| 彭伊梦,姚杨,马青,等.改良的国家早期预警评分对危重症病人预后评估的价值[J].安徽医药,2023,27(5):936-940. |
| 改良的国家早期预警评分对危重症病人预后评估的价值 |
| The value of INEWS score in prognostic evaluation of critically ill patients |
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| DOI：10.3969/j.issn.1009-6469.2023.05.019 |
| 中文关键词: 危重病 国家早期预警评分 预后 死亡率 |
| 英文关键词: Critical illness NEWS score Prognosis Mortality rate |
| 基金项目:西安市第七批科技计划［ 20YXYJ0001(7)］；医学科研发展基金项目 -临床与基础研究专项( B21021BN) |
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| 中文摘要: |
| 目的评估改良的国家早期预警评分( INEWS评分)在危重症病人预后中的价值。方法选取 2016年 1月至 2019年 12月入住西安医学院第一附属医院呼吸与危重症医学科的危重症病人 733例，收集病人入院 24 h内的基本生命体征、相关生化指标、意识状态等进行 INEWS评分、急性生理学和慢性健康状况评价 Ⅱ(APACHEⅡ评分)、英国国家早期预警评分( NEWS评分)。依据病人出院结局分为存活组和死亡组，比较两组病人相关指标及评分差异，研究评分与病人死亡率之间的关系，绘制受试者操作特征曲线( ROC曲线)比较各评分 ROC曲线下面积( AUC)、截断值( Cut-off值)比较两组病人 INEWS评分的生存曲线，预测死亡率。结果共纳入病，人 733例，男 468例，女 265例，存活组 572例，死亡组1，61例，生存率 78.04％，死亡率 21.96％。死亡组病人的 INEWS评分、 APACHEⅡ评分、 NEWS评分分别为 18分( 14，25)、 10分( 7，12)、 11分( 8，13)，均高于存活组评分 11分( 8，16)、 7分( 5.25，9)、 8分( 6，10)差异有统计学意义( P<0.05)。 INEWS评分、 APACHEⅡ评分、 NEWS评分的 AUC分别为 0.74，0.76，0.70，95％CI分别为( 0.69.78)(0.72，0.81)、(0.65，0.75)。 INEWS评分约登指数为 10.5分(特异度 0，85.3％，灵敏度 50.3％)。生存分析表明，当约登指数 ≥10.5分时， ICU病人住院死亡率远高于 INEWS<10.5分的病人，差异有统计学意义( P<0.001)。结论 INEWS评分可以用来预测危重症病人的预后。评分 ≥10.5分时，提示高的死亡率， INEWS评分可为医疗工作者提供更便捷 ICU病人预后评估新指标。 |
| 英文摘要: |
| Objective To evaluate the prognostic value of improved national early warning score (INEWS) in critically ill patients. Methods The 24 h basic vital signs, related biochemical indexes and state of consciousness of 733 patients admitted to the Pulmo-nary and Critical Care Department of The First Affiliated Hospital of Xi'an Medical College from January 2016 to December 2019 werecollected for INEWS scoring, acute physiology and chronic health evaluation score (APACHEⅡ score) and British national early warn-ing score (NEWS score). According to the discharge outcome, the patients were assigned into survival group and death group. The differ-ences in related indexes and scores between the two groups were compared to study the relationship between score and mortality, the re-ceiver operating characteristic curve (ROC curve) was drawn to compare the area under ROC curve (AUC) and cutoff value (Cut-off val-ue), and the survival curves of INEWS score of the two groups were compared to predict mortality.Results In total, 733 patients wereenrolled in the study, including 468 males, 265 females, 572 in the survival group and 161 in the death group, with survival rate of78.04% and mortality rate of 21.96%. The INEWS, APACHEⅡ, and NEWS scores in the death group were 18 (14, 25), 10 (7, 12), 11(8, 13), respectively, all higher than those in the survival group [11 (1, 16), 7 (5.25, 9), 8 (6, 10)]; the differences were statistically signif-icant (P<0.05). The AUCs and 95％ CIs of INEWS, APACHEⅡ and NEWS were 0.74, 0.76, 0.70, and (0.69, 0.78),(0.72, 0.81), (0.65,0.75), respectively. The Youden index of INEWS was 10.5 points with a specificity of 85.3%, and a sensitivity of 50.3%. Survival analy-sis results showed that when Youden index ≥ 10.5 points, about the hospitalized mortality rate of ICU patients was much higher than that of the patients with INEWS <10.5 points; the difference was statistically significant (P<0.001).Conclusion The INEWS can be used to predict the prognosis in critically ill patients. Score of 10.5 or higher indicates high mortality, thus INEWS can provide moreconvenient prognostic evaluation indicators of ICU patients for medical workers. |
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