城市三级护理医院急诊科严重脓毒症死亡率评分的效用

Usefulness of the Mortality in Severe Sepsis in the Emergency Department score in an urban tertiary care hospital.

作者信息

McCormack Denise, Ruderman Avi, Menges William, Kulkarni Miriam, Murano Tiffany, Keller Steven E

机构信息

Department of Emergency Medicine, Rutgers University-New Jersey Medical School, Newark, NJ 07103.

Rutgers University-School of Biomedical Sciences, Newark, NJ 07103.

出版信息

Am J Emerg Med. 2016 Jun;34(6):1117-20. doi: 10.1016/j.ajem.2016.03.037. Epub 2016 Mar 17.

DOI:10.1016/j.ajem.2016.03.037

PMID:27061500

Abstract

BACKGROUND

The Mortality in Severe Sepsis in the Emergency Department (MISSED) score is a newly proposed scoring system. The goal of this study is to determine if the MISSED score is generalizable to an urban tertiary care hospital.

METHODS

This is a retrospective chart review conducted from July 2012 to June 2014. Inclusion criteria consisted of adult emergency department (ED) patients with severe sepsis, defined as lactate level 4mmol/L or greater. Demographics, lactate, international normalized ratio (INR), albumin, intensive care unit admission, and ED intubation were analyzed using χ(2) test, t test, and logistic regression. The MISSED score was calculated using the variables albumin 27g/L or less, INR 1.3 or greater, and age 65years or older and analyzed using the area under the curve. The primary outcome was inhospital mortality.

RESULTS

A total of 182 patients met inclusion criteria, and mortality was 32%. Patients in the mortality group had older age (58.1±17.2 vs 62.7±14.7; P=.07), higher lactate (5.9±2.7 vs 7.3±3.1; P<.01), lower albumin (34.3±8.3 vs 25.6±7.1; P<.0001), higher INR (1.4±0.6 vs 2.4±1.9; P<.0001), ED intubation (21% vs 56%; P<.0001), and intensive care unit admission (41% vs 78%; P<.0001). The regression model found that albumin of 27g/L or less (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.05-3.36), INR 1.3 or greater (OR, 8.3; 95% CI, 3.35-20.51), and ED intubation (OR, 5.6; 95% CI, 2.56-12.35) predicted mortality. The area under the curve for the MISSED score was 0.78 (95% CI, 0.73-0.85).

CONCLUSION

The MISSED score is useful for predicting mortality in ED patients with severe sepsis.

摘要

背景

急诊科严重脓毒症死亡率（MISSED）评分是一种新提出的评分系统。本研究的目的是确定MISSED评分是否可推广至一家城市三级医疗中心医院。

方法

这是一项于2012年7月至2014年6月进行的回顾性病历审查。纳入标准包括成年急诊科（ED）严重脓毒症患者，定义为乳酸水平4mmol/L或更高。使用χ²检验、t检验和逻辑回归分析人口统计学、乳酸、国际标准化比值（INR）、白蛋白、重症监护病房入住情况和急诊科插管情况。MISSED评分使用白蛋白27g/L或更低、INR 1.3或更高以及年龄65岁或以上这些变量进行计算，并使用曲线下面积进行分析。主要结局是院内死亡率。

结果

共有182例患者符合纳入标准，死亡率为32%。死亡组患者年龄更大（58.1±17.2对62.7±14.7；P = 0.07），乳酸水平更高（5.9±2.7对7.3±3.1；P < 0.01），白蛋白更低（34.3±8.3对25.6±7.1；P < 0.0001），INR更高（1.4±0.6对2.4±1.9；P < 0.0001），急诊科插管比例更高（21%对56%；P < 0.0001），重症监护病房入住比例更高（41%对78%；P < 0.0001）。回归模型发现白蛋白27g/L或更低（比值比[OR]，1.8；95%置信区间[CI]，1.05 - 3.36）、INR 1.3或更高（OR，8.3；95% CI，3.35 - 20.51）以及急诊科插管（OR，5.6；95% CI，2.56 - 12.35）可预测死亡率。MISSED评分的曲线下面积为0.78（9% CI，0.73 - 0.85）。