The Diagnostic Value of H Formula to Predict Mortality in Hospitalized Patients with Infectious Diseases

摘要

The ability to identify patients with risk of mortality in the initial stages allows us to introduce a more aggressive treatment in order to improve patients’ survival. In this study, we used systemic inflammatory response syndrome (SIRS) criteria, respiratory and heart rate per minute, and consciousness level [(Glasgow coma scale (GCS)] to develop a formula to predict death in patients admitted to the Infectious Diseases ward of Imam Reza hospital. Methods: This descriptive study was a cross sectional study done in the Infectious Diseases ward of Imam Reza hospital, Mashhad University of Medical Sciences, Iran. Alive and dead patients between the dates September 1, 2006 to September 1, 2007 were studied. In this study, data such as past medical history, prescribed drugs and their administration by nursing and medical staff was extracted from patients’ files. Also, the time of death, the first vital signs recorded in the hospital and the formula H = (PR + RR) - GCS (respiratory rate per minute plus heart rate per minute minus Glasgow coma scale (GCS)) was calculated for both alive and dead patients. Data was analyzed by SPSS software. Mann-Whitney test, Roc Curve, and logistic regression model were used for data analysis. Results: The total number of admitted patients was 1007 of whom 90 (10.82%) died. One patient was excluded from the study. Out of 90 dead patients, 51 (56.6%) were male and 39 (43.3%) were female. There was no significant difference between the two groups regarding the gender (P > 0.05). The mean age of the study group (deceased) was 59 ± 21 and the mean age of the control group (alive) was 58 ± 21. The Mann-Whitney test showed that the result of H Formula was significantly different between the two groups, (126 ± 26 for the study group and 111 ± 22 for the control group). The cutoff for H Formula was equal to 112.5. Negative and positive predictive values, specificity and sensitivity were 0.85, 0.35, 0.57, and 0.70 respectively. Logistic regression results show that the H index contents independently affected the mortality of infected patients. Conclusion: With regard to the importance of measuring vital signs in diagnosis and determining the mortality in patients with infectious disease, the H (Heydari) formula can be valuable for evaluation and determination of mortality risk and consequently, early intervention. Patients with severe tachycardia, severe tachypnea and altered mental status that cannot be properly and quickly improved within 2 hours after admission via hydration and other measures are at higher risk of mortality.