ED-SAS 评分用于急性胰腺炎早期预测死亡率和发病率的推导和验证：一项回顾性观察研究。
Derivation and validation of the ED-SAS score for very early prediction of mortality and morbidity with acute pancreatitis: a retrospective observational study.
机构信息
Henry Ford Hospital, Department of Emergency Medicine, 2799 W Grand Blvd, Detroit, MI, 48202, USA.
Wayne State University, Detroit, MI, USA.
出版信息
BMC Emerg Med. 2021 Jan 28;21(1):16. doi: 10.1186/s12873-021-00410-w.
BACKGROUND
Existing scoring systems to predict mortality in acute pancreatitis may not be directly applicable to the emergency department (ED). The objective of this study was to derive and validate the ED-SAS, a simple scoring score using variables readily available in the ED to predict mortality in patients with acute pancreatitis.
METHODS
This retrospective observational study was performed based on patient data collected from electronic health records across 2 independent health systems; 1 was used for the derivation cohort and the other for the validation cohort. Adult patients who were eligible presented to the ED, required hospital admission, and had a confirmed diagnosis of acute pancreatitis. Patients with chronic or recurrent episodes of pancreatitis were excluded. The primary outcome was 30-day mortality. Analyses tested and derived candidate variables to establish a prediction score, which was subsequently applied to the validation cohort to assess odds ratios for the primary and secondary outcomes.
RESULTS
The derivation cohort included 599 patients, and the validation cohort 2011 patients. Thirty-day mortality was 4.2 and 3.9%, respectively. From the derivation cohort, 3 variables were established for use in the predictive scoring score: ≥2 systemic inflammatory response syndrome (SIRS) criteria, age > 60 years, and SpO2 < 96%. Summing the presence or absence of each variable yielded an ED-SAS score ranging from 0 to 3. In the validation cohort, the odds of 30-day mortality increased with each subsequent ED-SAS point: 4.4 (95% CI 1.8-10.8) for 1 point, 12.0 (95% CI 4.9-29.4) for 2 points, and 41.7 (95% CI 15.8-110.1) for 3 points (c-statistic = 0.77).
CONCLUSION
An ED-SAS score that incorporates SpO2, age, and SIRS measurements, all of which are available in the ED, provides a rapid method for predicting 30-day mortality in acute pancreatitis.
背景
现有的预测急性胰腺炎死亡率的评分系统可能不能直接应用于急诊科（ED）。本研究的目的是开发和验证 ED-SAS，这是一种使用 ED 中易于获得的变量来预测急性胰腺炎患者死亡率的简单评分系统。
方法
本回顾性观察性研究基于来自 2 个独立医疗系统的电子健康记录中的患者数据进行；一个用于推导队列，另一个用于验证队列。符合条件的成年患者在 ED 就诊，需要住院治疗，并确诊为急性胰腺炎。排除患有慢性或复发性胰腺炎的患者。主要结局是 30 天死亡率。分析测试并推导候选变量以建立预测评分，然后将其应用于验证队列，以评估主要和次要结局的比值比。
结果
推导队列包括 599 名患者，验证队列包括 2011 名患者。30 天死亡率分别为 4.2%和 3.9%。从推导队列中，确定了 3 个变量用于预测评分：≥2 个全身炎症反应综合征（SIRS）标准、年龄>60 岁和 SpO2<96%。每个变量的存在或不存在相加得出 ED-SAS 评分范围为 0 至 3。在验证队列中，随着 ED-SAS 分数的增加，30 天死亡率的几率也随之增加：1 分的几率为 4.4（95%CI 1.8-10.8），2 分的几率为 12.0（95%CI 4.9-29.4），3 分的几率为 41.7（95%CI 15.8-110.1）（C 统计量=0.77）。
结论
一种 ED-SAS 评分系统，纳入了 ED 中均可获得的 SpO2、年龄和 SIRS 测量值，为预测急性胰腺炎 30 天死亡率提供了一种快速方法。
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