MEDS评分结合血清降钙素原对脓毒症早期诊断和预后价值的评价

目的：比较急诊脓毒症病死率评分（ MEDS）和血清降钙素原（ PCT）对急诊重症监护病房中脓毒症的早期诊断和预后价值。方法采用前瞻性、临床病例观察及诊断试验研究。入选病例分为全身炎症反应综合征（systemic inflammatory response syndrome ，SIRS）组、非严重脓毒症组、严重脓毒症组、非SIRS对照组。测定24 h内的炎症指标、MEDS评分及PCT浓度并进行相关分析。结果198例患者入选，其中对照组59例，SIRS组57例，非严重脓毒症组52例，严重脓毒症组30例。根据受试者工作特征曲线（ROC曲线）分析，诊断脓毒症中PCT 的ROC曲线下面积（AUC）为0．936±0．02。根据重症脓毒症组和非重症脓毒症组的 PCT、APACHE Ⅱ评分和 MEDS 评分数值绘制ROC曲线，由ROC曲线计算上述各指标的曲线下面积（AUC），PCT的AUC面积为0．586±0．065，显著低于APACHE Ⅱ评分0．941±0．023和MEDS评分0．791±0．049。结论 PCT是早期诊断脓毒症并能与SIRS鉴别的特异性较高的炎症指标；但PCT 不能将脓毒症进行危险分层，结合 MEDS评分和PC T可以预测脓毒症的发病概率及客观判断脓毒症病情的严重性。

Evaluation of early diagnostic and prognostic value of MEDS score combining procalcitonin in pa-tients with sepsis

Objective To study the diagnostic and prognostic value of procalcitonin （PCT ） ,com-bining with mortality in emergency department sepsis （MEDS） scores in patients with sepsis in early stage .Methods According to the definition of ACCP/SCCM Consensus Conference ,patients were clas-sified into 4 groups which were non-systemic inflammatory response syndrome （SIRS） group ,SIRS group ,non-severe sepsis group ,and severe sepsis group .APACHE ,MEDS and concentration of PCT were determined at 24 hours ,and their correlations were analyzed .Results Total of 198 patients were enrolled ,including 59 in non-SIRS group（control group） ,57 in SIRS group ,52 in sepsis group , 30 in severe sepsis group .There was highly difference in PCT concentrations between Sepsis group and SIRS group .ROC curves were drawn and area under these curves （AUC） was calculated .In the diagnosis of sepsis ,AUC values were 0 .936 ± 0 .02 for PCT .While in the diagnosis of sever sepsis AUC values were only 0 .586 ± 0 .065 for PCT and 0 .791 ± 0 .049 for MEDS score ,0 .941 ± 0 .023 for APACHE .Conclusion PCT can be used to predict the incidence of sepsis while APACHE and MEDS score are the more reliable prognostic indicator of sepsis .