Background Community-acquired pneumonia （CAP） remains one of the leading causes ot death from infectious diseases around the world.Most severe CAP patients are admitted to the intensive care unit （ICU）,and receive...Background Community-acquired pneumonia （CAP） remains one of the leading causes ot death from infectious diseases around the world.Most severe CAP patients are admitted to the intensive care unit （ICU）,and receive intense treatment.The present study aimed to evaluate the role of the pneumonia severity index （PSI）,CURB-65,and sepsis score in the management of hospitalized CAP patients and explore the effect of ICU treatment on prognosis of severe cases.Methods A total of 675 CAP patients hospitalized in the Second Affiliated Hospital of Zhejiang University School of Medicine were retrospectively investigated.The ability of different pneumonia severity scores to predict mortality was compared for effectiveness,while the risk factors associated with 30-day mortality rates and hospital length of stay （LOS） were evaluated.The effect of ICU treatment on the outcomes of severe CAP patients was also investigated.Results All three scoring systems revealed that the mortality associated with the low-risk or intermediate-risk group was significantly lower than with the high-risk group.As the risk level increased,the frequency of ICU admission rose in tandem and LOS in the hospital was prolonged.The areas under the receiver operating characteristic curve in the prediction of mortality were 0.94,0.91 and 0.89 for the PSI,CURB-65 and sepsis score,respectively.Compared with the corresponding control groups,the mortality was markedly increased in patients with a history of smoking,prior admission to ICU,respiratory failure,or co-morbidity of heart disease.The differences were also identified in LOS between control groups and patients with ICU treatment,heart,or cerebrovascular disease.Logistic regression analysis showed that age over 65 years,a history of smoking,and respiratory failure were closely related to mortality in the overall CAP cohort,whereas age,ICU admission,respiratory failure,and LOS at home between disease attack and hospital admission were identified as independent risk factors for mortality in th展开更多
目的验证急诊脓毒症病死率评分（mortality in emergency department sepsis score，MEDS）对于急诊脓毒症患者病情评估的应用价值，并将其对患者28d病死率的预测效果进行比较。方法对2009年9月至2010年9月首都医科大学附属北京朝阳医...目的验证急诊脓毒症病死率评分（mortality in emergency department sepsis score，MEDS）对于急诊脓毒症患者病情评估的应用价值，并将其对患者28d病死率的预测效果进行比较。方法对2009年9月至2010年9月首都医科大学附属北京朝阳医院急诊抢救室救治的613例脓毒症患者进行前瞻性研究。记录患者的证急诊脓毒症病死率评分（MEDS）、急性生理学与慢性健康情况评价系统Ⅱ（acute physiology and chronic health evaluation，APACHEⅡ）、简化急性生理学评分Ⅱ（simplified acute physiology score，SAPSⅡ）和改良早期预警评分（modified early warning score，MEWS）。随访28d转归。根据患者MEDS评分分值将死亡风险分级：极低危险组（0～4分）、低度危险组（5～7分）、中度危险组（8—12分）、高度危险组（13～15分）、极高危险组（大于15分），各组间实际病死率采用Х^2检验比较。再对生存组和死亡组进行比较，通过logistic回归分析确定预测死亡的独立因素，应用受试者工作特征曲线（ROC曲线）比较MEDS与APACHEⅡ，SAPSⅡ和MEWS评分对预后的预测能力。结果失访10例，完整记录603例。MEDS评分患者各组实际病死率分别为0％，7．7％，18．5％，46．7％，63％，各组间实际病死率有显著区别。生存组（440例）与死亡组（163例）之间年龄和四种评分差异均具有统计学意义（P〈0．01）。MEDS，APACHEⅡ，SAPSⅡ、MEWS评分均是预测死亡的独立因素，ROC曲线下的面积（AUC）分别为0．767，0．743，0．741和0．636。结论MEDS评分可以对脓毒症患者死亡风险进行分级，在患者28d病死率方面有较好的预测能力，适用于急诊脓毒症患者。展开更多
