Comparative study between Charlison′s weighted index of comorbidities score, the diagnostic criteria for emergency sepsis score and combination of the two scoring systems to predict the emergency pulmonary infection prognosis

Abstract

Objective To compare the predictive effect of Charlison's weighted index of comorbidities (WIC), the diagnostic criteria for emergency sepsis (MEDS) and combination of the two scoring systems to predict the emergency pulmonary infection prognosis. Methods A total of 327 patients with pulmonary infection admitted from January 2016 to January 2017 were enrolled in this study whose WIC score, MEDS score and risk stratification were recorded at admission. They were divided into survival group and death group according to the 28 d treatment outcome, the optimal cutoff of WIC score and MEDS score to predict the prognosis were found by ROC curve, and the prediction effect of WIC score, MEDS score, the combined use of both and APACHE Ⅱ to predict the prognosis were compared. Results The mortality of low, middle and high risk of WIC score were 13.7% (29/212), 48.7% (38/78) and 78.4% (29/37) with significant difference (χ2= 82.097, P = 0.000), mortality of low, middle and high risk of MEDS score were 11.3%(23/203), 50.6%(40/77) and 73.3%(33/45) with significant difference (χ2= 145.526, P = 0.000). The WIC scores in survival group and death group were 1.3 ± 0.9 and 2.7 ± 1.1 with significant difference (t = 11.030, P = 0.000). The MEDS score of live group (6.1 ± 4.0) was significantly lower than death group (12.6 ± 4.9) (t = 11.502, P = 0.000). the optimal cutoff values of WIC and MEDS to predict prognosis were 1.7 points, 11.6 points, the ROC curve area between WIC, MEDS score and combined application to predict prognosis were 0.632, 0.798, 0.897, and the sensitivity and accuracy of the combined prediction[93.8% (212/226)/89.9% (294/327)] were significantly higher than those of the individual WIC[72.7% (168/231)/75.2% (246/327)] and MEDS[67.5% (156/232)/72.2% (236/327)] (χ2=0.562-42.594, P 0.05). Conclusions The sensitivity and accuracy of WIC score combined with MEDS score to predict the prognosis of patients with acute lung infection is higher than the individual WIC score and MEDS score, and its prediction effect is more better. Key words: Charlson′s weighted index of comorbidities; Mortality in emergency department sepsis; Emergency; Lung infection; Outcome