Purpose:Sepsis is a common acute life-threatening condition that emergency physicians routinely face.Diagnostic options within the Emergency Department(ED)are limited due to lack of infrastructure,consequently limitin...Purpose:Sepsis is a common acute life-threatening condition that emergency physicians routinely face.Diagnostic options within the Emergency Department(ED)are limited due to lack of infrastructure,consequently limiting the use of invasive hemodynamic monitoring or imaging tests.The mortality rate due to sepsis can be assessed via multiple scoring systems,for example,mortality in emergency department sepsis(MEDS)score and sepsis patient evaluation in the emergency department(SPEED)score,both of which quantify the variation of mortality rates according to clinical findings,laboratory data,or therapeutic interventions.This study aims to improve the management processes of sepsis patients by comparing SPEED score and MEDS score for predicting the 28-day mortality in cases of emergency sepsis.Methods:The study is a cross-sectional,prospective study including 61 sepsis patients in ED in Suez Canal University Hospital,Egypt,from August 2017 to June 2018.Patients were selected by two steps:(1)suspected septic patients presenting with at least one of the following abnormal clinical findings:(a)body temperature higher than 38℃ or lower than 36℃,(b)heart rate higher than 90 beats/min,(c)hyperventilation evidenced by respiratory rate higher than 20 breaths/min or PaCO2 lower than 32 mmHg,and(d)white blood cell count higher than 12,000/μL or lower than 4000/μL;(2)confirmed septic patients with at least a 2-point increase from the baseline total sequential organ failure assessment(SOFA)score following infection.Other inclusion criteria included adult patients with an age≥18 years regardless of gender and those who had either systemic inflammatory response syndrome or suspected/confirmed infection.Patients were shortly follow-up for the 28-day mortality.Each patient was subject to SPEED score and MEDS score and then the results were compared to detect which of them was more effective in predicting outcome.The receiver operating characteristic curves were also done for MEDS and SPEED scores.Results:Among the 61 patients,41 died with the mortality rate of 67.2%.The mortality rate increased with a higher SPEED and MEDS scores.Both SPEED and MEDS scores revealed significant difference between the survivors and nonsurvivors(p=0.004 and p<0.001,respectively),indicating that both the two systems are effective in predicting the 28-day mortality of sepsis patients.Thereafter,the receiver operating characteristic curves were plotted,which showed that SPEED was better than the MEDS score when applied to the complete study population with an area under the curve being 0.87(0.788-0.963)as compared with 0.75(0.634-0.876)for MEDS.Logistic regression analysis revealed that the best fitting predictor of 28-day mortality for sepsis patients was the SPEED scoring system.For every one unit increase in SPEED score,the odds of 28-day mortality increased by 37%.Conclusion:SPEED score is more useful and accurate than MEDS score in predicting the 28-day mortality among sepsis patients.Therefore SPEED rather than MEDS should be more widely used in the ED for sepsis patients.展开更多
