Hao Liqun, Zhou Yue, Zou Jiatong, Hao Lirong, Deng Peng
Department of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
Department of Emergency Medicine, West China Hospital Shangjin Branch, Sichuan University, Chengdu, Sichuan, People's Republic of China.
J Inflamm Res. 2023 Jul 13;16:2947-2954. doi: 10.2147/JIR.S419538. eCollection 2023.
To explore the predictive value of the Programme on Research for Integrating Services for the Maintenance of Autonomy 7 (PRISMA-7), quick Sequential Organ Failure Assessment (qSOFA) score, Emergency Severity Index (ESI), and Clinical Frailty Scale (CFS) on the 28-day mortality risk in emergency elderly patients.
A multicenter prospective observational study was conducted to select elderly patients (≥65 years old) admitted to the emergency department of three Grade-A hospitals in different regions of China from January 2020 to March 2022. Primary data were collected at the time of admission. All patients were followed up for 28 days. The primary outcome was 28-day mortality. The predictive value of four scoring systems for 28-day mortality in elderly emergency patients was assessed by receiver operating characteristic (ROC) and logistic regression analysis.
A total of 687 elderly emergency patients were enrolled, of whom 66 (9.61%) died within 28 days. Age, ICU admission rate, PRISMA-7, qSOFA, and CFS were significantly higher in the death group than in the survival group (P < 0.05), and ESI was lower than in the survival group (P < 0.001). The AUC for CFS was the largest of the four scoring systems at 0.80. According to the Youden index, the optimal cutoff values for PRISMA-7, qSOFA, ESI, and CFS were >3.5, >0.5, <2.5, and >4.5, respectively. Logistic regression revealed that qSOFA and CFS were the primary risk factors for increased 28-day mortality in elderly emergency patients (P < 0.001). The combined predictor L (L=X1+0.50X2, X1 and X2 are qSOFA and CFS values, respectively) had an AUC of 0.86 and a cutoff value >2.75.
PRISMA-7, qSOFA, ESI, CFS, and the combined qSOFA+CFS predictor were all effective predictors of 28-day mortality risk in elderly emergency patients, with the combined qSOFA+CFS predictor having the best predictive power.
探讨综合服务维持自主性研究项目7（PRISMA - 7）、快速序贯器官衰竭评估（qSOFA）评分、急诊严重程度指数（ESI）和临床衰弱量表（CFS）对老年急诊患者28天死亡风险的预测价值。
进行一项多中心前瞻性观察性研究，选取2020年1月至2022年3月在中国不同地区的三家三级甲等医院急诊科收治的老年患者（≥65岁）。入院时收集原始数据。所有患者随访28天。主要结局为28天死亡率。通过受试者工作特征（ROC）曲线和逻辑回归分析评估四种评分系统对老年急诊患者28天死亡率的预测价值。
共纳入687例老年急诊患者，其中66例（9.61%）在28天内死亡。死亡组的年龄、入住重症监护病房（ICU）率、PRISMA - 7、qSOFA和CFS显著高于存活组（P < 0.05），而ESI低于存活组（P < 0.001）。在四种评分系统中，CFS的曲线下面积（AUC）最大，为0.80。根据约登指数，PRISMA - 7、qSOFA、ESI和CFS的最佳截断值分别为>3.5、>0.5、<2.5和>4.5。逻辑回归显示，qSOFA和CFS是老年急诊患者28天死亡率增加的主要危险因素（P < 0.001）。联合预测指标L（L = X1 + 0.50X2，X1和X2分别为qSOFA和CFS值）的AUC为0.86，截断值>2.75。
PRISMA - 7、qSOFA、ESI、CFS以及联合qSOFA + CFS预测指标均是老年急诊患者28天死亡风险的有效预测指标，联合qSOFA + CFS预测指标的预测能力最佳。
