者生存状态为观察终点,使用受试者工作曲线下面积(AUC)评价sMISSED评分、APACHEⅡ评分,SOFA评分预测患者预后的价值,采用Kaplan-Meier生存分析法分析患者生存情况。结果:sMISSED评分、APACHEⅡ评分、SOFA评分预测脓毒症休克患者预后的AUC分别是0.712(95%CI:0.608～0.816),0.788(95%CI:0.698～0.879),0.748(95%CI:0.651～0.845),sMISSED评分2～3组病死率明显高于0～1分45.3%(29/64) vs 19.6%(9/46),χ~2=7.847,P=0.005。两组行生存分析采用Kaplan-Meier法,差异有统计学意义(P=0.002)。结论:sMISSED评分简单实用,在急诊科对评估脓毒症休克预后及危险分层有一定价值。

Objective:To explore the the simplified MISSED score(sMISSED score)in the assessment of patients with septic shock in the emergency department.Method:Demographic,clinical and 1 aboratory data of 110 septic shock patients admitted to ICU in Shanghai Pudong Hospital were prospectively collected from 2016-08 to 2018-06,A retrospective analysis was performed and Clinical end points were death in 28 days after hospital admission.The discriminative power of the sMISSED score、APACHEⅡscore、SOFA score was evaluated by The area under the receiver operating characteristic curve(AUC).the survival analysis was performed by Kaplan-Meier method.Result:AUC of sMISSED score、APACHEⅡscore、SOFA score was 0.712(95%CI:0.608-0.816),0.788(95%CI:0.698-0.879),0.748(95%CI:0.651-0.845),respectively.in comparison with those withsMISSED score of 0~1.The mortality of sMISSED score of 2~3 was significantly higher than sMISSED score of 0~1,45.3%(29/64)vs 19.6%(9/46),χ^2=7.847,P=0.005,and the difference was statistically significant by Kaplan-Meier method(P=0.002).Conclusion:sMISSED score is simple and useful tool for risk stratification and prognosis in septic shock patients in the emergency department.