目的 探讨英国国家早期预警评分（national early warning score, NEWS）、改良早期预警评分（modified early warning score，MEWS）和急诊脓毒症死亡风险评分（mortality in emergency department sepsis score，MEDS）对急诊感染患...目的 探讨英国国家早期预警评分（national early warning score, NEWS）、改良早期预警评分（modified early warning score，MEWS）和急诊脓毒症死亡风险评分（mortality in emergency department sepsis score，MEDS）对急诊感染患者预后的评估价值，并探究新的评分方法。 方法 回顾性分析2016-01～2016-08就诊于清华大学附属北京清华长庚医院急诊科的215例感染患者，记录性别、年龄、既往基础疾病、就诊时生命体征、感染部位及相关实验室检验，分别进行NEWS、MEWS和MEDS，以进入研究后28 d生存情况分为死亡组与存活组，分析两组间各评分差异。为探究新的评分方法，进一步应用Logistic回归分析评估各因素与28 d预后的关系，并最终获得拟合方程。应用受试者工作特征曲线（ROC曲线）比较各评分系统及拟合方程对28 d预后的预测能力。结果 215例急性感染患者28 d 病死率为14.88%。死亡组NEWS、MEWS和MEDS均高于存活组。单因素Logistic回归分析显示，年龄、恶性肿瘤病史、心率、呼吸频率、收缩压、血氧饱和度（SpO2）、血小板、红细胞压积、血肌酐（serum creatinine, Scr）、肾小球滤过率（estimated glomerular filtration rate, eGFR）是28 d死亡的预测因素（P＜0.05）。NEWS、MEWS、MEDS和联合多变量建立的拟合方程对28 d死亡预测的ROC曲线下面积分别为0.881、0.757、0.935和0.954。NEWS与MEDS比较差异无统计学意义（P＞0.05），与MEWS比较差异有统计学意义（P＜0.01）。联合多变量后建立的拟合方程敏感度最佳，曲线下面积最大，优于MEWS（P＜0.01）及NEWS（P＜0.05）。结论 MEDS的预测能力同NEWS能力相当，优于MEWS。联合MEDS与心率、Scr获得的拟合方程的预测能力更优于NEWS和MEWS。展开更多
目的验证急诊脓毒症病死率评分（mortality in emergency department sepsis score，MEDS）对于急诊脓毒症患者病情评估的应用价值，并将其对患者28d病死率的预测效果进行比较。方法对2009年9月至2010年9月首都医科大学附属北京朝阳医...目的验证急诊脓毒症病死率评分（mortality in emergency department sepsis score，MEDS）对于急诊脓毒症患者病情评估的应用价值，并将其对患者28d病死率的预测效果进行比较。方法对2009年9月至2010年9月首都医科大学附属北京朝阳医院急诊抢救室救治的613例脓毒症患者进行前瞻性研究。记录患者的证急诊脓毒症病死率评分（MEDS）、急性生理学与慢性健康情况评价系统Ⅱ（acute physiology and chronic health evaluation，APACHEⅡ）、简化急性生理学评分Ⅱ（simplified acute physiology score，SAPSⅡ）和改良早期预警评分（modified early warning score，MEWS）。随访28d转归。根据患者MEDS评分分值将死亡风险分级：极低危险组（0～4分）、低度危险组（5～7分）、中度危险组（8—12分）、高度危险组（13～15分）、极高危险组（大于15分），各组间实际病死率采用Х^2检验比较。再对生存组和死亡组进行比较，通过logistic回归分析确定预测死亡的独立因素，应用受试者工作特征曲线（ROC曲线）比较MEDS与APACHEⅡ，SAPSⅡ和MEWS评分对预后的预测能力。结果失访10例，完整记录603例。MEDS评分患者各组实际病死率分别为0％，7．7％，18．5％，46．7％，63％，各组间实际病死率有显著区别。生存组（440例）与死亡组（163例）之间年龄和四种评分差异均具有统计学意义（P〈0．01）。MEDS，APACHEⅡ，SAPSⅡ、MEWS评分均是预测死亡的独立因素，ROC曲线下的面积（AUC）分别为0．767，0．743，0．741和0．636。结论MEDS评分可以对脓毒症患者死亡风险进行分级，在患者28d病死率方面有较好的预测能力，适用于急诊脓毒症患者。展开更多
目的 探究血氨在急诊科脓毒症患者预后评估中的应用,并与急诊脓毒症病死率评 分(mortality in emergency department sepsis,MEDS)进行分析比较。方法 采用回顾性临床研究,纳入2017年6月至2018年5月期间于四川大学华西医院急诊科确诊...目的 探究血氨在急诊科脓毒症患者预后评估中的应用,并与急诊脓毒症病死率评 分(mortality in emergency department sepsis,MEDS)进行分析比较。方法 采用回顾性临床研究,纳入2017年6月至2018年5月期间于四川大学华西医院急诊科确诊的、符合2001年美国胸科医师协会/危重病医学会共识会议的诊断标准的脓毒症患者的临床资料,排除伴有其他影响血氨水平的疾病及失访的对象,并收集MEDS评分,电话随访统计患者的生存情况。采用独立样本t检验比较两组间差异,应用受试者操作特性(ROC)曲线评估脓毒症病死率预测的准确性,使用logistic回归模型探讨血氨与MEDS评分联合应用的价值。结果 最终纳入80例研究对象,按预后分为1周存活组(n=52)、1周死亡组(n=28);4周存活组(n=37)、4周死亡组(n=43);12周存活组(n=33)、12周死亡组(n=47);1年存活组(n=32)、1年死亡组(n=48),组间研究对象的人口特征差异无统计学意义,所有死亡对象的血氨水平均比同期存活的患者更高[(116.57±85.33)μmol/L vs (77.64±35.82)μmol/L,(108.53±73.00)μmol/L vs (71.19±32.53)μmol/L,(106.75±71.59)μmol/L vs (69.21±28.84)μmol/L,(105.77±71.14)μmol/L vs (69.50±29.25)μmol/L,P<0.05];根据1周、4周、12周和1年后的死亡情况得出,血氨的ROC曲线下面积(AUC)分别0.668(95%CI:0.542~0.793,P=0.014)、0.706(95%CI:0.593~0.819,P=0.002)、0.705(95%CI:0.592~0.818,P=0.002)、0.697(95%CI:0.582~0.811,P=0.003);与单独使用血氨、乳酸或MEDS评分相比,血氨与MEDS的联合使用会提高对脓毒症患者预后评估的准确性(P<0.05)。结论 血氨用于预测急诊科脓毒症患者的近期和1年预后都具有较高的价值,与MEDS评分的联合使用,可以进一步提高其预测价值。展开更多
