不同评分系统对急诊自发性非创伤性脑出血患者病情及预后判断的影响
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摘要
目的探讨快速急诊内科评分(REMS)、改良早期预警评分(MEWS)、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)和改良急诊脑出血分级量表(mEDICH)在急诊自发性非创伤性脑出血(sICH)患者病情及预后判断中的价值。方法收集2017年9月～2018年8月武汉大学人民医院急诊科首诊的sICH患者201例,根据其院内死亡或30 d内死亡分为存活组和死亡组,比较这4种评分系统不同分值段的病死率差异,并应用ROC曲线比较REMS、MEWS、APACHEⅡ和mEDICH评分评估急诊sICH患者预后的准确性和临床价值。结果院内死亡或30 d内死亡与存活的s ICH患者的REMS、MEWS、APACHEⅡ和mEDICH评分比较,差异有高度统计学意义(P <0.01)。各量表评分越高,病死率越高,且各分值段间病死率比较,差异均有高度统计学意义(P <0.01)。REMS、MEWS、APACHEⅡ和mEDICH评分的ROC曲线下面积分别为0.733、0.777、0.833和0.899。m EDICH评分的ROC曲线下面积显著大于REMS、MEWS和APACHEⅡ评分的曲线下面积(P <0.01)。结论 REMS、MEWS、APACHEⅡ和mEDICH评分均能较好的对急诊sICH患者院内死亡或30 d内死亡风险进行预测,以mEDICH的预测能力最佳。
Objective To discuss rapid emergency medical grade(REMS), modified early warning score(MEWS) and acute physiology and chronic health evaluation system Ⅱ(APACHE Ⅱ) and the improvement of emergency(mEDICH)in emergency treatment of spontaneous cerebral hemorrhage grading scale non traumatic cerebral hemorrhage(sICH)patients and prognosis judgement of value. Methods A total of 201 cases of patients with sICH collected from September 2017 to August 2018, Department, Emergency of Renmin Hospital of Wuhan University, according to the hospital within 30 d death or death is divided into survival group and death group, and compared the four different points scoring system of case fatality rate difference was compared, and ROC curve was used to compare REMS, MEWS, APACHEⅡ and mEDICH score evaluation of the accuracy and clinical value of the prognosis of emergency patients with sICH. Results Within 30 d hospital death or death and survival of patients with sICH REMS, MEWS, APACHEⅡ and mEDICH score comparison, highly significant difference(P < 0.01). The higher the score of each scale was, the higher the fatality rate was, and the difference between each score segment was highly statistically significant(P < 0.01). REMS,MEWS, APACHE Ⅱ and mEDICH score area under the ROC curve were 0.733, 0.777, 0.833 and 0.899, respectively.Area under the ROC curve of mEDICH score significantly greater than the REMS, MEWS and APACHE Ⅱ(P < 0.01).Conclusion REMS, MEWS, APACHE Ⅱ and mEDICH scores are good for emergency treatment of sICH patients was dead or not within 30 d to predict the risk of death, the predictive ability of mEDICH is the best.
Objective To discuss rapid emergency medical grade(REMS), modified early warning score(MEWS) and acute physiology and chronic health evaluation system Ⅱ(APACHE Ⅱ) and the improvement of emergency(mEDICH)in emergency treatment of spontaneous cerebral hemorrhage grading scale non traumatic cerebral hemorrhage(sICH)patients and prognosis judgement of value. Methods A total of 201 cases of patients with sICH collected from September 2017 to August 2018, Department, Emergency of Renmin Hospital of Wuhan University, according to the hospital within 30 d death or death is divided into survival group and death group, and compared the four different points scoring system of case fatality rate difference was compared, and ROC curve was used to compare REMS, MEWS, APACHEⅡ and mEDICH score evaluation of the accuracy and clinical value of the prognosis of emergency patients with sICH. Results Within 30 d hospital death or death and survival of patients with sICH REMS, MEWS, APACHEⅡ and mEDICH score comparison, highly significant difference(P < 0.01). The higher the score of each scale was, the higher the fatality rate was, and the difference between each score segment was highly statistically significant(P < 0.01). REMS,MEWS, APACHE Ⅱ and mEDICH score area under the ROC curve were 0.733, 0.777, 0.833 and 0.899, respectively.Area under the ROC curve of mEDICH score significantly greater than the REMS, MEWS and APACHE Ⅱ(P < 0.01).Conclusion REMS, MEWS, APACHE Ⅱ and mEDICH scores are good for emergency treatment of sICH patients was dead or not within 30 d to predict the risk of death, the predictive ability of mEDICH is the best.
引文
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[14] Satop魨¤魨¤J,Mustanoja S,Meretoja A,et al. Comparison of all 19 published prognostic scores for intracerebral hemorrhage[J]. J Neurol Sci,2017,379:103-108.
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[16] Chuwei Y,Hui L,Yufei L. Modified early warning scoring system in the value of emergency treatment of sudden cerebral hemorrhage[J]. Chinese J Practical Neruous Diseases,2015,18(11):15-17.
