成人急诊科脓毒症患者死亡率的预测

Prediction of mortality in adult emergency department patients with sepsis.

作者信息

Vorwerk C, Loryman B, Coats T J, Stephenson J A, Gray L D, Reddy G, Florence L, Butler N

机构信息

Emergency Department Academic Unit, Leicester Royal Infirmary, Leicester, UK.

出版信息

Emerg Med J. 2009 Apr;26(4):254-8. doi: 10.1136/emj.2007.053298.

DOI:10.1136/emj.2007.053298

PMID:19307384

Abstract

OBJECTIVES

To determine the efficacy of the abbreviated Mortality in Emergency Department Sepsis (MEDS) score, the Modified Early Warning (MEW) score and near-patient-test (NPT) lactate levels in predicting 28-day mortality in adult emergency department (ED) patients with sepsis.

METHODS

A retrospective cohort study of adult ED patients with sepsis admitted to hospital was conducted in a large urban teaching and a district general hospital. Data were collected during four time periods between 1 January 2006 and 31 January 2007. Inclusion criteria were age > or =16 years and an ED diagnosis of sepsis. Primary outcome for all patients was 28-day mortality. Patients were preassigned to risk groups according to their abbreviated MEDS score, MEW score and NPT lactate.

RESULTS

307 ED patients with sepsis were included in the study. Among these there were 72 deaths (23%). Mortality rates for the low-, moderate- and high-risk groups of the abbreviated MEDS score were 1/63 (1.6%), 48/205 (23.4%) and 23/39 (59.0%) patients. The MEDS score for low-risk patients was 98.6% (95% CI 92.5% to 99.9%) sensitive and 26.5% (95% CI 21.0% to 32.6%) specific and for high-risk patients it was 31.9% (95% CI 21.4% to 44.0%) sensitive and 93.2% (95% CI 89.2% to 96.1%) specific for death within 28 days. Mortality rates for the low- and high-risk MEW score were 20/159 (12.6%) and 52/148 (35.1%) patients. The MEW score for high-risk patients was 72.2% (95% CI 60.4% to 82.1%) sensitive and 59.2% (95% CI 52.6% to 65.5%) specific for mortality. An NPT lactate level of > or =4 mmol/l was 49.1% (95% CI 35.1% to 63.2%) sensitive and 74.3% (95% CI 64.8% to 82.3%) specific for 28-day mortality.

CONCLUSION

These results demonstrate the efficacy of the abbreviated MEDS score, the MEW score and NPT venous lactate levels in predicting 28-day mortality in ED patients with sepsis. The abbreviated MEDS score was found to be the best performing risk assessment model which, with prospective validation, may aid early clinical decision-making in ED patients with sepsis and might affect the outcome from sepsis.

摘要

目的

确定简化版急诊科脓毒症死亡率（MEDS）评分、改良早期预警（MEW）评分及床旁检测（NPT）乳酸水平对成人急诊科（ED）脓毒症患者28天死亡率的预测效能。

方法

在一家大型城市教学医院和一家区综合医院开展一项针对收入院的成年ED脓毒症患者的回顾性队列研究。于2006年1月1日至2007年1月31日期间的四个时间段收集数据。纳入标准为年龄≥16岁且ED诊断为脓毒症。所有患者的主要结局为28天死亡率。根据患者的简化MEDS评分、MEW评分及NPT乳酸水平预先分为风险组。

结果

307例ED脓毒症患者纳入研究。其中72例死亡（23%）。简化MEDS评分低、中、高风险组的死亡率分别为1/63（1.6%）、48/205（23.4%）和23/39（59.0%）。低风险患者的MEDS评分对28天内死亡的敏感度为98.6%（95%CI 92.5%至99.9%），特异度为26.5%（95%CI 21.0%至32.6%）；高风险患者的敏感度为31.9%（95%CI 21.4%至44.0%），特异度为93.2%（95%CI 89.2%至96.1%）。MEW评分低、高风险组的死亡率分别为20/159（12.6%）和52/148（35.1%）。高风险患者的MEW评分对死亡率的敏感度为72.2%（95%CI 60.4%至82.1%），特异度为59.2%（95%CI 52.6%至65.5%）。NPT乳酸水平≥4 mmol/L对28天死亡率的敏感度为49.1%（95%CI 35.1%至63.2%），特异度为74.3%（95%CI 64.8%至82.3%）。