Department of Anaesthesia and Critical Care, Makerere University College of Health Sciences, Kampala, Uganda.
Gitwe Hospital and Gitwe School of Medicine, Gitwe, Rwanda.
PLoS One. 2020 Feb 21;15(2):e0228966. doi: 10.1371/journal.pone.0228966. eCollection 2020.
To assess the value of the inability to walk unassisted to predict hospital mortality in patients with suspected infection in a resource-limited setting.
This is a post hoc study of a prospective trial performed in rural Rwanda. Patients hospitalized because of a suspected acute infection and who were able to walk unassisted before this disease episode were included. At hospital presentation, the walking status was graded into: 1) can walk unassisted, 2) can walk assisted only, 3) cannot walk. Receiver operating characteristic (ROC) analyses and two-by-two tables were used to determine the sensitivity, specificity, negative and positive predictive values of the inability to walk unassisted to predict in-hospital death.
One-thousand-sixty-nine patients were included. Two-hundred-one (18.8%), 315 (29.5%), and 553 (51.7%) subjects could walk unassisted, walk assisted or not walk, respectively. Their hospital mortality was 0%, 3.8% and 6.3%, respectively. The inability to walk unassisted had a low specificity (20%) but was 100% sensitive (CI95%, 90-100%) to predict in-hospital death (p = 0.00007). The value of the inability to walk unassisted to predict in-hospital mortality (AUC ROC, 0.636; CI95%, 0.564-0.707) was comparable to that of the qSOFA score (AUC ROC, 0.622; CI95% 0.524-0.728). Fifteen (7.5%), 34 (10.8%) and 167 (30.2%) patients who could walk unassisted, walk assisted or not walk presented with a qSOFA score count ≥2 points, respectively (p<0.001). The inability to walk unassisted correlated with the presence of risk factors for death and danger signs, vital parameters, laboratory values, length of hospital stay, and costs of care.
Our results suggest that the inability to walk unassisted at hospital admission is a highly sensitive predictor of in-hospital mortality in Rwandese patients with a suspected acute infection. The walking status at hospital admission appears to be a crude indicator of disease severity.
在资源有限的环境中，评估无法独立行走预测疑似感染患者住院死亡率的价值。
这是一项在卢旺达农村进行的前瞻性试验的事后研究。纳入因疑似急性感染住院且在疾病发作前能够独立行走的患者。入院时，行走状态分为：1）可独立行走，2）仅可辅助行走，3）无法行走。采用受试者工作特征（ROC）分析和四格表确定无法独立行走预测住院死亡的敏感性、特异性、阴性和阳性预测值。
共纳入 169 例患者。分别有 210（18.8%）、315（29.5%）和 553（51.7%）例患者可独立行走、辅助行走或无法行走。他们的住院死亡率分别为 0%、3.8%和 6.3%。无法独立行走的特异性较低（20%），但对预测住院死亡的敏感性为 100%（95%CI，90-100%）（p=0.00007）。无法独立行走预测住院死亡率的价值（ROC AUC，0.636；95%CI，0.564-0.707）与 qSOFA 评分相当（ROC AUC，0.622；95%CI，0.524-0.728）。分别有 15（7.5%）、34（10.8%）和 167（30.2%）例可独立行走、辅助行走或无法行走的患者 qSOFA 评分≥2 分（p<0.001）。无法独立行走与死亡风险因素和危险体征、生命体征、实验室值、住院时间和医疗费用相关。
我们的结果表明，入院时无法独立行走是卢旺达疑似急性感染患者住院死亡率的高度敏感预测指标。入院时的行走状态似乎是疾病严重程度的粗略指标。
