Comparison of SAPS 3-PIRO score with other four scoring systems for assessing sepsis / 中华急诊医学杂志

Objective To investigate the feasibility of SAPS 3-PIRO score for prediction of outcomes in severe sepsis patients in the intensive care units (ICU).The optimal scoring system was also evaluated in this study.Methods Data of 677 patients with sepsis,treated in ICU of the emergency department at the Beijing Chaoyang Hospital between January 2008 and December 2011,were analyzed.The inclusion criteria were:age ≥18 years and the diagnostic criteria of severe sepsis and organ damage recommended by the International Sepsis Definitions Conference in Washington DC,USA in 2001,as well as the criteria developed by the Conference as a reference.The patients,who did not meet the criteria were excluded from the study.Age,gender,underlying disease,main infection site,and duration of ventilator support of all cases were recorded.Vital signs,hematological findings (gases,biochemistry,coagulation) and causative pathogens and organ damage on day-1 in the ICU were also recorded.According to the data of the most unfavorable findings in the ICU on day-1,scores got from APACHE Ⅱ,SOFA (sequential organ failure assessment),SAPS Ⅲ(simplified acute physiological score Ⅲ),SAPS 3-PIRO (predisposition,infection,response,organ failure/dysfunction) and MEDS (mortality in emergency department sepsis score) scoring systems were calculated.All patients were followed up for 28 days.The outcome of survival and death at 28 days were the endpoints of this study.SPSS V13.0 (SPSS,Chicago,IL,USA) was used to analyze data.Continuous variables with normal distribution were expressed as mean ± standard deviation.The independentsample t test was applied when normality (and homogeneity of variance) assumptions were fulfilled otherwise the t' test would be used.The distribution of categorical variables in two groups was tested using the x2 test.Binary logistic regression models were also used according to the survival status.The values of scoring system in predicting outcomes and the determination of dividing value in predicting death were analyzed using receiver operating characteristic (ROC) curves.The area under the receiver operating characteristic (AUROC) curves was compared using Z test.P values less than 0.05 were considered statistically significant.Results The total 28-day mortality was 41.9％.APACHE Ⅱ,SOFA,SAPS Ⅲ,SAPS 3-PIRO and MEDS scoring systems were used to find the independent predictive factors of death within 28 hours in patients with severe sepsis.By using ROC curve and AUROC curve to compare the validity of these scoring systems,SAPS 3-PIRO score had comparable predictive capability in comparison with APACHE Ⅱ,SOFA and SAPS Ⅲ scores,and MEDS was superior to SAPS 3-PIRO,APACHE Ⅱ,SOFA and SAPS Ⅲ score.Conclusions For patients with severe sepsis admitted in ICU,MEDS was superior to SAPS 3-PIRO,APACHE Ⅱ,SOFA and SAPS Ⅲ score in predicting prognosis.MEDS has favorable capability in predicting death within 28 days.MEDS ≥ 11 was the sign of increased mortality.SAPS 3-PIRO score has comparable predictive capability in comparison with APACHE Ⅱ,SOFA and SAPS Ⅲ score and it may be suggested for clinical practice.

The Prognostic Abilities of Severity Scoring Systems for Patients with Septic Shock

PURPOSE: The aim of the study was to validate abbreviated mortality in emergency department sepsis (MEDS) scoring system by comparing it with original MEDS score and to assess the prognostic value of other prognostic factor for sepsis patients including multiple organ dysfunction score (MODS), sepsis-related organ failure assessment (SOFA) score, and serum procalcitonin level. METHODS: Adult patients visiting emergency department (ED) with evidence of septic shock were enrolled to the study. MEDS score, MODS, and SOFA score were calculated based on initial clinical data. Receiver-operating characteristics (ROC) analyses were used to assess the prognostic factors for predicting mortality. Kaplan-Meier survival analyses (KMSA) were used to determine whether the prognostic factors had correlation with survival time. RESULTS: Only MODS showed significant predicting power for mortality (p=0.003, area under curve=0.625). Estimated median survival of all the patients calculated by KMSA was 11.0 (standard error 1.7) days, and predefined criteria of all prognostic factors showed significant differences in survival time. CONCLUSION: MEDS, abbreviated MEDS, MODS, and SOFA scoring systems were useful factors for predicting survival time of septic shock patients visiting ED.

Utility of quantitative procalcitonin level and abbreviated MEDS scoring system as prognostic factors of sepsis patients in the emergency department

