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国家早期预警评分和改良早期预警评分对重症监护病房再入院率和死亡率的预后价值：一项前瞻性观察研究
Frontiers in Medicine
(
IF
3.1
)
Pub Date : 2022-08-04
, DOI:
10.3389/fmed.2022.938005
Ata Mahmoodpoor
1
,
Sarvin Sanaie
1
,
Seied Hadi Saghaleini
2
,
Zohreh Ostadi
2
,
Mohammad-Salar Hosseini
3
,
Naeeme Sheshgelani
3
,
Amir Vahedian-Azimi
4
,
Abbas Samim
5
,
Farshid Rahimi-Bashar
6
Affiliation
- Research Center for Integrative Medicine in Aging, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran.
- Department of Anesthesiology and Intensive Care, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran.
- Trauma Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran.
- Chemical Injuries Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran.
- Anesthesia and Critical Care Department, Hamadan University of Medical Sciences, Hamadan, Iran.
Background改良早期预警评分（MEWS）和国家早期预警评分（NEWS）被广泛用于预测重症患者的死亡率和重症监护病房（ICU）入院情况。本研究旨在评估和比较 NEWS 和 MEWS 在预测重症患者出院时 ICU 再入院、死亡率和相关结局方面的预后价值。
Methods这项多中心、前瞻性、观察性研究于 2019 年 4 月至 2020 年 3 月在伊朗西北部两家大学附属医院的普通 ICU 进行了一年多。使用单变量和多变量二元逻辑回归，根据患者的结果（包括死亡率、ICU 再入院、再入院时间、出院类型、机械通气 (MV)、MV 持续时间和再入院后多器官衰竭）比较 MEWS 和 NEWS。受试者工作特征 (ROC) 曲线用于确定 MEWS 和 NEWS 的结果可预测性。
Results本研究共招募了 410 名 ICU 患者。根据多变量逻辑回归分析，MEWS 和 NEWS 都是 ICU 再入院、再入院时间、再入院后 MV 状态、MV 持续时间和再入院后多器官衰竭的预测因子。预测死亡率的 ROC 曲线下面积 (AUC) 为 0.91 (95% CI = 0.88–0.94,磷< 0.0001) 对于 NEWS 和 0.88 (95% CI = 0.84–0.91,磷< 0.0001) 对于 MEWS。NEWS的AUC与MEWS预测死亡率的AUC无显着差异（磷= 0.082)。然而，对于 ICU 再入院 (0.84 vs. 0.71)、再入院时间 (0.82 vs. 0.67)、再入院后 MV (0.83 vs. 0.72)、MV 持续时间 (0.81 vs. 0.67) 和多器官衰竭 (0.833 vs. 0.710) ），MEWS 的 AUC 显着更大（磷< 0.001)。
Conclusion国家早期预警评分和 > 4 的 MEWS 值表明在确定患者从 ICU 出院的死亡风险方面具有很高的敏感性和特异性。然而，我们发现 MEWS 在预测其他结果方面表现出优于 NEWS 分数。最终，MEWS 可以被认为是危重患者发病率和死亡率的有效预测评分。
"点击查看英文标题和摘要"
Prognostic value of National Early Warning Score and Modified Early Warning Score on intensive care unit readmission and mortality: A prospective observational study
BackgroundModified Early Warning Score (MEWS) and National Early Warning Score (NEWS) are widely used in predicting the mortality and intensive care unit (ICU) admission of critically ill patients. This study was conducted to evaluate and compare the prognostic value of NEWS and MEWS for predicting ICU readmission, mortality, and related outcomes in critically ill patients at the time of ICU discharge.
MethodsThis multicenter, prospective, observational study was conducted over a year, from April 2019 to March 2020, in the general ICUs of two university-affiliated hospitals in Northwest Iran. MEWS and NEWS were compared based on the patients’ outcomes (including mortality, ICU readmission, time to readmission, discharge type, mechanical ventilation (MV), MV duration, and multiple organ failure after readmission) using the univariable and multivariable binary logistic regression. The receiver operating characteristic (ROC) curve was used to determine the outcome predictability of MEWS and NEWS.
ResultsA total of 410 ICU patients were enrolled in this study. According to multivariable logistic regression analysis, both MEWS and NEWS were predictors of ICU readmission, time to readmission, MV status after readmission, MV duration, and multiple organ failure after readmission. The area under the ROC curve (AUC) for predicting mortality was 0.91 (95% CI = 0.88–0.94, P < 0.0001) for the NEWS and 0.88 (95% CI = 0.84–0.91, P < 0.0001) for the MEWS. There was no significant difference between the AUC of the NEWS and the MEWS for predicting mortality (P = 0.082). However, for ICU readmission (0.84 vs. 0.71), time to readmission (0.82 vs. 0.67), MV after readmission (0.83 vs. 0.72), MV duration (0.81 vs. 0.67), and multiple organ failure (0.833 vs. 0.710), the AUCs of MEWS were significantly greater (P < 0.001).
ConclusionNational Early Warning Score and MEWS values of >4 demonstrated high sensitivity and specificity in identifying the risk of mortality for the patients’ discharge from ICU. However, we found that the MEWS showed superiority over the NEWS score in predicting other outcomes. Eventually, MEWS could be considered an efficient prediction score for morbidity and mortality of critically ill patients.
更新日期：2022-08-04
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