早期预警评分与乳酸相结合以预测严重脓毒症/脓毒性休克住院患者转入重症监护病房的情况。
A combination of early warning score and lactate to predict intensive care unit transfer of inpatients with severe sepsis/septic shock.
作者信息
Yoo Jung-Wan, Lee Ju Ry, Jung Youn Kyung, Choi Sun Hui, Son Jeong Suk, Kang Byung Ju, Park Tai Sun, Huh Jin-Won, Lim Chae-Man, Koh Younsuck, Hong Sang Bum
机构信息
Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Medical Emergency Team, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
出版信息
Korean J Intern Med. 2015 Jul;30(4):471-7. doi: 10.3904/kjim.2015.30.4.471. Epub 2015 Jun 29.
BACKGROUND/AIMS: The modified early warning score (MEWS) is used to predict patient intensive care unit (ICU) admission and mortality. Lactate (LA) in the blood lactate (BLA) is measured to evaluate disease severity and treatment efficacy in patients with severe sepsis/septic shock. The usefulness of a combination of MEWS and BLA to predict ICU transfer in severe sepsis/septic shock patients is unclear. We evaluated whether use of a combination of MEWS and BLA enhances prediction of ICU transfer and mortality in hospitalized patients with severe sepsis/septic shock.
METHODS
Patients with severe sepsis/septic shock who were screened or contacted by a medical emergency team between January 2012 and August 2012 were enrolled at a university-affiliated hospital with ~2,700 beds, including 28 medical ICU beds.
RESULTS
One hundred patients were enrolled and the rate of ICU admittance was 38%. MEWS (7.37 vs. 4.85) and BLA concentration (5 mmol/L vs. 2.19 mmol/L) were significantly higher in patients transferred to ICU than those in patients treated in general wards. The combination of MEWS and BLA was more accurate than MEWS alone in terms of ICU transfer (C-statistics: 0.898 vs. 0.816, p = 0.019). The 28-day mortality rate was 19%. MEWS was the only factor significantly associated with 28-day mortality rate (odds ratio, 1.462; 95% confidence interval, 1.122 to 1.905; p = 0.005).
CONCLUSIONS
The combination of MEWS and BLA may enhance prediction of ICU transfer in patients with severe sepsis/septic shock.
背景/目的：改良早期预警评分（MEWS）用于预测患者入住重症监护病房（ICU）及死亡情况。检测血乳酸（BLA）中的乳酸（LA）以评估严重脓毒症/脓毒性休克患者的疾病严重程度及治疗效果。MEWS与BLA联合用于预测严重脓毒症/脓毒性休克患者转入ICU的价值尚不清楚。我们评估了MEWS与BLA联合使用是否能增强对住院严重脓毒症/脓毒性休克患者转入ICU及死亡的预测能力。
方法
选取2012年1月至2012年8月间由医疗急救团队筛查或联系的严重脓毒症/脓毒性休克患者，纳入一家拥有约2700张床位（包括28张内科ICU床位）的大学附属医院。
结果
共纳入100例患者，ICU入住率为38%。转入ICU的患者MEWS（7.37对4.85）及BLA浓度（5 mmol/L对2.19 mmol/L）显著高于普通病房治疗的患者。就转入ICU而言，MEWS与BLA联合比单独使用MEWS更准确（C统计量：0.898对0.816，p = 0.019）。28天死亡率为19%。MEWS是与28天死亡率显著相关的唯一因素（比值比，1.462；95%置信区间，1.122至1.905；p = 0.005）。
结论
MEWS与BLA联合可能增强对严重脓毒症/脓毒性休克患者转入ICU的预测能力。
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