遵义医科大学学报2026，Vol.49Issue(8)：857-864,8.
不同时间点改良早期预警评分对院内心脏骤停复苏后患者住院死亡的预测价值
Prognostic value of modified early warning scores at different time points for predicting in-hospital mortality after in-hospital cardiac arrest resuscitation
摘要
Abstract
Objective To investigate the prognostic value of the modified early warning score(MEWS)assessed at different time points for predicting in-hospital mortality in patients with in-hospital cardiac arrest(IHCA)who achieved return of spontaneous circulation(ROSC).Methods We performed a retrospective cohort study invol-ving IHCA patients who attained ROSC and were hospitalized at Zigong Fourth People's Hospital(2019-2023)and Fushun County People's Hospital(2019-2020).MEWS was calculated on admission,at the most recent assessment before cardiac arrest,and immediately after ROSC,defined as MEWS1,MEWS2,and MEWS3,re-spectively.Multivariable Logistic regression was used to identify independent predictors of death.Restricted cu-bic spline(RCS)modelling explored the dose-response relationship between MEWS and mortality.Discrimina-tion was assessed with receiver operating characteristic(ROC)analysis,internally validation via bootstrap resa-mpling.Differences in area under the curve(AUC)were compared using the DeLong test.K-means cluster a-nalysis was performed to explore potential latent classes.Results A total of 596 patients were included,and 446(74.8%)died during hospitalization.Multivariable logistic regression showed that MEWS2(OR=1.094,95%CI:1.002～1.195,P=0.045)and MEWS3(OR=1.421,95%CI:1.282～1.575,P<0.001)were inde-pendent risk factors for in-hospital mortality.RCS analysis showed linear associations between MEWS2,MEWS3 and mortality risk(P>0.05 for nonlinearity).MEWS3 had the highest predictive value for in-hospital mortality(AUC=0.729,95%CI:0.681～0.777),which was confirmed by bootstrap validation.DeLong test showed that MEWS3 had superior predictive performance(P<0.05).K-means cluster analysis showed that patients with a sharply increasing MEWS pattern had the highest in-hospital mortality,whereas those with a low and sta-ble pattern had the highest survival rate(P<0.05).Conclusion MEWS measured immediately after ROSC of-fers the best accurate prediction of in-hospital death in IHCA patients.Incorporating this score into early post-re-suscitation evaluations could support timely risk stratification and guide clinical decision-making.关键词
院内心脏骤停/改良早期预警评分/心脏骤停复苏后院内生存预测评分/风险评估/预测价值Key words
in-hospital cardiac arrest/modified early warning score/cardiac arrest survival prediction score/risk assessment/prognostic value分类
医药卫生引用本文复制引用
陈涌,钟志涛,高霞,黄霞,任艳,段海真,徐平..不同时间点改良早期预警评分对院内心脏骤停复苏后患者住院死亡的预测价值[J].遵义医科大学学报,2026,49(8):857-864,8.基金项目
国家自然科学基金资助项目(NO:82260385) （NO:82260385）
四川省科技计划资助项目(NO:2024JDKP0021). （NO:2024JDKP0021）
