摘要
目的探讨改良早期预警评分(modified early warning score, MEWS)对急性胸痛患者的危险分层和近期预后的预测价值。方法记录230例急性胸痛患者的临床资料、HEART和MEWS评分,随访患者发病30 d内不良预后情况;采用Logistic回归分析急性胸痛患者发生不良预后的影响因素,并通过受试者工作曲线分析MEWS、HEART评分对急性胸痛患者危险分层和近期预后的预测价值。结果 230例急性胸痛患者发病30 d出现预后不良24例(10.43%);Logistic回归分析结果显示,MEWS评分(OR=3.202)、LDL-C(OR=1.149)、HEART评分(OR=1.071)是急性胸痛患者不良预后的危险因素(P<0.05);MEWS评分预测高危型胸痛的AUC为0.821(95%CI:0.769~0.872),特异性为79.39%,敏感性为79.55%;MEWS预测急性胸痛患者30 d内不良预后的AUC值为0.916(95%CI:0.890~0.961),高于HEART评分(AUC:0.838,95%CI:0.791~0.887),差异有统计学意义(P<0.05);MEWS预测急性胸痛患者30 d内不良预后的特异性为86.9%,敏感性为85.4%。结论 MEWS评分系统操作简单、指标获取简便,可作为急性胸痛患者危险分层和近期预后的参考指标。
Objective To evaluate the value of modified early warning score(MEWS) for the assessment of stratified risks and short-term prognosis for patients with acute chest pain. Methods Firstly, the clinical data, HEART score and MEWS score of 230 patients with acute chest pain were collected. Cardiovascular adverse events occurred within 30 days after the onset of the disease were followed up. Secondly, multivariate logistic regression equation was used to identify the independent risk factors for adverse prognosis of patients with acute chest pain. The predictive value of MEWS score and HEART score on risk stratification and prognosis of patients with acute chest pain was evaluated by ROC. Results Of the 230 subjects, 24(10.43%) patients were found to bear unfavourable prognosis within 30 days after onset. The results of logistic regression analysis showed that MEWS score(OR=3.202), LDL-C(OR=1.149) and HEART score(OR=1.071) were risk factors that led to the unfavourable prognosis(P<0.05). The AUC of high-risk chest pain as predicted by MEWS score was 0.821(95% CI: 0.769~0.872) where the specificity was 79.39% and the sensitivity was 79.55%. The AUC of unfavourable prognosis of patients with acute chest pain within 30 days after onset as predicted by MEWS was 0.916(95% CI: 0.890~0.961), which was greater than that as predicted by HEART score(AUC: 0.838, 95% CI: 0.791~0.887). The difference was statistically significant(P<0.05);The specificity and sensitivity of adverse prognosis of the subjects as predicted by MEWS were 86.9% and 85.4% respectively. Conclusions MEWS score is easy to use and effective in turning out indicators and therefore can serve as a desirable guide for the assessment of risk stratification and short-term prognosis of patients with acute chest pain.
作者
闵建明
齐旭浩
MIN Jianming;QI Xuhao(Medical Department,Huzhou Emergency Center,Huzhou 313000;Internal Medicine-Cardiovascular Department,the First People’s Hospital of Huzhou,Huzhou 313000,China)
出处
《健康研究》
CAS
2019年第6期683-686,690,共5页
Health Research
关键词
急性胸痛
改良早期预警评分
危险分层
预后
acute chest pain
modified early warning score
risk stratification
prognosis