文摘Purpose:Sepsis is a common acute life-threatening condition that emergency physicians routinely face.Diagnostic options within the Emergency Department(ED)are limited due to lack of infrastructure,consequently limiting the use of invasive hemodynamic monitoring or imaging tests.The mortality rate due to sepsis can be assessed via multiple scoring systems,for example,mortality in emergency department sepsis(MEDS)score and sepsis patient evaluation in the emergency department(SPEED)score,both of which quantify the variation of mortality rates according to clinical findings,laboratory data,or therapeutic interventions.This study aims to improve the management processes of sepsis patients by comparing SPEED score and MEDS score for predicting the 28-day mortality in cases of emergency sepsis.Methods:The study is a cross-sectional,prospective study including 61 sepsis patients in ED in Suez Canal University Hospital,Egypt,from August 2017 to June 2018.Patients were selected by two steps:(1)suspected septic patients presenting with at least one of the following abnormal clinical findings:(a)body temperature higher than 38℃ or lower than 36℃,(b)heart rate higher than 90 beats/min,(c)hyperventilation evidenced by respiratory rate higher than 20 breaths/min or PaCO2 lower than 32 mmHg,and(d)white blood cell count higher than 12,000/μL or lower than 4000/μL;(2)confirmed septic patients with at least a 2-point increase from the baseline total sequential organ failure assessment(SOFA)score following infection.Other inclusion criteria included adult patients with an age≥18 years regardless of gender and those who had either systemic inflammatory response syndrome or suspected/confirmed infection.Patients were shortly follow-up for the 28-day mortality.Each patient was subject to SPEED score and MEDS score and then the results were compared to detect which of them was more effective in predicting outcome.The receiver operating characteristic curves were also done for MEDS and SPEED scores.Results:Among the 61 patients,41 died with the mortality rate of 67.2%.The mortality rate increased with a higher SPEED and MEDS scores.Both SPEED and MEDS scores revealed significant difference between the survivors and nonsurvivors(p=0.004 and p<0.001,respectively),indicating that both the two systems are effective in predicting the 28-day mortality of sepsis patients.Thereafter,the receiver operating characteristic curves were plotted,which showed that SPEED was better than the MEDS score when applied to the complete study population with an area under the curve being 0.87(0.788-0.963)as compared with 0.75(0.634-0.876)for MEDS.Logistic regression analysis revealed that the best fitting predictor of 28-day mortality for sepsis patients was the SPEED scoring system.For every one unit increase in SPEED score,the odds of 28-day mortality increased by 37%.Conclusion:SPEED score is more useful and accurate than MEDS score in predicting the 28-day mortality among sepsis patients.Therefore SPEED rather than MEDS should be more widely used in the ED for sepsis patients.
