Ishimaru Naoto, Kinami Saori, Shimokawa Toshio, Seto Hiroyuki, Kanzawa Yohei
Department of General Internal Medicine Akashi Medical Center Akashi Japan.
Clinical Study Support Centre Wakayama Medical University Wakayama Japan.
J Gen Fam Med. 2020 Apr 27;21(4):134-139. doi: 10.1002/jgf2.323. eCollection 2020 Jul.
This study aimed to clarify the accuracy of an in-hospital mortality prediction score for patients with hypothermia. The score consists of five variables (age ≥70 years, mean arterial pressure <90 mm Hg, pH < 7.35, creatinine >1.5 mg/dL, and confusion). In contrast to the previously reported population in southern Israel, a desert climate, we apply the score system to a Japanese humid subtropical climate.
The study included patients with a principal diagnosis of hypothermia who were admitted to our community hospital between January 2008 and January 2019. Using the medical records from initial visits, we retrospectively calculated in-hospital mortality prediction scores along with sensitivity and specificity.
We recruited 69 patients, 67 of which had analyzable data. Among them, the in-hospital mortality rate was 25.4%. Hypothermia was defined as mild (32-35°C) in 34 cases (50.7%), moderate (28-32°C) in 23 cases (34.3%), and severe (<28°C) in 10 cases (14.9%). The C-statistics of the in-hospital mortality prediction score was 0.703 (95% confidence interval, 0.55-0.84) for thirty-day survival prediction. After adjustment of the cutoff point of each item with ROC analysis and selection of the variants, the C-statistics of the in-hospital mortality prediction score rose to 0.81 (95% confidence interval, 0.69-0.92).
The in-hospital mortality prediction scores showed slightly less predictive value than those in the previous report. With some modification, however, the score system could still be applied efficiently in the humid Japanese subtropical climate. An appropriate management strategy could be established based on the predicted mortality risk.
本研究旨在阐明体温过低患者院内死亡率预测评分的准确性。该评分由五个变量组成（年龄≥70岁、平均动脉压<90 mmHg、pH<7.35、肌酐>1.5 mg/dL以及意识模糊）。与先前报道的以色列南部沙漠气候人群不同，我们将该评分系统应用于日本湿润亚热带气候人群。
本研究纳入了2008年1月至2019年1月期间入住我们社区医院、主要诊断为体温过低的患者。利用初诊时的病历，我们回顾性计算了院内死亡率预测评分以及敏感性和特异性。
我们招募了69例患者，其中67例有可分析数据。其中，院内死亡率为25.4%。体温过低被定义为轻度（32 - 35°C）34例（50.7%）、中度（28 - 32°C）23例（34.3%）、重度（<28°C）10例（14.9%）。院内死亡率预测评分的C统计量在预测30天生存率时为0.703（95%置信区间，0.55 - 0.84）。通过ROC分析调整每个项目的截断点并选择变量后，院内死亡率预测评分的C统计量升至0.81（95%置信区间，0.69 - 0.92）。
院内死亡率预测评分的预测价值略低于先前报告。然而，经过一些修改，该评分系统仍可在日本湿润亚热带气候中有效应用。可基于预测的死亡风险制定适当的管理策略。
