Analysis of risk factors about the prognosis in the critically ill patients of emergency room

doi:10.3969/j.issn.1006-7795.2017.04.021

Abstract

Abstract: Objective To investigated the biological indicators and evaluation scales of critically ill patients for predicting the prognosis of 28-day in a university hospital emergency room. Methods A prospective investigation was done in the emergency room of Beijing Chao-Yang Hospital, Capital Medical University from January 2014 to May 2015, and 28-day mortality was recorded. Monitor vital signs, blood biochemical, coagulation, arterial blood gas analysis, lactic acid, C-reactive protein and other laboratory indicators in admission of 24 hours. Acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ), simplified acute physiology score Ⅱ (SAPS Ⅱ), sepsis-related organ failure assessment system (SOFA) and the mortality in emergency department sepsis (MEDS) score were evaluated. Results A total of 2 089 patients were involved in, and were divided into two groups by 28-day prognosis: survival (n=1617) and dead (n=472). No significant difference of age, gender, body mass index and disease composition were found between the two groups(P>0.05). APACHEⅡ、SAPSⅡ、SOFA and MEDS scores of the survival and dead groups were 11.64±4.33 vs 20.87±5.46, 25.23±8.67 vs 42.96±12.97, 6.28±4.54 vs 10.98±5.89 and 1.86±1.80 vs 4.90±3.97 respectively, significant differences were found between the two groups (P<0.001).C-reactive protein and lactic acid were increased significantly (P<0.001 vs the survival group. The risk factors of poor prognosis, which were increased APACHE Ⅱ, MEDS, SAPS Ⅱ and lactic acid, were confirmed by Logistic analysis. The predicting power of APACHE Ⅱ was confirmed by ROC curve further; the sensibility and specificity were 88.38% and 82.93% respectively. Conclusion In the four scoring systems, the APACHE Ⅱ score was the most predictor of the 28-day prognosis in critically ill patients, and the biologic index of blood lactic acid could be used as an independent risk factor for the 28-day prognosis of critically ill patients.

Key words: scoring systems, biological indicators, emergency, critically ill, prognosis

CLC Number:

R459.7

Wang Tao, Wang Shuo, Tang Ziren, Li Chunsheng. Analysis of risk factors about the prognosis in the critically ill patients of emergency room[J]. Journal of Capital Medical University, 2017, 38(4): 597-603.

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