Acil Servisteki Sepsisli Hastaların Prognozunda MEWS, qSOFA ve MEDS Skorlarının Karşlaştırılması

Öz

Amaç: Sepsis, tedavideki tüm gelişmelere rağmen mortalitesi yüksek seyreden bir sendromdur. Acil servislerde sepsis hastalarının prognozunda erken tanı ve hızlı müdahale büyük önem arz etmektedir. Hastalığın ciddiyetinin belirlenmesinde sağlık personeline yardımcı skorlama sistemleri geliştirilmiştir. Çalışmamızda, bu skorlama sistemlerinden Modifiye Erken Uyarı Skoru (MEWS), hızlı Ardışık Organ Yetmezliği Değerlendirme Puanı (qSOFA) ve Acil Serviste Sepsis Mortalite Skoru (MEDS) ‘nun prognoz ve mortaliteyi öngörmedeki güçleri karşılaştırılarak, hangisinin daha güvenilir olduğunun belirlenmesi amaçlandı. Gereç ve Yöntem: Çalışmaya Sağlık Bilimleri Üniversitesi Dışkapı Yıldırım Beyazıt Eğitim ve Araştırma Hastanesi Acil Servis Kliniği ‘nde 01.04.2017-01.04.2019 tarihleri arasında sepsis tanısı konulan hastalar retrospektif olarak dahil edildi. Hastaların demografik ve klinik özellikleri kaydedilerek MEWS, qSOFA, MEDS puanları hesaplandı. Hastalar ölen ve sağ kalan olmak üzere iki grupta incelendi. Ölen hasta grubu ilk 28 günde sepsis nedeniyle ölen hastalardan oluşturuldu. Bulgular: Çalışmaya yaş ortalaması 73.4±14.6 yıl ve %52,4 ‘ü(n=165) erkek olan toplam 315 hasta dahil edildi. En sık ek hastalık %54,2(n=171) ile hipertansiyondu. En sık enfeksiyon kaynağı %57,5(n=181) ile solunum sistemiydi. Hastaların %47,6 ’sının(n=150) öldüğü tespit edildi. MEDS, 28 günlükmortalite tahmininde en yüksek öngörüye sahipti (EAK=0.78). MEDS≥9 olduğunda mortaliteyi öngörmedeki sensitivitesi %95,3, spesifitesi %37,6 ve negatif prediktif değeri %89,9 idi. MEWS≥5 iken sensitivitesi %77,3, spesifitesi %47,3 ve negatif prediktif değeri %69,6 idi(EAK=0.66). QSOFA skoru≥2 iken sensitivitesi %84, spesifitesi %41,8 ve negatif prediktif değeri %74,2 idi (EAK=0.67). MEDS’ in mortaliteyi öngörmedeki gücü qSOFA ve MEWS’den daha iyi bulundu (p<0.001). Sonuç: Çalışmamızda MEDS skoru, mortalite tahmininde en yüksek sensitiviteye ve negatif öngörücülüğe sahip bulundu. qSOFA ve MEWS’in mortalite tahmin etmekteki güçleri ise benzerdi.

Anahtar Kelimeler

• MEDS
• MEWS
• Mortalite
• qSOFA
• Sepsis

Comparison of MEWS, QSOFA and MEDS Scores in the Prognosis of Patients with Sepsis in Emergency Department

Öz

Objective: Sepsis is a syndrome with high mortality rate. Early diagnosis and rapid intervention are of great importance in the prognosis of sepsis patients in emergency departments. Scoring systems have been developed to assist health personnel in determining the severity of the disease. In our study, it was aimed to determine which of these scoring systems was more reliable by comparing the power of Modified Early Warning Score (MEWS), rapid Sequential Organ Failure Evaluation Score (qSOFA) and Emergency Service Sepsis Mortality Score (MEDS) in predicting prognosis and mortality. Materials and Methods: Patients with sepsis between the dates 01.04.2017-01.04.2019 in the Emergency Department Clinic of the University of Health Sciences, Diskapi Yildirim Beyazit Education and Research Hospital have been included retrospectively. The demographic and clinical characteristics of the patients have been recorded and MEWS, qSOFA, MEDS scores have been calculated. The patients were divided into two groups as died and survivors. The group of patients who died was composed of patients who died due to sepsis in the first 28 days. Results: A total of 315 patients with an average age of 73.4±14.6 have been included in the study. 52,4%(n=165) of the patients are male. The most common source of infection is the respiratory system with 57,5%(n=181). It has been found that 47,6%(n=150) of the patients have died. The MEDS (ROC=0.78) has a significant distinguishing ability in the 28-day mortality prediction. When MEDS≥9, its sensitivity in predicting mortality is 95,3%, specificity is 37,6%, and its negative predictive value is 89,9%. On the other hand, while MEWS≥5, sensitivity, specificity, and negative predictive value are 77,3%, 47,3%, 69,6% respectively (ROC=0.66). Finally, qSOFA≥2, sensitivity, specificity, and negative predictive value are 84%, 41,8%, 74,2% respectively (ROC=0.67). The power of MEDSin predicting mortality has been found better than qSOFA and MEWS (p<0.001). Conclusion: Within the scope of this study, MEDS has been found to have the highest sensitivity and negative predictive value in predicting mortality. The ability of qSOFA and MEWS in predicting mortality are similar.

Anahtar Kelimeler

• MEDS
• MEWS
• MORTALITY
• QSOFA
• SEPSIS

Kaynakça

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