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A novel scoring system for assessing the severity of electrolyte and acid-base disorders and predicting outcomes in hospitalized patients.

Authors:
Yimei Wang Jiachang Hu Xuemei Geng Xiaoyan Zhang Xialian Xu Jing Lin Jie Teng Xiaoqiang Ding

J Investig Med 2019 04 6;67(4):750-760. Epub 2018 Dec 6.

Department of Nephrology, Zhongshan Hospital, Fudan University, Shanghai, China.

Electrolyte and acid-base disorders are commonly seen in critically ill and other hospitalized patients. A scoring system is needed to assess the severity of electrolyte and acid-base disorders and to predict outcome in hospital patients. Herein, we prospectively enrolled a total of 322,046 patients, including 84,700 patients in the derivation cohort and 237,346 in the validation cohort, in a large, tertiary hospital in East China from 2014 to 2017. A points-scoring system of general electrolyte and acid-base disorders with a sum of 20.8 points was generated by multiple logistic regression analysis of the derivation cohort. Receiver operating characteristic curve analysis showed that the optimal cut-off value of 2.0 was associated with 65.4% sensitivity and 88.4% specificity (area under the curve: 0.818 (95% CI 0.809 to 0.827)) to predict hospital mortality in the validation cohort. On Kaplan-Meier survival analysis, the five intervals of risk score (Q1: 0 to 2.0; Q2: 2.1 to 2.5; Q3: 2.6 to 3.3; Q4: 3.4 to 4.5; and Q5: >4.5 points) showed differences in hospital survival (p<0.001). Elevated (delta) risk score >2 during hospitalization increased the risk of hospital death, while those with a delta risk score <0 and <-2 points had higher survival rates. This novel scoring system could be used to evaluate and to dynamically monitor the severity of electrolyte and acid-base disorders in hospitalized patients.

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http://dx.doi.org/10.1136/jim-2018-000900DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6581099PMC
April 2019

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