Servicio de Urgencias, Hospital Universitario Clínico San Carlos, Madrid, España. Instituto de Investigación Sanitaria San Carlos (IdISSC), Madrid, España. Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España.
Servicio de Urgencias, Complejo Hospitalario de Toledo, Toledo, España.
Emergencias. 2018;30(4):241-246.
To build a model to predict 30-day mortality and compare it to prediction based on the Mortality in Emergency Department Sepsis (MEDS) score in patients aged 75 years or older treated for infection and systemic inflammatory response syndrome (SIRS) in the emergency department.
Prospective analysis of a convenience cohort of patients aged 75 years or older treated for infection and SIRS in 13 Spanish emergency departments in 2013. We recorded demographic variables; comorbidity; risk factors for poor outcome; functional dependence at baseline; site of infection; and hemodynamic, clinical and laboratory findings on start of care.The main outcome variable was 30-day all-cause mortality.
Three hundred seventy-nine patients with a mean (SD) age of 84 (5.8) years were included; 186 (49.,1%) were women, 150 (39.6%) had a high degree of comorbidity, and 113 (34.2%) had a high level of functional dependence. Seventy-nine (20.8%) died within 30 days. The model built by the infection working group (INFURG) of the Spanish Society of Emergency Medicine (SEMES) included the presence of metastasis from a solid tumor (odds ratio [OR], 5.4; 95% CI, 1.6-18.2; P=.006), respiratory insufficiency (OR, 3.02; 95% CI, 1.5-6.0; P=.002), renal insufficiency (OR, 2.4; 95% CI, 1.0-5.5; P=.045), arterial hypertension (OR, 2.4; 95% CI, 1.2-5.0; P=.015), and altered level of consciousness (OR, 2.9; 95% CI, 1.4-5.8; P=.003). The area under the receiver operating characteristic curve of the INFURG-OLDER model was 0.78 (95% CI, 0.72-0.84; P<.001) (vs 0.72 (95% CI, 0.64-0.80; P<.001 for the MEDS model).
The INFURG-OLDER model has good predictive ability for 30-day mortality in patients aged 75 years or older who are treated in emergency departments for SIRS.
建立一个模型来预测 30 天死亡率，并将其与基于 75 岁或以上因感染和全身炎症反应综合征（SIRS）在急诊科接受治疗的患者的 Mortality in Emergency Department Sepsis（MEDS）评分的预测进行比较。
对 2013 年在西班牙 13 家急诊科因感染和 SIRS 接受治疗的 75 岁或以上的便利队列患者进行前瞻性分析。我们记录了人口统计学变量；合并症；不良预后的危险因素；基线时的功能依赖；感染部位；以及开始治疗时的血流动力学、临床和实验室发现。主要结局变量是 30 天全因死亡率。
共纳入 379 名平均（标准差）年龄为 84（5.8）岁的患者；186 名（49.1%）为女性，150 名（39.6%）有高度合并症，113 名（34.2%）有高度功能依赖。79 名（20.8%）在 30 天内死亡。由西班牙急诊医学学会（SEMES）感染工作组（INFURG）建立的模型包括来自实体瘤的转移（比值比 [OR]，5.4；95%置信区间，1.6-18.2；P=.006）、呼吸衰竭（OR，3.02；95%置信区间，1.5-6.0；P=.002）、肾功能不全（OR，2.4；95%置信区间，1.0-5.5；P=.045）、动脉高血压（OR，2.4；95%置信区间，1.2-5.0；P=.015）和意识水平改变（OR，2.9；95%置信区间，1.4-5.8；P=.003）。INFURG-OLDER 模型的受试者工作特征曲线下面积为 0.78（95%置信区间，0.72-0.84；P<.001）（vs 0.72（95%置信区间，0.64-0.80；P<.001 为 MEDS 模型）。
INFURG-OLDER 模型对因 SIRS 在急诊科接受治疗的 75 岁或以上患者的 30 天死亡率具有良好的预测能力。