[17] Vincent JL,Moreno R. Clinical review:Scoring systems in the critically ill[J]. Critical Care,2010,14(2):207.
[18]张运周,高冉,高岱佺,等.改良急诊脑出血分级量表对自发性脑出血患者30天病死率的预测作用[J].中华老年心脑血管病杂志,2016,18(6):564-566.
[19] Huang KB,Ji Z,Wu YM,et al. The prediction of 30-day mortality in patients with primary pontine hemorrhage:a scoring system comparison[J]. Eur J Neurol,2012,19(9):1245-1250.
[20] Pan K,Panwar A,Roy U,et al. A Comparison of the Intracerebral Hemorrhage Score and the Acute Physiology and Chronic Health EvaluationⅡScore for 30-Day Mortality Prediction in Spontaneous Intracerebral Hemorrhage[J].J Stroke Cerebrovasc Dis,2017,26(11):2563-2569.
[2] Safatli DA,Günther A,Schlattmann P,et al. Predictors of30-day mortality in patients with spontaneous primary intracerebral hemorrhage[J]. Surg Neurol Int,2016,7(Suppl18):S510-S517.
[3] Hemphill JR,Greenberg SM,Anderson CS,et al. Guidelines for the Management of Spontaneous Intracerebral Hemorrhage:A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association[J]. Stroke,2015,46(7):2032-2060.
[4] Zis P,Leivadeas P,Michas D,et al. Predicting 30-Day Case Fatality of Primary Inoperable Intracerebral Hemorrhage Based on Findings at the Emergency Department[J]. J Stroke Cerebrovasc Dis,2014,23(7):1928-1933.
[5] Masotti L,Di NM,Godoy DA,et al. Predictive Ability of a Modified Version of Emergency Department Intracerebral Hemorrhage Grading Scale for Short-term Prognosis of Intracerebral Hemorrhage[J]. J Stroke Cerebrovasc Dis,2015,24(5):1100-1104.
[6]浦清,李友梅,胡亮,等.入院高血糖与急性自发性脑出血患者预后的相关性分析[J].临床急诊杂志,2018,19(8):500-504.
[7] Kothari RU,Brott T,Broderick JP,et al. The ABCs of measuring intracerebral hemorrhage volumes[J]. Stroke,1996,27(8):1304-1305.
[8] Hanley JA,Mcneil BJ. A method of comparing the areas under receiver operating characteristic curves derived from the same cases[J]. Radiology,1983,148(3):839-843.
[9] Chu SY,Hwang DY. Predicting Outcome for Intracerebral Hemorrhage Patients:Current Tools and Their Limitations[J].Semin Neurol,2016,36(3):254-260.
[10] Al-Shahi SR,Law ZK,Bath PM,et al. Haemostatic therapies for acute spontaneous intracerebral haemorrhage[J].Cochrane Database Syst Rev,2018,4:D5951.
[11] Mahdy M,Moussa A,Fahmy A,et al. Admission plasma d dimer as a predictor of outcome in patients with primary intracerebral hemorrhage[J]. Int J Adv Res,2017,5(6):1489-1493.
[12] Masotti L,Lorenzini G,Napoli MD,et al. Prognostic ability of four clinical grading scores in spontaneous intracerebral hemorrhage[J]. Acta Neurol Belg,2017,117(1):325-327.
[13]陈佳.三种脑出血分级量表对自发性脑出血预后的评价比较[D].大连:大连医科大学,2016.
[14] Satop魨¤魨¤J,Mustanoja S,Meretoja A,et al. Comparison of all 19 published prognostic scores for intracerebral hemorrhage[J]. J Neurol Sci,2017,379:103-108.
[15] Han JX,See AAQ,King NKK. Validation of Prognostic Models to Predict Early Mortality in Spontaneous Intracerebral Hemorrhage:A Cross-Sectional Evaluation of a Singapore Stroke Database[J]. World Neurosurg,2018,109:e601-e608.
[16] Chuwei Y,Hui L,Yufei L. Modified early warning scoring system in the value of emergency treatment of sudden cerebral hemorrhage[J]. Chinese J Practical Neruous Diseases,2015,18(11):15-17.
[17] Vincent JL,Moreno R. Clinical review:Scoring systems in the critically ill[J]. Critical Care,2010,14(2):207.
[18]张运周,高冉,高岱佺,等.改良急诊脑出血分级量表对自发性脑出血患者30天病死率的预测作用[J].中华老年心脑血管病杂志,2016,18(6):564-566.
[19] Huang KB,Ji Z,Wu YM,et al. The prediction of 30-day mortality in patients with primary pontine hemorrhage:a scoring system comparison[J]. Eur J Neurol,2012,19(9):1245-1250.
[20] Pan K,Panwar A,Roy U,et al. A Comparison of the Intracerebral Hemorrhage Score and the Acute Physiology and Chronic Health EvaluationⅡScore for 30-Day Mortality Prediction in Spontaneous Intracerebral Hemorrhage[J].J Stroke Cerebrovasc Dis,2017,26(11):2563-2569.
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