WSES腹腔内复杂感染患者脓毒症严重程度评分的全球验证：一项前瞻性多中心研究（WISS研究）
Global validation of the WSES Sepsis Severity Score for patients with complicated intra-abdominal infections: a prospective multicentre study (WISS Study).
作者信息
Sartelli Massimo, Abu-Zidan Fikri M, Catena Fausto, Griffiths Ewen A, Di Saverio Salomone, Coimbra Raul, Ordoñez Carlos A, Leppaniemi Ari, Fraga Gustavo P, Coccolini Federico, Agresta Ferdinando, Abbas Asrhaf, Abdel Kader Saleh, Agboola John, Amhed Adamu, Ajibade Adesina, Akkucuk Seckin, Alharthi Bandar, Anyfantakis Dimitrios, Augustin Goran, Baiocchi Gianluca, Bala Miklosh, Baraket Oussama, Bayrak Savas, Bellanova Giovanni, Beltràn Marcelo A, Bini Roberto, Boal Matthew, Borodach Andrey V, Bouliaris Konstantinos, Branger Frederic, Brunelli Daniele, Catani Marco, Che Jusoh Asri, Chichom-Mefire Alain, Cocorullo Gianfranco, Colak Elif, Costa David, Costa Silvia, Cui Yunfeng, Curca Geanina Loredana, Curry Terry, Das Koray, Delibegovic Samir, Demetrashvili Zaza, Di Carlo Isidoro, Drozdova Nadezda, El Zalabany Tamer, Enani Mushira Abdulaziz, Faro Mario, Gachabayov Mahir, Giménez Maurel Teresa, Gkiokas Georgios, Gomes Carlos Augusto, Gonsaga Ricardo Alessandro Teixeira, Guercioni Gianluca, Guner Ali, Gupta Sanjay, Gutierrez Sandra, Hutan Martin, Ioannidis Orestis, Isik Arda, Izawa Yoshimitsu, Jain Sumita A, Jokubauskas Mantas, Karamarkovic Aleksandar, Kauhanen Saila, Kaushik Robin, Kenig Jakub, Khokha Vladimir, Kim Jae Il, Kong Victor, Koshy Renol, Krasniqi Avidyl, Kshirsagar Ashok, Kuliesius Zygimantas, Lasithiotakis Konstantinos, Leão Pedro, Lee Jae Gil, Leon Miguel, Lizarazu Pérez Aintzane, Lohsiriwat Varut, López-Tomassetti Fernandez Eudaldo, Lostoridis Eftychios, Mn Raghuveer, Major Piotr, Marinis Athanasios, Marrelli Daniele, Martinez-Perez Aleix, Marwah Sanjay, McFarlane Michael, Melo Renato Bessa, Mesina Cristian, Michalopoulos Nick, Moldovanu Radu, Mouaqit Ouadii, Munyika Akutu, Negoi Ionut, Nikolopoulos Ioannis, Nita Gabriela Elisa, Olaoye Iyiade, Omari Abdelkarim, Ossa Paola Rodríguez, Ozkan Zeynep, Padmakumar Ramakrishnapillai, Pata Francesco, Pereira Junior Gerson Alves, Pereira Jorge, Pintar Tadeja, Pouggouras Konstantinos, Prabhu Vinod, Rausei Stefano, Rems Miran, Rios-Cruz Daniel, Sakakushev Boris, Sánchez de Molina Maria Luisa, Seretis Charampolos, Shelat Vishal, Simões Romeo Lages, Sinibaldi Giovanni, Skrovina Matej, Smirnov Dmitry, Spyropoulos Charalampos, Tepp Jaan, Tezcaner Tugan, Tolonen Matti, Torba Myftar, Ulrych Jan, Uzunoglu Mustafa Yener, van Dellen David, van Ramshorst Gabrielle H, Vasquez Giorgio, Venara Aurélien, Vereczkei Andras, Vettoretto Nereo, Vlad Nutu, Yadav Sanjay Kumar, Yilmaz Tonguç Utku, Yuan Kuo-Ching, Zachariah Sanoop Koshy, Zida Maurice, Zilinskas Justas, Ansaloni Luca
机构信息
Department of Surgery, Macerata Hospital, Macerata, Italy.
Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates.
出版信息
World J Emerg Surg. 2015 Dec 16;10:61. doi: 10.1186/s13017-015-0055-0. eCollection 2015.
BACKGROUND
To validate a new practical Sepsis Severity Score for patients with complicated intra-abdominal infections (cIAIs) including the clinical conditions at the admission (severe sepsis/septic shock), the origin of the cIAIs, the delay in source control, the setting of acquisition and any risk factors such as age and immunosuppression.
METHODS
The WISS study (WSES cIAIs Score Study) is a multicenter observational study underwent in 132 medical institutions worldwide during a four-month study period (October 2014-February 2015). Four thousand five hundred thirty-three patients with a mean age of 51.2 years (range 18-99) were enrolled in the WISS study.
RESULTS
Univariate analysis has shown that all factors that were previously included in the WSES Sepsis Severity Score were highly statistically significant between those who died and those who survived (p < 0.0001). The multivariate logistic regression model was highly significant (p < 0.0001, R2 = 0.54) and showed that all these factors were independent in predicting mortality of sepsis. Receiver Operator Curve has shown that the WSES Severity Sepsis Score had an excellent prediction for mortality. A score above 5.5 was the best predictor of mortality having a sensitivity of 89.2 %, a specificity of 83.5 % and a positive likelihood ratio of 5.4.
CONCLUSIONS
WSES Sepsis Severity Score for patients with complicated Intra-abdominal infections can be used on global level. It has shown high sensitivity, specificity, and likelihood ratio that may help us in making clinical decisions.
背景
为验证一种针对复杂性腹腔内感染（cIAIs）患者的新实用脓毒症严重程度评分，该评分涵盖入院时的临床状况（严重脓毒症/脓毒性休克）、cIAIs的来源、感染源控制的延迟、感染发生的环境以及年龄和免疫抑制等任何风险因素。
方法
WISS研究（WSES cIAIs评分研究）是一项多中心观察性研究，在2014年10月至2015年2月的四个月研究期间，在全球132家医疗机构开展。4533例平均年龄51.2岁（范围18 - 99岁）的患者纳入了WISS研究。
结果
单因素分析表明，先前纳入WSES脓毒症严重程度评分的所有因素在死亡患者和存活患者之间具有高度统计学意义（p < 0.0001）。多因素逻辑回归模型具有高度统计学意义（p < 0.0001，R2 = 0.54），表明所有这些因素在预测脓毒症死亡率方面均具有独立性。受试者工作特征曲线表明，WSES脓毒症严重程度评分对死亡率具有出色的预测能力。评分高于5.5是死亡率的最佳预测指标，灵敏度为89.2%，特异度为83.5%，阳性似然比为5.4。
结论
用于复杂性腹腔内感染患者的WSES脓毒症严重程度评分可在全球范围内使用。它具有高灵敏度、特异度和似然比，可能有助于我们做出临床决策。
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