英国国家早期预警评分对急诊老年严重脓毒症及脓毒症休克患者预后的评估价值

目的探讨英国国家早期预警评分(NEWS)对急诊老年严重脓毒症及脓毒性休克患者病情及预后的评估。方法收集首都医科大学宣武医院急诊老年严重脓毒症和脓毒性休克患者116例,就诊后采集患者的常规生理生化指标,并行NEWS评分,APACHEⅡ评分和SOFA评分,随访28 d,根据患者预后分为死亡组和存活组,分别比较死亡组和存活组NEWS评分,APACHEⅡ评分及SOFA评分区别;比较脓毒性休克和严重脓毒症组的NEWS评分,APACHEⅡ评分及SOFA评分的区别;NEWS评分与APACHEⅡ评分。SOFA评分的相关性分析;通过分析ROC曲线下面积(AUC)确定NEWS评分对老年严重脓毒症和脓毒性休克患者预后的评估价值。结果脓毒性休克组患者NEWS评分;APACHEII评分和SOFA评分大于严重脓毒症组;死亡组NEWS评分;APACHEII评分和SOFA评分均显著大于存活组(P<0.05);NEWS评分水平与APACHEⅡ评分。SOFA评分具有显著相关性(r=0.807、0.883,P<0.05),NEWS评分;APACHEII评分和SOFA评分预测死亡ROC曲线下面积分别为0.870、880、0.865(P>0.05)。结论 NEWS评分对急诊老年严重脓毒症和脓毒性休克患者的病情和预后具有重要的评估价值,评分愈高提示患者预后愈差。

Value of England National Early Warning Score in evaluating prognosis of elderly patients with severe sepsis and septic shock in emergency department

Objective To study the value of England National Early Warning Score(NEWS) for the prognosis of elderly patients with severe sepsis and septic shock in emergency department.Methods A total of 116 elderly patients with severe sepsis and septic shock in Xuanwu Hospital of Capital Medical University were selected.Routine physiological and biochemical indicators were collected and NEWS score, APACHEⅡscores and SOFA scores were given to them.The follow-up was lasted for 28 d, and afterwards the patients were divided into survival group and death group according to the prognosis.The NEWS scores, APACHEⅡ scores and SOFA scores of two groups were compared.And above indicators were also compared between the severe sepsis and septic shock patients.Meanwhile, the correlation between NEWS scores, and APACHEⅡ scores, SOFA scores were analyzed.The value of NEWS scores for the prognosis of elderly patients with severe sepsis and septic shock was predicted by the area under the ROC curve(AUC).Results The NEWS scores, and APACHEⅡ scores, and SOFA scores in septic shock group were higher than that in severe sepsis group, and the death group was higher than survival group(P<0.05).NEWS scores showed a correlation with APACHEII scores and SOFA scores(P<0.05).The areas under the ROC curve of NEWS scores, APACHEII scores and SOFA scores were 0.870, 0.880, 0.865, respectively.Conclusion NEWS scores could evaluate the condition and prognosis of elderly patients with severe sepsis and sepsis shock, and the consistently higher scores of NEWS is associated with poorer prognosis.