目的 探究血氨在急诊科脓毒症患者预后评估中的应用,并与急诊脓毒症病死率评 分(mortality in emergency department sepsis,MEDS)进行分析比较。方法 采用回顾性临床研究,纳入2017年6月至2018年5月期间于四川大学华西医院急诊科确诊...目的 探究血氨在急诊科脓毒症患者预后评估中的应用,并与急诊脓毒症病死率评 分(mortality in emergency department sepsis,MEDS)进行分析比较。方法 采用回顾性临床研究,纳入2017年6月至2018年5月期间于四川大学华西医院急诊科确诊的、符合2001年美国胸科医师协会/危重病医学会共识会议的诊断标准的脓毒症患者的临床资料,排除伴有其他影响血氨水平的疾病及失访的对象,并收集MEDS评分,电话随访统计患者的生存情况。采用独立样本t检验比较两组间差异,应用受试者操作特性(ROC)曲线评估脓毒症病死率预测的准确性,使用logistic回归模型探讨血氨与MEDS评分联合应用的价值。结果 最终纳入80例研究对象,按预后分为1周存活组(n=52)、1周死亡组(n=28);4周存活组(n=37)、4周死亡组(n=43);12周存活组(n=33)、12周死亡组(n=47);1年存活组(n=32)、1年死亡组(n=48),组间研究对象的人口特征差异无统计学意义,所有死亡对象的血氨水平均比同期存活的患者更高[(116.57±85.33)μmol/L vs (77.64±35.82)μmol/L,(108.53±73.00)μmol/L vs (71.19±32.53)μmol/L,(106.75±71.59)μmol/L vs (69.21±28.84)μmol/L,(105.77±71.14)μmol/L vs (69.50±29.25)μmol/L,P<0.05];根据1周、4周、12周和1年后的死亡情况得出,血氨的ROC曲线下面积(AUC)分别0.668(95%CI:0.542~0.793,P=0.014)、0.706(95%CI:0.593~0.819,P=0.002)、0.705(95%CI:0.592~0.818,P=0.002)、0.697(95%CI:0.582~0.811,P=0.003);与单独使用血氨、乳酸或MEDS评分相比,血氨与MEDS的联合使用会提高对脓毒症患者预后评估的准确性(P<0.05)。结论 血氨用于预测急诊科脓毒症患者的近期和1年预后都具有较高的价值,与MEDS评分的联合使用,可以进一步提高其预测价值。展开更多
目的 探讨英国国家早期预警评分（national early warning score, NEWS）、改良早期预警评分（modified early warning score，MEWS）和急诊脓毒症死亡风险评分（mortality in emergency department sepsis score，MEDS）对急诊感染患...目的 探讨英国国家早期预警评分（national early warning score, NEWS）、改良早期预警评分（modified early warning score，MEWS）和急诊脓毒症死亡风险评分（mortality in emergency department sepsis score，MEDS）对急诊感染患者预后的评估价值，并探究新的评分方法。 方法 回顾性分析2016-01～2016-08就诊于清华大学附属北京清华长庚医院急诊科的215例感染患者，记录性别、年龄、既往基础疾病、就诊时生命体征、感染部位及相关实验室检验，分别进行NEWS、MEWS和MEDS，以进入研究后28 d生存情况分为死亡组与存活组，分析两组间各评分差异。为探究新的评分方法，进一步应用Logistic回归分析评估各因素与28 d预后的关系，并最终获得拟合方程。应用受试者工作特征曲线（ROC曲线）比较各评分系统及拟合方程对28 d预后的预测能力。结果 215例急性感染患者28 d 病死率为14.88%。死亡组NEWS、MEWS和MEDS均高于存活组。单因素Logistic回归分析显示，年龄、恶性肿瘤病史、心率、呼吸频率、收缩压、血氧饱和度（SpO2）、血小板、红细胞压积、血肌酐（serum creatinine, Scr）、肾小球滤过率（estimated glomerular filtration rate, eGFR）是28 d死亡的预测因素（P＜0.05）。NEWS、MEWS、MEDS和联合多变量建立的拟合方程对28 d死亡预测的ROC曲线下面积分别为0.881、0.757、0.935和0.954。NEWS与MEDS比较差异无统计学意义（P＞0.05），与MEWS比较差异有统计学意义（P＜0.01）。联合多变量后建立的拟合方程敏感度最佳，曲线下面积最大，优于MEWS（P＜0.01）及NEWS（P＜0.05）。结论 MEDS的预测能力同NEWS能力相当，优于MEWS。联合MEDS与心率、Scr获得的拟合方程的预测能力更优于NEWS和MEWS。展开更多
基金This study was supported by grants from the National Natural Science Foundation of China （No.30871130 and 30500229）,the Qianjiang Talent Project of Science and Technology Department of Zhejiang Province （No.2010R10080）,and the Youth Talent Fund of Health Bureau of Zhejiang Province,China （No.2008QN016）.
