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首页> 外文期刊>Journal of Clinical and Diagnostic Research >Prediction of Mortality in Sepsis using Rapid Emergency Medicine Score A Cohort Study
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Prediction of Mortality in Sepsis using Rapid Emergency Medicine Score A Cohort Study

机译：使用快速急诊医学评分群岛苏联的死亡率预测队列队列研究

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Organ dysfunction due to sepsis is manifested as acute rise of 2 points in quick Sequential Organ Failure Assessment (qSOFA) score from baseline, which is assessed by: 1) Systolic Blood Pressure (SBP) ≤100 mmHg; 2) Respiration Rate (RR) ≥22/min; 3) altered mentation, each having one point. For timely and specific management, an early diagnosis and stratification of severity of the sepsis is important. To predict the outcome of sepsis many scoring systems like SOFA, Acute Physiology and Chronic Health Evaluation II (APACHE II), Rapid Emergency Medicine Score (REMS), Mortality Prediction Model (MPM) have been developed. REMS is simple and feasible scoring system comprising of simple variables like, age in years, Pulse Rate (PR), RR, Mean Arterial Pressure (MAP), Glasgow Coma Scale (GCS) and SpO_(2) estimation.Aim: The aim of the study was to evaluate the efficacy of REMS score and to validate its utility in patients with sepsis to predict mortality.Materials and Methods: This was an observational, cohort study conducted in the Department of Medicine of SCB Medical College and Hospital, Cuttack. A total of 100 patients of sepsis admitted to medical wards and Intensive Care Unit (ICU) of Medicine department were included in the study. Vital parameters like PR, SBP, RR, GCS, SpO_(2) were noted. REMS score was calculated for patients with sepsis and septic shock, among survivors and non survivors. Primary outcome was either death or discharged. The observed data was statistically analysed for utility of REMS score in predicting mortality, which is the secondary outcome of the study. Student’s t-test and Mann-Whitney U test were used for comparing normally and non-normally distributed data respectively. Univariate and multivariate logistic regression was done for all parameters in REMS.Results: The average age of the patients was 49 years (SD 14.5) with males and females almost equally distributed. Major source of infection were pneumonia (24%) followed by urinary tract infections (19%). REMS score was calculated on the day of admission of all 100 patients. It clearly distinguished survivors from non survivors (p<0.001). The median value of REMS among non survivors was 9 (7-10), which was highly significant compared to survivors; median value of REMS among survivors was 3.5 (2-5). REMS score was high among patients with septic shock than patients with sepsis {median REMS: 9 (7-10.5) vs. 4 (2-5.75); p<0.001}. All the variables in REMS were significantly associated with mortality, however with multivariate analysis only the RR was independent predictor of mortality. REMS at cut-off score 7 has sensitivity of 87.5%, specificity of 88.2%, Positive Predictive Value (PPV) of 70%, Negative Predictive Value (NPV) of 95.7%, and accuracy of REMS was 88%.Conclusion: REMS score showed a significant difference among survivors and non survivors with higher score predicting higher mortality. Hence, REMS is a valid scoring system that can be used in resource limited emergency departments to predict the mortality in patients with sepsis and septic shock.
机译：由于败血症引起的器官功能障碍表现为快速顺序器官衰竭评估（QSOFA）从基线评分的急性上升2点，评估：1）收缩压（SBP）≤100mmHg; 2）呼吸速率（RR）≥22/ min; 3）改变的助长，每个都有一个点。对于及时和特异性的管理，脓毒症严重程度的早期诊断和分层是重要的。为了预测SEPSIS许多评分系统，如沙发，急性生理和慢性健康评估II（Apache II），已经开发出快速急诊医学评分（REM），死亡率预测模型（MPM）。 Rems是简单且可行的评分系统，包括简单的变量，如多年的年龄，脉搏率（PR），RR，平均动脉压（MAP），Glasgow Coma Scale（GCS）和Spo_（2）估计。 AIM：该研究的目的是评估REMS评分的疗效，并验证其在脓毒症患者中的效用，以预测死亡率。材料和方法：这是SCB医学院医学部门进行的观察团，队列研究和医院，cuttack。研究中，共有100名败血症患者被录取为医学病房和医学部门（ICU）的研究。注意到Pr，SBP，RR，GCS，SPO_（2）等重要参数。针对脓毒症和脓毒症患者，幸存者和非幸存者的患者计算了REMS评分。主要结果是死亡或出院。观察到的数据在预测死亡率预测死亡率的效用进行了统计学分析，这是该研究的二次结果。学生的T-Test和Mann-Whitney U测试用于分别比较正常和非正常分布的数据。为REM的所有参数进行单变量和多变量逻辑回归。结果：患者的平均年龄为49岁（SD 14.5），男性和女性几乎同样分布。感染的主要来源是肺炎（24％），然后是泌尿道感染（19％）。 REMS评分是在所有100名患者的入场时计算的。它清楚地介绍了来自非幸存者的幸存者（P <0.001）。非幸存者中REMS的中值为9（7-10），与幸存者相比，这是非常重要的;幸存者中REM的中位数为3.5（2-5）。脓毒症患者的患者比患者患者比败血症患者{中位数REMS：9（7-10.5）与4（2-5.75）; P <0.001}。 Rems中的所有变量与死亡率显着相关，但是，只有多变量分析，RR是独立的死亡率预测因子。截止分数7的REMS具有87.5％的敏感性，特异性为88.2％，阳性预测值（PPV）为70％，阴性预测值（NPV）为95.7％，REM的准确性为88％。结论：REMS评分显示出幸存者和幸存者的显着差异，具有更高的分数预测更高的死亡率。因此，REMS是一个有效的评分系统，可用于资源有限的急诊部门，以预测脓毒症和脓毒症休克患者的死亡率。

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