Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Medicine, National Cheng Kung University Medical College, Tainan, Taiwan.
Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Am J Emerg Med. 2020 Feb;38(2):282-287. doi: 10.1016/j.ajem.2019.05.002. Epub 2019 May 3.
The Mortality in Emergency Department Sepsis (MEDS) score can be used to stratify ED patients with suspected infections according to mortality risk. However, it has yet to be externally validated for patients having bloodstream infections.
We retrospectively computed clinical information for the MEDS score, Pitt bacteremia score (PBS), Charlson comorbidity index (CCI), and McCabe-Jackson comorbid classification (MJCC) for adults with community-onset bacteremia. The MEDS score was validated by the comparisons with the following scoring systems: the PBS, CCI, MJCC, PBS plus MJCC, and PBS plus CCI. We evaluated goodness-of-fit statistics and c-statistics as measures of model calibration and discrimination, respectively.
Of 2328 adults, a good calibration for 28-day crude mortality was obtained only in the MEDS score and PBS plus MJCC; a higher c-statistic (0.870, P < 0.001) were achieved by the MEDS score, compared to the PBS, CCI MJCC, PBS plus MJCC, and PBS plus CCI. A high c-statistic was observed in two combinative scoring system: the PBS plus CCI (0.855, P < 0.001) and PBS plus MJCC (0.843, P < 0.001). According to the Kaplan-Meier curves, 28-day crude mortality significantly differed between patients with scores equal to or higher than selected cutoff values and those with scores lower than selected cutoff values: 10 in the MEDS score and 5 in the PBS plus MJCC, respectively.
The MEDS score is an excellent predictor of short-term outcomes in patients with community-onset bacteremia because it provides estimates with higher calibration and discrimination than those of the other scoring systems.
急诊脓毒症死亡率（MEDS）评分可用于根据死亡率风险对疑似感染的 ED 患者进行分层。然而，它尚未在血流感染患者中进行外部验证。
我们回顾性计算了 MEDS 评分、Pitt 菌血症评分（PBS）、Charlson 合并症指数（CCI）和 McCabe-Jackson 合并症分类（MJCC）的临床信息，这些信息适用于社区获得性菌血症的成年人。通过与以下评分系统的比较验证了 MEDS 评分：PBS、CCI、MJCC、PBS+MJCC 和 PBS+CCI。我们评估了拟合优度统计量和 c 统计量，分别作为模型校准和区分的度量。
在 2328 名成年人中，仅在 MEDS 评分和 PBS+MJCC 中获得了 28 天粗死亡率的良好校准；与 PBS、CCI、MJCC、PBS+MJCC 和 PBS+CCI 相比，MEDS 评分的 c 统计量更高（0.870，P < 0.001）。在两个组合评分系统中观察到高 c 统计量：PBS+CCI（0.855，P < 0.001）和 PBS+MJCC（0.843，P < 0.001）。根据 Kaplan-Meier 曲线，28 天粗死亡率在评分等于或高于所选截止值的患者与评分低于所选截止值的患者之间有显著差异：MEDS 评分为 10，PBS+MJCC 评分为 5。
MEDS 评分是社区获得性菌血症患者短期预后的优秀预测指标，因为它提供的估计值具有比其他评分系统更高的校准和区分能力。
