Comparison of Modified Early Warning Score (MEWS), Simplified Acute Physiology Score II (SAPS II), Sequential Organ Failure Assessment (SOFA), and Acute Physiology and Chronic Health Evaluation II (APACHE II) for early prediction of septic shock in diabetic patients in Emergency Departments.

IF 2.3 3区 医学 Q1 EMERGENCY MEDICINE
Wijittra Liengswangwong, Ranchana Siriwannabhorn, Sittichok Leela-Amornsin, Chaiyaporn Yuksen, Pitsucha Sanguanwit, Chonthicha Duangsri, Nusara Kusonkhum, Parnthap Saelim
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引用次数: 0

Abstract

Introduction: Sepsis is a severe medical condition that can be life-threatening. If sepsis progresses to septic shock, the mortality rate increases to around 40%, much higher than the 10% mortality observed in sepsis. Diabetes increases infection and sepsis risk, making management complex. Various scores of screening tools, such as Modified Early Warning Score (MEWS), Simplified Acute Physiology Score (SAPS II), Sequential Organ Failure Assessment Score (SOFA), and Acute Physiology and Chronic Health Evaluation (APACHE II), are used to predict the severity or mortality rate of disease. Our study aimed to compare the effectiveness and optimal cutoff points of these scores. We focused on the early prediction of septic shock in patients with diabetes in the Emergency Department (ED).

Methods: We conducted a retrospective cohort study to collect data on patients with diabetes. We collected prediction factors and MEWS, SOFA, SAPS II and APACHE II scores to predict septic shock in these patients. We determined the optimal cutoff points for each score. Subsequently, we compared the identified scores with the gold standard for diagnosing septic shock by applying the Sepsis-3 criteria.

Results: Systolic blood pressure (SBP), peripheral oxygen saturation (SpO2), Glasgow Coma Scale (GCS), pH, and lactate concentrations were significant predictors of septic shock (p < 0.001). The SOFA score performed well in predicting septic shock in patients with diabetes. The area under the receiver operating characteristics (ROC) curve for the SOFA score was 0.866 for detection within 48 h and 0.840 for detection after 2 h of admission to the ED, with the optimal cutoff score of ≥ 6.

Conclusion: SBP, SpO2, GCS, pH, and lactate concentrations are crucial for the early prediction of septic shock in patients with diabetes. The SOFA score is a superior predictor for the onset of septic shock in patients with diabetes compared with MEWS, SAPS II, and APACHE II scores. Specifically, a cutoff of ≥ 6 in the SOFA score demonstrates high accuracy in predicting shock within 48 h post-ED visit and as early as 2 h after ED admission.

比较改良早期预警评分 (MEWS)、简化急性生理学评分 II (SAPS II)、序贯器官衰竭评估 (SOFA) 和急性生理学和慢性健康评估 II (APACHE II) 对急诊科糖尿病患者脓毒性休克的早期预测作用。
简介败血症是一种严重的内科疾病,可危及生命。如果败血症发展为脓毒性休克,死亡率会增加到 40% 左右,远远高于败血症 10% 的死亡率。糖尿病会增加感染和败血症的风险,使治疗变得复杂。各种筛查工具的评分,如改良早期预警评分(MEWS)、简化急性生理学评分(SAPS II)、序贯器官衰竭评估评分(SOFA)和急性生理学和慢性健康评估(APACHE II),被用来预测疾病的严重程度或死亡率。我们的研究旨在比较这些评分的有效性和最佳临界点。我们重点研究了急诊科(ED)糖尿病患者脓毒性休克的早期预测:我们开展了一项回顾性队列研究,收集糖尿病患者的数据。我们收集了预测因素和 MEWS、SOFA、SAPS II 和 APACHE II 评分,以预测这些患者的脓毒性休克。我们确定了每个评分的最佳临界点。随后,我们将确定的评分与采用败血症-3 标准诊断脓毒性休克的金标准进行了比较:结果:收缩压(SBP)、外周血氧饱和度(SpO2)、格拉斯哥昏迷量表(GCS)、pH 值和乳酸浓度对脓毒性休克有显著的预测作用(p 结论:收缩压、SBP、SpO2、GCS、pH 值和乳酸浓度对脓毒性休克有显著的预测作用:SBP、SpO2、GCS、pH 值和乳酸浓度对早期预测糖尿病患者的脓毒性休克至关重要。与 MEWS、SAPS II 和 APACHE II 评分相比,SOFA 评分能更好地预测糖尿病患者脓毒性休克的发生。具体来说,SOFA评分≥6分的临界值在预测急诊室就诊后48小时内和急诊室入院后2小时内的休克方面具有很高的准确性。
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来源期刊
BMC Emergency Medicine
BMC Emergency Medicine Medicine-Emergency Medicine
CiteScore
3.50
自引率
8.00%
发文量
178
审稿时长
29 weeks
期刊介绍: BMC Emergency Medicine is an open access, peer-reviewed journal that considers articles on all urgent and emergency aspects of medicine, in both practice and basic research. In addition, the journal covers aspects of disaster medicine and medicine in special locations, such as conflict areas and military medicine, together with articles concerning healthcare services in the emergency departments.
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