PURPOSE: Procalcitonin (PCT) is a newly introduced marker of systemic bacterial infection. The MEDS (Mortality in Emergency Department Sepsis) scoring system has proven to be the most useful and appropriate clinical prediction tool in cases of systemic bacterial infection in the emergency department. There have been no studies comparing the PCT assay with the abbreviated MEDS scoring system (without neutrophil bands). This study aimed to determine the efficacy of quantitative PCT assay and the abbreviated MEDS score in predicting the 28-day mortality and intensive care unit (ICU) admission in emergency department patients with systemic inflammatory response syndrome (SIRS). METHODS: This study was carried out prospectively on 212 patients >18-years-of-age with the criteria of SIRS who had visited to the emergency department. They were included if they had an emergency department diagnosis of sepsis, two or more SIRS criteria. We checked the initial PCT concentration and calculated abbreviated MEDS score. The primary outcome was 28-day mortality and ICU admission. We evaluated the predictive abilities of the initial PCT assay and abbreviated MEDS score. Receiver operating characteristic (ROC) curves were used to identify the value of PCT and abbreviated MEDS scoring system that maximized the sum sensitivity and specificity. RESULTS: Among the 212 patients included in this study, the mortality rate was 21%(45 of 212 patients) and the ICU admission rate was 33%(70 of 212 patients). Non-survivor group had a significantly higher PCT concentration (median, interquartile range (IQR), 12.23 ng/mL, 2.33-39.77 vs. 0.58 ng/mL, 0.10-3.60, p=0.05) and a higher abbreviated MEDS score (12.62+/-4.33 vs. 5.53+/-3.57, p<0.05) than the survival group. ICU admission patients had a significantly higher PCT concentration (median, IQR, 7.75 ng/mL, 1.43-36.85 vs. 0.55 ng/mL, 0.08-3.03 p<0.05) and a higher abbreviated MEDS score (10.90+/-4.60 vs. 5.13+/-3.48, p<0.05) than general ward admission patients. ROC analysis showed the discriminative power of the abbreviated MEDS score and PCT assay in predicting ICU admission and 28-day mortality. For ICU admission, areas of under the curves (AUC) of abbreviated MEDS score and PCT were 0.842 and 0.749, respectively (p<0.05). For PCT, AUC of abbreviated MEDS and PCT were 0.888 and 0.784, respectively (p<0.05). The optimal PCT threshold in predicting ICU admission was 1.22 ng/mL (odds ratio (OR), 6.92; 95% confidence interval (CI), 3.51-13.63; p<0.05) and 1.90 ng/mL in predicting 28-day mortality (OR, 11.90; 95% CI, 4.76-29.74). The optimal threshold of abbreviated MEDS score in predicting ICU admission was 8 (OR, 10.95; 95% CI, 5.47-21.90; p<0.05) and 9 in predicting 28 day mortality (OR, 19.03; 95% CI, 8.28-43.78; p<0.05). CONCLUSION: Both abbreviated MEDS scoring system and single plasma PCT assays can be used as a useful marker in rapidly and accurately predicting poor prognosis in emergency department patients with sepsis.

Utility of quantitative procalcitonin level and abbreviated MEDS scoring system as prognostic factors of sepsis patients in the emergency department

PURPOSE: Procalcitonin (PCT) is a newly introduced marker of systemic bacterial infection. The MEDS (Mortality in Emergency Department Sepsis) scoring system has proven to be the most useful and appropriate clinical prediction tool in cases of systemic bacterial infection in the emergency department. There have been no studies comparing the PCT assay with the abbreviated MEDS scoring system (without neutrophil bands). This study aimed to determine the efficacy of quantitative PCT assay and the abbreviated MEDS score in predicting the 28-day mortality and intensive care unit (ICU) admission in emergency department patients with systemic inflammatory response syndrome (SIRS). METHODS: This study was carried out prospectively on 212 patients >18-years-of-age with the criteria of SIRS who had visited to the emergency department. They were included if they had an emergency department diagnosis of sepsis, two or more SIRS criteria. We checked the initial PCT concentration and calculated abbreviated MEDS score. The primary outcome was 28-day mortality and ICU admission. We evaluated the predictive abilities of the initial PCT assay and abbreviated MEDS score. Receiver operating characteristic (ROC) curves were used to identify the value of PCT and abbreviated MEDS scoring system that maximized the sum sensitivity and specificity. RESULTS: Among the 212 patients included in this study, the mortality rate was 21%(45 of 212 patients) and the ICU admission rate was 33%(70 of 212 patients). Non-survivor group had a significantly higher PCT concentration (median, interquartile range (IQR), 12.23 ng/mL, 2.33-39.77 vs. 0.58 ng/mL, 0.10-3.60, p=0.05) and a higher abbreviated MEDS score (12.62+/-4.33 vs. 5.53+/-3.57, p<0.05) than the survival group. ICU admission patients had a significantly higher PCT concentration (median, IQR, 7.75 ng/mL, 1.43-36.85 vs. 0.55 ng/mL, 0.08-3.03 p<0.05) and a higher abbreviated MEDS score (10.90+/-4.60 vs. 5.13+/-3.48, p<0.05) than general ward admission patients. ROC analysis showed the discriminative power of the abbreviated MEDS score and PCT assay in predicting ICU admission and 28-day mortality. For ICU admission, areas of under the curves (AUC) of abbreviated MEDS score and PCT were 0.842 and 0.749, respectively (p<0.05). For PCT, AUC of abbreviated MEDS and PCT were 0.888 and 0.784, respectively (p<0.05). The optimal PCT threshold in predicting ICU admission was 1.22 ng/mL (odds ratio (OR), 6.92; 95% confidence interval (CI), 3.51-13.63; p<0.05) and 1.90 ng/mL in predicting 28-day mortality (OR, 11.90; 95% CI, 4.76-29.74). The optimal threshold of abbreviated MEDS score in predicting ICU admission was 8 (OR, 10.95; 95% CI, 5.47-21.90; p<0.05) and 9 in predicting 28 day mortality (OR, 19.03; 95% CI, 8.28-43.78; p<0.05). CONCLUSION: Both abbreviated MEDS scoring system and single plasma PCT assays can be used as a useful marker in rapidly and accurately predicting poor prognosis in emergency department patients with sepsis.

