| Objective:The purpose of this study was to search the most appropriate rapid assessment tool that can provide the basis for evaluating the condition and prognosis by comparing the predictive value of the REMS,qSOFA,NEWS,MEWS and RAPS score on admission to intensive care unit and death within 28 days for patients with sepsis.Methods:207 patients with sepsis admitted to the Affiliated Hospital of North Sichuan Medical College between January 2018 and December 2020 were included in this retrospective analysis.Age,sex,hospital stays,duration of mechanical ventilation,and infection sites were collected.The blood pressure,heart rate,respiration,body temperature,pulse oxygen saturation,consciousness,GCS score,and whether the patient inhaled oxygen at the time of admission were also recorded.REMS,qSOFA,NEWS,MEWS and RAPS score were calculated from recorded vital parameters.According to whether the patient was admitted to the intensive care unit,all cases were divided into ICU group and non-ICU group.At the same time,all patients with sepsis were divided into survival group and death group according to the 28-day mortality,and their data were compared.The multivariate Logistic regression analysis was performed with statistically different variables.The receiver operating characteristic curve(ROC)of REMS,qSOFA,NEWS,MEWS and RAPS score were drawn respectively according to whether the patient was admitted to the intensive care unit and whether the patient died.The area under the curve(AUC)was compared to evaluate the value of different scores in predicting the prognosis of patients with sepsis.Results:1.There were 151 cases in the ICU group and 56 cases in the non-ICU group.The rate of admission to intensive care unit was 72.9%.A statistical difference was found in infection site,heart rate,respiratory rate,systolic pressure,SpO2 and GCS between the two groups(P<0.05),but not in hospital stays,age,gender,diastolic pressure or body temperature(P>0.05).2.There were 130 cases in the survival group and 77 cases in the death group.The mortality rate was 37.2%.Statistical differences were found in age,mechanical ventilation time,hospital stays,heart rate,respiratory rate,systolic pressure,SpO2 and GCS between the two groups(P<0.05),but not in gender,infection sites,diastolic pressure or body temperature(P>0.05).Age,mechanical ventilation time,heart rate,respiratory rate,systolic pressure,SpO2 and GCS were analyzed by multivariate Logistic regression analysis,the result showed that age(OR:2.691,95%CI:1.358～5.330,P=0.005),respiratory rate(OR:4.794,95%CI:2.535～9.067,P<0.001)and systolic pressure(OR:0.191,95%CI:0.191～0.718,P=0.003)were independent risk factors for death in patients with sepsis.3.The REMS,qSOFA,NEWS,MEWS and RAPS score of patients in the ICU group were higher than those in non-ICU group(P<0.05),and the higher those scores,the higher the rate of admission to intensive care unit.The scores of patients in the death group were also higher than those in the survival group(P<0.05),the higher those scores,the higher the mortality rate of patients.4.The ROC curve according to whether the patient was admitted to the intensive care unit showed that the AUC of REMS,qSOFA,NEWS,MEWS and RAPS score were 0.823(95%CI:0.768～0.877),0.747(95%CI:0.675～0.820),0.812(95%CI:0.751～0.874),0.776(95%CI:0.711～0.841),and 0.846(95%CI:0.793～0.899).The RAPS score had the highest predictive value,and its critical value was 4.5 points,the sensitivity was 62.9%,and the specificity was 96.4%.5.The ROC curve based on the 28-day clinical outcome of the patient showed that the AUC of REMS,qSOFA,NEWS,MEWS and RAPS score were 0.819(95%CI:0.762～0.832),0.726(95%CI:0.655～0.797),0.816(95%CI:0.754～0.877),0.759(95%CI:0.691～0.826)and 0.802(95%CI:0.741～0.863).The REMS score has the best predictive performance,and its critical value was 8.5,the sensitivity was 58.3%,and the specificity was 80.1%.Conclusion:1.REMS,qSOFA,NEWS,MEWS and RAPS score can be used to evaluate whether patients with sepsis need to be admitted to the intensive care unit,in which RAPS score has the greatest value.2.When assessing the risk of death in patients with sepsis,REMS,qSOFA,NEWS,MEWS and RAPS score have great predictive value,in which REMS score is the most effective one. |
