摘要目的：探讨改良早期预警评分（MEWS）对急诊重症患者早期预后的预测价值。方法采用前瞻性队列研究方法，连续入选2014年2月13日至4月20日在北京协和医院急诊抢救室就诊患者，记录患者临床资料，进行MEWS评分并随访患者临床转归，比较MEWS阳性组（MEWS≥5分）和MEWS阴性组（MEWS 0～4分）患者主要终点（3 d内死亡）及次要终点〔所有死亡，以及转入重症加强治疗病房（ICU）、心肺复苏（CPR）和死亡联合终点〕的发生率，采用多因素回归分析主要终点的影响因素。结果入选176例临床资料完整的患者，平均年龄（56.86±21.46）岁；男性98例，占55.68%；平均MEWS评分（4.30±2.74）分。MEWS阳性组74例，MEWS阴性组102例。共有41例患者出现主要终点，MEWS阳性组3 d内病死率显著高于MEWS阴性组〔37.84%（28/74）比12.74%（13/102），优势比（OR）＝4.167，95%可信区间（95%CI）＝1.973～8.804，P＜0.001〕。次要终点事件中，MEWS阳性组所有死亡〔54.05%（40/74）比17.65%（18/102），OR＝5.490，95%CI＝2.770～10.883，P＜0.001〕以及转入ICU、CPR和死亡联合终点〔64.86%（48/74）比25.49%（26/102），OR＝5.396，95%CI＝2.809～10.366，P＜0.001〕发生率也显著高于MEWS阴性组。多因素回归分析显示，意识状态异常是3 d内死亡的预测因子（OR＝3.606，95%CI＝1.541～8.436，P＝0.003），而MEWS≥5分则不是（OR＝1.672，95%CI＝0.622～4.494，P＝0.308）。结论尽管MEWS≥5分的急诊重症患者较MEWS 0～4分患者发生严重不良事件风险显著增加，但MEWS≥5分不能有效预测患者3 d内死亡的风险，而意识状态改变对急诊重症患者的早期死亡具有一定预测意义。

abstractsObjectiveTo evaluate the value of modified early warning score (MEWS) in predicting mortality of critically ill patients admitted to emergency department.Methods A prospective cohort study was conducted. Clinical data of emergency patients admitted to resuscitation room of Peking Union Medical College Hospital from Feburary 13rd, 2014 to April 20th, 2014 were collected, and their MEWS were calculated based on medical records and their clinical outcomes was followed. Incidence of primary outcome (3-day mortality) and secondary outcome [all deaths and composite outcome of intensive care unit (ICU) transfer, cardio-pulmonary resuscitation, and death] were compared between MEWS positive (MEWS≥5) or negative (MEWS 0-4) patients, and multi-regression logistic analysis was done to look for the impact factors of primary outcome in these patients.Results 176 patients, among them 98 (55.68%) were male, were enrolled in the study. Their mean age was (56.86±21.46) years old. Mean MEWS was 4.30±2.74. There was 74 cases in MEWS positive group, and 102 in negative group. Primary endpoint occurred in 41 patients, and the 3-days mortality in MEWS positive group was significantly higher than that in MEWS negative group [37.84 (28/74) vs. 12.74% (13/102), odds ratio (OR) = 4.167, 95% confidence interval (95%CI) = 1.973-8.804,P< 0.001]. At the meantime, incidence of all death [54.05% (40/74) vs. 17.65% (18/102),OR = 5.490, 95%CI = 2.770-10.883,P< 0.001] and the incidence of ICU transfer, cardio-pulmonary resuscitation and death [64.86% (48/74) vs. 25.49% (26/102),OR = 5.396, 95%CI = 2.809-10.366,P< 0.001] were also significantly higher in MEWS positive group as compared with negative group. Multi-regression logistic showed abnormal mental status (OR = 3.606, 95%CI = 1.541-8.436,P = 0.003) but not MEWS≥5 (OR = 1.672, 95%CI = 0.622-4.494,P = 0.308)was the predictor of 3-day mortality in emergency admitted critically ill patients.Conclusions Although the incidence of severe adverse events is significantly increased in patients with MEWS≥5 compared with those with MEWS 0-4, MEWS≥5 cannot be an efficient predictor for 3-day mortality. Abnormal mental status shows some predictive value for early mortality in critically ill patients seen in emergency department.