文摘Background Community-acquired pneumonia （CAP） remains one of the leading causes ot death from infectious diseases around the world.Most severe CAP patients are admitted to the intensive care unit （ICU）,and receive intense treatment.The present study aimed to evaluate the role of the pneumonia severity index （PSI）,CURB-65,and sepsis score in the management of hospitalized CAP patients and explore the effect of ICU treatment on prognosis of severe cases.Methods A total of 675 CAP patients hospitalized in the Second Affiliated Hospital of Zhejiang University School of Medicine were retrospectively investigated.The ability of different pneumonia severity scores to predict mortality was compared for effectiveness,while the risk factors associated with 30-day mortality rates and hospital length of stay （LOS） were evaluated.The effect of ICU treatment on the outcomes of severe CAP patients was also investigated.Results All three scoring systems revealed that the mortality associated with the low-risk or intermediate-risk group was significantly lower than with the high-risk group.As the risk level increased,the frequency of ICU admission rose in tandem and LOS in the hospital was prolonged.The areas under the receiver operating characteristic curve in the prediction of mortality were 0.94,0.91 and 0.89 for the PSI,CURB-65 and sepsis score,respectively.Compared with the corresponding control groups,the mortality was markedly increased in patients with a history of smoking,prior admission to ICU,respiratory failure,or co-morbidity of heart disease.The differences were also identified in LOS between control groups and patients with ICU treatment,heart,or cerebrovascular disease.Logistic regression analysis showed that age over 65 years,a history of smoking,and respiratory failure were closely related to mortality in the overall CAP cohort,whereas age,ICU admission,respiratory failure,and LOS at home between disease attack and hospital admission were identified as independent risk factors for mortality in th
文摘目的验证急诊脓毒症病死率评分（mortality in emergency department sepsis score，MEDS）对于急诊脓毒症患者病情评估的应用价值，并将其对患者28d病死率的预测效果进行比较。方法对2009年9月至2010年9月首都医科大学附属北京朝阳医院急诊抢救室救治的613例脓毒症患者进行前瞻性研究。记录患者的证急诊脓毒症病死率评分（MEDS）、急性生理学与慢性健康情况评价系统Ⅱ（acute physiology and chronic health evaluation，APACHEⅡ）、简化急性生理学评分Ⅱ（simplified acute physiology score，SAPSⅡ）和改良早期预警评分（modified early warning score，MEWS）。随访28d转归。根据患者MEDS评分分值将死亡风险分级：极低危险组（0～4分）、低度危险组（5～7分）、中度危险组（8—12分）、高度危险组（13～15分）、极高危险组（大于15分），各组间实际病死率采用Х^2检验比较。再对生存组和死亡组进行比较，通过logistic回归分析确定预测死亡的独立因素，应用受试者工作特征曲线（ROC曲线）比较MEDS与APACHEⅡ，SAPSⅡ和MEWS评分对预后的预测能力。结果失访10例，完整记录603例。MEDS评分患者各组实际病死率分别为0％，7．7％，18．5％，46．7％，63％，各组间实际病死率有显著区别。生存组（440例）与死亡组（163例）之间年龄和四种评分差异均具有统计学意义（P〈0．01）。MEDS，APACHEⅡ，SAPSⅡ、MEWS评分均是预测死亡的独立因素，ROC曲线下的面积（AUC）分别为0．767，0．743，0．741和0．636。结论MEDS评分可以对脓毒症患者死亡风险进行分级，在患者28d病死率方面有较好的预测能力，适用于急诊脓毒症患者。
文摘目的 探究血氨在急诊科脓毒症患者预后评估中的应用,并与急诊脓毒症病死率评 分(mortality in emergency department sepsis,MEDS)进行分析比较。方法 采用回顾性临床研究,纳入2017年6月至2018年5月期间于四川大学华西医院急诊科确诊的、符合2001年美国胸科医师协会/危重病医学会共识会议的诊断标准的脓毒症患者的临床资料,排除伴有其他影响血氨水平的疾病及失访的对象,并收集MEDS评分,电话随访统计患者的生存情况。采用独立样本t检验比较两组间差异,应用受试者操作特性(ROC)曲线评估脓毒症病死率预测的准确性,使用logistic回归模型探讨血氨与MEDS评分联合应用的价值。结果 最终纳入80例研究对象,按预后分为1周存活组(n=52)、1周死亡组(n=28);4周存活组(n=37)、4周死亡组(n=43);12周存活组(n=33)、12周死亡组(n=47);1年存活组(n=32)、1年死亡组(n=48),组间研究对象的人口特征差异无统计学意义,所有死亡对象的血氨水平均比同期存活的患者更高[(116.57±85.33)μmol/L vs (77.64±35.82)μmol/L,(108.53±73.00)μmol/L vs (71.19±32.53)μmol/L,(106.75±71.59)μmol/L vs (69.21±28.84)μmol/L,(105.77±71.14)μmol/L vs (69.50±29.25)μmol/L,P<0.05];根据1周、4周、12周和1年后的死亡情况得出,血氨的ROC曲线下面积(AUC)分别0.668(95%CI:0.542~0.793,P=0.014)、0.706(95%CI:0.593~0.819,P=0.002)、0.705(95%CI:0.592~0.818,P=0.002)、0.697(95%CI:0.582~0.811,P=0.003);与单独使用血氨、乳酸或MEDS评分相比,血氨与MEDS的联合使用会提高对脓毒症患者预后评估的准确性(P<0.05)。结论 血氨用于预测急诊科脓毒症患者的近期和1年预后都具有较高的价值,与MEDS评分的联合使用,可以进一步提高其预测价值。