Uso de entrevistas on-line no método de explicitação do discurso subjacente (MEDS) / Use of online interviews in the underlying discourse unveiling method (UDUM)

Tradicionalmente, tal como outros métodos qualitativos que usam entrevistas, a coleta de dados do MEDS é realizada em encontros presenciais que têm como modelo as conversas cotidianas em contextos informais. Com o advento da Internet, grande parte dessas conversas migrou para os ambientes de troca instantânea de mensagens on-line, que se popularizaram rapidamente. O argumento central deste trabalho é o de que, desde então, a coleta de dados por meio de entrevistas on-line, baseadas no modelo das conversas cotidianas informais que também ocorrem on-line, se tornou um procedimento de pesquisa sério e viável. São, portanto, discutidas as especificidades, requisitos, vantagens e desvantagens desta nova forma de entrevista. São, ainda, revelados o histórico, os raciocínios e as necessidades que a legitimam.

Traditionally, as in other qualitative methods that use interviews, data collection in UDUM is done in face-to-face encounters based on the model of daily conversations in informal contexts. With the advent of the Internet, a large part of such conversations migrated to online environments of instant message exchanges, which soon became widely popular. The main argument of this paper is that, since then, data collection through informal online interviews, which have equally informal online daily conversations as a model, has become a serious and viable research procedure. Specificities, requisites, advantages and disadvantages of this new form of interview are, therefore, discussed. The history, reasoning and needs that legitimate it are also revealed.

Comparing the Usefulness of the Initial Acute Physiologic and Chronic Health Evaluation (APACHE) II Score in the Emergency Department (ED) and the Mortality in Emergency Department Sepsis (MEDS) Score for Predicting the Prognosis of Septic Patients Admitt / 대한구급학회지

BACKGROUND: To determine the prognostic value of the initial APACHE II score in the ED compared with the classic APACHE II score in the ICU and to check the usefulness of the MEDS score together for more rapid risk stratification of septic patients admitted to the ICU via the ED. METHODS: We prospectively checked the initial APACHE II and MEDS scores of all the patients who had systemic inflammatory response syndrome in the ED and the classic APACHE II scores after admission to the ICU, as well 6 months later. We enrolled the only sepsis cases in the final diagnosis after reviewing the medical records. We evaluated the predictive abilities of the initial APACHE II and MEDS scores compared with the classic APACHE II score. RESULTS: During 6 months, 58 patients diagnosed with sepsis were enrolled. Twenty-four (41.4%) patients died within 28 days of admission and 34 patients survived. The mortality group had a significantly higher mean classic APACHE II score (19 +/- 6.7 vs. 15 +/- 5.0, p < 0.01) and a higher mean MEDS score (16.67 +/- 2.70 vs. 8.91 +/- 3.11, p < 0.01) than the survivor group. The initial APACHE II score at the ED was not significantly different between the two groups. ROC analysis showed the discriminative power of the MEDS score in predicting mortality was much better than the APACHE II score (areas under the curves of the APACHE II score in the ED and ICU, and the MEDS scores were 0.668, 0.807, and 0.967, respectively; p < 0.01). CONCLUSIONS: The initial APACHE II score in the ED did not predict mortality better than the classic APACHE II score. However, the MEDS score predicted the poor prognosis of septic patients more rapidly and accurately in the ED than the APACHE II model.

O campo da pesquisa qualitativa e o Método de Explicitação do Discurso Subjacente (MEDS) / The field of qualitative research and the Underlying Discourse Unveiling Method (UDUM)

Desde o final do século XX, uma revolução qualitativa vem ocorrendo nas ciências sociais e humanas. Impelidos pela necessidade de explorar a fundo novos fenômenos humanos e sociais, inúmeros pesquisadores abandonaram o positivismo e abraçaram metodologias qualitativas. O campo da pesquisa qualitativa passou a abranger uma variedade tão grande de métodos que a discussão das especificidades de qualquer um deles requer a identificação dos pontos em que o método em questão se aproxima ou se distancia dos outros métodos que compõem o campo. Neste trabalho, tal procedimento é usado para a discussão das especificidades do Método de Explicitação do Discurso Subjacente (MEDS).

Since the end of the 20th century, a qualitative revolution has been going on in the social and human sciences. Prompted by the need to attain deeper knowledge of new human and social phenomena, several researchers abandoned positivism and embraced qualitative methodologies. The field of qualitative research has become so vast that a discussion of the specificities of any particular method requires the identification of the similarities and differences that exist between such method and the various other methods in the field. In the present paper, this procedure is used for the discussion of the specificities of the Underlying Discourse Unveiling Method (UDUM).