Combining Heart Rate Variability with Disease Severity Score Variables for Mortality Risk Stratification in Septic Patients Presenting at the Emergency Department
Combining Heart Rate Variability with Disease Severity Score Variables for Mortality Risk Stratification in Septic Patients Presenting at the Emergency Department
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DOI：
10.3390/ijerph16101725
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发表时间：
2019-05-02
影响因子：
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通讯作者：
Liu, Nan
中科院分区：
文献类型：
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作者：
Pong, Jeremy Zhenwen;Fook-Chong, Stephanie;Liu, Nan
急诊科（艾德）是许多脓毒症患者的第一个医院接触点，在那里风险分层是非常宝贵的。我们设计了一个结合人口统计学、临床和心率变异性（HRV）参数的组合模型，以及序贯器官衰竭评估（SOFA）、急性生理学和慢性健康评估II（APACHE II）和急诊室败血症死亡率（MEDS）评分的个体变量，用于死亡风险分层。招募符合全身炎症反应综合征标准的艾德患者。计算国家预警评分（NEWS）、改良预警评分（MEWS）、快速SOFA（qSOFA）、SOFA、APACHE II和MEDS评分。对于30天住院死亡率的预测，使用受试者操作特征曲线下面积为0.91的组合模型进行（95%置信区间（CI）：0.88-0.95），优于NEWS（0.70，95% CI：0.63-0.77），MEWS（0.61，95% CI 0.53-0.69），qSOFA（0.70，95% CI：0.63-0.77）、SOFA（0.74，95% CI：0.67-0.80）、APACHE II（0.76，95% CI：0.69-0.82）和MEDS评分（0.86，95% CI：0.81-0.90）。组合模型的最佳灵敏度和特异性分别为91.4%（95% CI：81.6-96.5%）和77.9%（95% CI：72.6-82.4%）。一个结合临床、HRV和疾病严重程度评分变量的组合模型显示出对急诊脓毒症患者死亡风险分层的上级预测能力。
The emergency department (ED) serves as the first point of hospital contact for many septic patients, where risk-stratification would be invaluable. We devised a combination model incorporating demographic, clinical, and heart rate variability (HRV) parameters, alongside individual variables of the Sequential Organ Failure Assessment (SOFA), Acute Physiology and Chronic Health Evaluation II (APACHE II), and Mortality in Emergency Department Sepsis (MEDS) scores for mortality risk-stratification. ED patients fulfilling systemic inflammatory response syndrome criteria were recruited. National Early Warning Score (NEWS), Modified Early Warning Score (MEWS), quick SOFA (qSOFA), SOFA, APACHE II, and MEDS scores were calculated. For the prediction of 30-day in-hospital mortality, combination model performed with an area under the receiver operating characteristic curve of 0.91 (95% confidence interval (CI): 0.88-0.95), outperforming NEWS (0.70, 95% CI: 0.63-0.77), MEWS (0.61, 95% CI 0.53-0.69), qSOFA (0.70, 95% CI 0.63-0.77), SOFA (0.74, 95% CI: 0.67-0.80), APACHE II (0.76, 95% CI: 0.69-0.82), and MEDS scores (0.86, 95% CI: 0.81-0.90). The combination model had an optimal sensitivity and specificity of 91.4% (95% CI: 81.6-96.5%) and 77.9% (95% CI: 72.6-82.4%), respectively. A combination model incorporating clinical, HRV, and disease severity score variables showed superior predictive ability for the mortality risk-stratification of septic patients presenting at the ED.