| 摘要: |
| 目的 分析改良早期预警评分(MEWS)和快速急诊内科评分(REMS)对不同系统疾病患者医疗接触24小时内死亡的预测价值。方法 选择2016年1月至2024年8月经广西壮族自治区人民医院急诊科抢救室救治，医疗接触后24小时内死亡的281例非创伤患者作为死亡组，选取死亡患者中疾病种类排名前6位的对应病例，按1:3的比例，匹配同期于该院急诊科抢救室诊治并收治入内科病房的542例患者作为存活组，收集患者的临床资料。采用受试者工作特征曲线（ROC）分析MEWS和REMS评分的预测价值。结果 281例死亡患者以60~89岁的老年人群为主（65.48%）。死亡原因按疾病累及系统排序，前三位依次为心血管系统（36.17%）、呼吸系统（15.60%）、神经系统（14.59%）；在这三大系统中，按疾病诊断排名前6位依次为急性心肌梗死（71例）、重症肺炎（36例）、急性脑梗死（24例）、急性脑出血（17例）、急性主动脉夹层（16例）、急性心力衰竭（13例）。死亡组MEWS和REMS评分高于存活组，差异有统计学意义（P<0.05）。两者均可有效预测急诊内科患者医疗接触24小时内死亡（P＜0.05），两者的ROC曲线下面积（AUC）分别为0.885、0.886, MEWS评分敏感度为85.10%，特异性为72.10%, REMS评分敏感度为82.10%，特异度为80.60%。最佳截断值分别为4分、11分。对于排名前6位疾病患者，MEWS和REMS评分评分均能预测其医疗接触24小时内死亡（P＜0.05）,，两者的AUC、敏感度、特异度分别是（急性心肌梗死患者）0.977、90.10%、96.60%，0.962、94.40%、91.60%；（重症肺炎患者）0.629、66.70%、39.00%，0.786、77.80%、59.60%；（急性脑梗死患者）0.973、91.70%、97.80%，0.980、91.70%、87.60%；（急性脑出血患者）0.962、94.10%、80.60%, 0.932、94.10%、75.00%；（急性主动脉夹层患者）0.809、62.50%、85.10%，0.910、81.30%、79.20%; (急性心力衰竭患者）0.920、84.60%、74.10%，0.868、76.90%、66.70%。最佳截断值分别集中于3~6分和9~12分区间。结论 MEWS和REMS评分对不同疾病医疗接触24小时内患者死亡均有预测价值，但存在差异。MEWS评分在急性脑梗死、急性心力衰竭及急性脑出血患者接触24小时内死亡的预测价值优于REMS；REMS评分对急性主动脉夹层患者的识别更为敏感；两者对急性心肌梗死患者的预测价值相当；两者对重症肺炎的患者预测效能均较差。 |
| 关键词: 改良早期预警评分 快速急诊内科评分 急诊 医疗接触24小时内死亡 预测价值 |
| DOI： |
| 分类号: |
| 基金项目:广西壮族自治区卫生健康委员会自筹经费科研课题(合同编号:Z2012279),广西科技基地和人才专项(合同编号:2021AC04001) |
|
| Predictive Value of MEWS and REMS for 24-Hour Mortality After Medical Contact Across Systemic Diseases |
|
Huang pingmao
|
|
jiangbin hospital of Guangxi Zhuang Autonomous Region
|
| Abstract: |
| Objective This study aims to analyze the predictive value of the Modified Early Warning Score (MEWS) and the Rapid Emergency Medicine Score (REMS) score for 24-hour mortality after medical contact with different systemic diseases. Methods Between January 2016 and August 2024, 281 non-traumatic patients who died within 24 hours of medical contact in the emergency resuscitation room of the People's Hospital of Guangxi Zhuang Autonomous Region were enrolled as the death group. For the six most frequent diseases in this group, cases were matched 1:3 with 542 patients who attended the same resuscitation room and were admitted to internal medicine wards during the same period, forming the survival group. Clinical data were collected. Receiver operating characteristics (ROC) curve analysis was performed to evaluate and compare the performances of MEWS and REMS scores. Results Total patients who died within 24 hours of medical contact were 281, predominantly aged 60–89 years (65.48%) . The top three systems involved in causes of death were the cardiovascular system (36.17%) , respiratory system (15.60%), and nervous system (14.59%) respectively. Within these three systems, the six most common specific diseases ranked by frequency were acute myocardial infarction (71 cases) , severe pneumonia (36 cases) , acute cerebral infarction (24 cases) , acute cerebral hemorrhage (17 cases), acute aortic dissection (16 cases), and acute heart failure (13 cases) . The MEWS and REMS scores in the death group were significantly higher than those in the survival group, and the difference was statistically significant (P<0.05) . Both two scores effectively predicted 24-hour mortality after medical contact in emergency internal medicine patients (P < 0.05). The areas under the ROC curve (AUC) were 0.885 for MEWS and 0.886 for REMS. The MEWS score had a sensitivity of 85.1% and a specificity of 72.1%, whereas the REMS score had a sensitivity of 82.1% and a specificity of 80.6%. The optimal cut-off values were 4 for MEWS and 11 for REMS. For patients with the top six diseases, both two scores significantly predicted death within 24 hours of medical contact (P < 0.05). The AUC, sensitivities and specificities for the two scores across the six diseases were as follows: for patients with acute myocardial infarction, MEWS: 0.977, 90.10%, 96.60%; REMS: 0.962, 94.40%, 91.60%. For patients with severe pneumonia: MEWS: 0.629, 66.70%, 39.00%; REMS: 0.786, 77.80%, 59.60%. For patients with acute cerebral infarction: MEWS: 0.973, 91.70%, 97.80%; REMS: 0.980, 91.70%, 87.60%. For patients with acute cerebral hemorrhage: MEWS: 0.962, 94.10%, 80.60%; REMS: 0.932, 94.10%, 75.00%. For patients with acute aortic dissection: MEWS: 0.809, 62.50%, 85.10%; REMS: 0.910, 81.30%, 79.20%. For patients with acute heart failure: MEWS: 0.920, 84.60%, 74.10%; REMS: 0.868, 76.90%, 66.70%. The optimal cut-off values ranged from 3 to 6 for MEWS and from 9 to 12 for REMS. Conclusions MEWS and REMS scores both predict death within 24 hours of medical contact in patients with various diseases , but their predictive value differs. MEWS outperformed REMS for 24?hour mortality after medical contact in acute cerebral infarction, acute heart failure, and acute cerebral haemorrhage, whereas REMS was more sensitive for acute aortic dissection. The two scores performed comparably for acute myocardial infarction ,but both showed poor predictive value for severe pneumonia. |
| Key words: Modified Early Warning Score (MEWS) Rapid Emergency Medicine Score (REMS) Emergency Department (ED) 24-hour mortality for different internal medicine systems Predictive value |
