摘要目的 比较急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)、简化急性生理学评分Ⅱ(SAPSⅡ)、急诊脓毒症死亡风险评分(MEDS)对急诊抢救室全身炎症反应综合征(SIRS)患者28 d死亡的预测能力.方法 选取2006年12月-2007年9月在首都医科大学附属北京朝阳医院急诊抢救室救治的621例SIRS患者,分别进行APACHEⅡ、SAPSⅡ和MEDS评分,记录28 d转归情况.通过logistic回归分析评价各评分系统分值与预后的关系,确定SIRS患者28 d死亡的独立预测因素,通过受试者工作特征曲线(ROC曲线)对各独立预测因素的预后能力进行比较.结果 621例患者28 d死亡222例.死亡组患者年龄及3种评分系统的分值均显著高于存活组(年龄:73岁比70岁,APACHEⅡ评分:18分比14分,SAPSⅡ评分:36分比24分,MEDS评分:14分比7分,P<0.05或P<0.01).28 d死亡的独立预测因素有APACHEⅡ、SAPSⅡ、MEDS评分,ROC曲线下面积(AUC)分别为0.715、0.774、0.965.与APACHEⅡ评分比较,MEDS评分的预后能力更佳(Z=35.435,P<0.01).结论 对于急诊抢救室SIRS患者,MEDS具有较好的预后价值.

abstractsObjective To evaluate the predictive ability of 3 scoring systems, i.e. acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score, simplified acute physiology scoreⅡ (SAPSⅡ) and mortality in emergency department sepsis (MEDS) score in patients presenting systemic inflammatory response syndrome (SIRS) in emergency department. Methods Six hundred and twenty-one adult patients with SIRS admitted from December 2006 to September 2007 in the emergency department of Beijing Chaoyang Hospital were eligible for the study. The first 24-hour admission data necessary for the calculation of APACHEⅡ score, SAPSⅡ score, MEDS score and basic demographic statistics were collected and the outcomes in 28 days were recorded. Logistic regression analysis was used to determine the independent predictors for 28-day mortality. Discrimination of each scoring system was assessed with the areas under the receiver operating characteristics (ROC) curve (AUC). Results A total of 222 patients died in 28 days in a total of 621 patients. The age and mean levels of 3 scoring systems were predominantly higher in nonsurvivors than survivors (73 years vs. 70 years for age, P<0.05; 18 vs. 14 for APACHEⅡ score, P<0.01; 36 vs. 24 for SAPSⅡ score, P<0.01; 14 vs. 7 for MEDS score, P<0.01). The independent predictors of 28-day mortality were APACHEⅡ score, SAPSⅡ score and MEDS score. The AUCs were 0.715, 0.774 and 0.965 for APACHE Ⅱ score, SAPS Ⅱ score and MEDS score, respectively. There was significant difference between MEDS score and APACHEⅡ score in AUC (Z=35.435, P<0.01). Conclusion In emergency department patients with SIRS, the MEDS score possesses more predictive ability than APACHEⅡ score.