文摘目的验证急诊脓毒症病死率评分（mortality in emergency department sepsis score，MEDS）对于急诊脓毒症患者病情评估的应用价值，并将其对患者28d病死率的预测效果进行比较。方法对2009年9月至2010年9月首都医科大学附属北京朝阳医院急诊抢救室救治的613例脓毒症患者进行前瞻性研究。记录患者的证急诊脓毒症病死率评分（MEDS）、急性生理学与慢性健康情况评价系统Ⅱ（acute physiology and chronic health evaluation，APACHEⅡ）、简化急性生理学评分Ⅱ（simplified acute physiology score，SAPSⅡ）和改良早期预警评分（modified early warning score，MEWS）。随访28d转归。根据患者MEDS评分分值将死亡风险分级：极低危险组（0～4分）、低度危险组（5～7分）、中度危险组（8—12分）、高度危险组（13～15分）、极高危险组（大于15分），各组间实际病死率采用Х^2检验比较。再对生存组和死亡组进行比较，通过logistic回归分析确定预测死亡的独立因素，应用受试者工作特征曲线（ROC曲线）比较MEDS与APACHEⅡ，SAPSⅡ和MEWS评分对预后的预测能力。结果失访10例，完整记录603例。MEDS评分患者各组实际病死率分别为0％，7．7％，18．5％，46．7％，63％，各组间实际病死率有显著区别。生存组（440例）与死亡组（163例）之间年龄和四种评分差异均具有统计学意义（P〈0．01）。MEDS，APACHEⅡ，SAPSⅡ、MEWS评分均是预测死亡的独立因素，ROC曲线下的面积（AUC）分别为0．767，0．743，0．741和0．636。结论MEDS评分可以对脓毒症患者死亡风险进行分级，在患者28d病死率方面有较好的预测能力，适用于急诊脓毒症患者。
文摘目的 探究血氨在急诊科脓毒症患者预后评估中的应用,并与急诊脓毒症病死率评 分(mortality in emergency department sepsis,MEDS)进行分析比较。方法 采用回顾性临床研究,纳入2017年6月至2018年5月期间于四川大学华西医院急诊科确诊的、符合2001年美国胸科医师协会/危重病医学会共识会议的诊断标准的脓毒症患者的临床资料,排除伴有其他影响血氨水平的疾病及失访的对象,并收集MEDS评分,电话随访统计患者的生存情况。采用独立样本t检验比较两组间差异,应用受试者操作特性(ROC)曲线评估脓毒症病死率预测的准确性,使用logistic回归模型探讨血氨与MEDS评分联合应用的价值。结果 最终纳入80例研究对象,按预后分为1周存活组(n=52)、1周死亡组(n=28);4周存活组(n=37)、4周死亡组(n=43);12周存活组(n=33)、12周死亡组(n=47);1年存活组(n=32)、1年死亡组(n=48),组间研究对象的人口特征差异无统计学意义,所有死亡对象的血氨水平均比同期存活的患者更高[(116.57±85.33)μmol/L vs (77.64±35.82)μmol/L,(108.53±73.00)μmol/L vs (71.19±32.53)μmol/L,(106.75±71.59)μmol/L vs (69.21±28.84)μmol/L,(105.77±71.14)μmol/L vs (69.50±29.25)μmol/L,P<0.05];根据1周、4周、12周和1年后的死亡情况得出,血氨的ROC曲线下面积(AUC)分别0.668(95%CI:0.542~0.793,P=0.014)、0.706(95%CI:0.593~0.819,P=0.002)、0.705(95%CI:0.592~0.818,P=0.002)、0.697(95%CI:0.582~0.811,P=0.003);与单独使用血氨、乳酸或MEDS评分相比,血氨与MEDS的联合使用会提高对脓毒症患者预后评估的准确性(P<0.05)。结论 血氨用于预测急诊科脓毒症患者的近期和1年预后都具有较高的价值,与MEDS评分的联合使用,可以进一步提高其预测价值。
