Prognostic value of mortality in emergency department sepsis score, procalcitonin, and C-reactive protein in patients with sepsis at the emergency department
Prognostic value of mortality in emergency department sepsis score, procalcitonin, and C-reactive protein in patients with sepsis at the emergency department
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DOI：
10.1097/shk.0b013e31815077ca
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发表时间：
2008-03-01
期刊：
影响因子：
3.1
通讯作者：
Hsueh, Po-Ren
中科院分区：
文献类型：
--
作者：
Lee, Chien-Chang;Chen, Shey-Ying;Hsueh, Po-Ren
降钙素原（PCT）在急诊科（艾德）脓毒症患者中的预后价值尚未评估。我们进行了一项前瞻性观察性研究，以比较PCT对脓毒症的预后价值，并与一个经验证的评分、急诊室脓毒症死亡率（MEDS）评分和C反应蛋白（CRP）在城市大学医学中心的艾德环境中进行比较。前瞻性入组了525例连续入住艾德的符合美国临床药学院/重症监护医学会共识会议脓毒症定义的成人患者。对每例患者的血清PCT和CRP进行评价。采用标准化表格记录艾德入院时的临床特征和实验室检查结果。每例患者随访至少30天。主要结局是早期（5天）和晚期（6- 30天）死亡率。研究样本的中位年龄为64.0岁（四分位距，47-76岁），总体30天死亡率为10.5%。预测早期死亡率的c统计量分别为MEDS 0.89、PCT 0.76和CRP 0.68。预测晚期死亡率的c统计量分别为MEDS 0.78、PCT 0.70和CRP 0.63。总体而言，MEDS评分在三个测试标记中具有最好的区分能力。在最佳临界值下，PCT是最敏感的指标，MEDS评分是最特异的指标。我们建议进一步结合PCT和MEDS评分的信息，以提高预测艾德脓毒症死亡率的准确性。
The prognostic value of procalcitonin (PCT) in patients with sepsis at the emergency department (ED) has not been evaluated. We conducted a prospective observational study to compare the prognostic value of PCT on sepsis and compared with a validated score, Mortality in Emergency Department Sepsis (MEDS) score, and C-reactive protein (CRP) in the setting of ED of an urban, university-based medical center. Five hundred twenty-five consecutive adult patients admitted to the ED fulfilling the American College of Clinical Pharmacists/Society of Critical Care Medicine Consensus Conference definition of sepsis were prospectively enrolled. Serum PCT and CRP were evaluated for each patient. Clinical characteristics and laboratory results on ED admission were recorded using a standardized form. Each patient was followed for at least 30 days. The main outcome was early (5-day) and late (6- to 30-day) mortality. The median age of the study sample was 64.0 (interquartile range, 47-76) years old, and the overall 30-day mortality rate was 10.5%. The c-statistic in the prediction of early mortality was 0.89 for MEDS, 0.76 for PCT, and 0.68 for CRP. The c-statistic in the prediction of late mortality was 0.78 for MEDS, 0.70 for PCT, and 0.63 for CRP. Overall, MEDS score has the best discriminative capability among the three tested markers. Under the best cutoff value, PCT was the most sensitive, and MEDS score was the most specific marker. We suggest further combining the information on PCT and MEDS score to enhance the accuracy in predicting ED sepsis mortality.