ABSTRACT
Objective To analyze the comparation of national early warning score (NEWS), rapid emergency medicine score (REMS) and acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ) score in predicting prognosis of critically ill patients in emergency department (ED). Methods A retrospective study was conducted. Critically ill patients, aged > 16 years, hospitalized > 24 hours, and admitted to the ED of Nanhua Hospital Affiliated to South China University from January 2016 to June 2017 were enrolled. NEWS, REMS and APACHE Ⅱ score were calculated based on the worst value of each index within 24 hours after emergency admission. The primary endpoint was 28-day mortality. The relationship between the three scoring systems and the prognosis of patients was analyzed. The predictive value of three scoring systems for the prognosis of critically ill patients in ED was analyzed by receiver operating characteristic curve (ROC). Results A total of 119 emergency severe patients were enrolled in the study, and the 28-day mortality was 21.0%. The scores of NEWS, REMS and APACHE Ⅱ in the death group were significantly higher than those in the survival group (NEWS score: 9.40±3.19 vs. 5.72±2.35, REMS score: 12.64±4.46 vs. 7.97±3.28, APACHE Ⅱscore: 26.64±6.92 vs. 16.19±5.48, all P < 0.01). With the increase of NEWS, REMS and APACHE Ⅱ score, the 28-day mortality of patients gradually increased [28-day mortality of NEWS < 5, 5-6, ≥ 7 was 3.03% (1/34), 13.33% (4/34), 64.25% (20/51); 28-day mortality of REMS < 12, 12-16, ≥ 17 was 10.99% (10/91), 50.00% (11/22), 66.67% (4/6); 28-day mortality of APACHE Ⅱ < 15, 15-24, ≥ 25 was 2.33% (1/43), 15.09% (8/59), 69.57% (16/23), respectively, all P < 0.01]. The ROC curve analysis showed that the areas under the ROC curve (AUC)of NEWS, REMS and APACHE Ⅱ score for predicting the prognosis of emergency critically ill patients were 0.830 [95% confidence interval (95%CI) = 0.737-0.923], 0.782 (95%CI = 0.671-0.892) and 0.878 (95%CI = 0.800-0.956), respectively (all P = 0.000), and the accuracy of prediction was 57.4%, 48.6%, 65.4%, respectively. Conclusions The scores of NEWS, REMS and APACHE Ⅱ were useful in predicting prognosis of critically ill patients, with the highest accuracy of APACHE Ⅱ forecast, followed by NEWS, and the lowest of REMS. After comprehensive consideration of cost-effectiveness, NEWS is more reliable in ED.
ABSTRACT
Objective To investigate the effects on the renal function and the clinical symptoms of patients with aristolochic acid nephropathy (AAN) treated with the Chinese herbal medicine, Jiaweifuzilizhongtang. Method Twenty-seven patients with AAN were treated with Jiaweifuzilizhongtang. The indexes, such as blood urea nitrogen (BUN), serum creatinine (SCr), endogenous creatinine clearance rate (CCr), twenty-four-hour proteinuria quantitate (24 h Upo), ?-N-acetyglocosamidase (NAG), Urine Osmol (Uosm), erythrocyte (RBC), hemoglobin (HB) and so on, were observed before and after treatment, and the score of patients’ symptoms including aversion to cold and cold limbs, lassitude and weakness, poor appetite and anorexia, nausea and vomiting, pale complexion, was also calculated. Result Compared with that of treatment bebore, the renal function of patients after treatment was significantly improved (P