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School of Medicine, University of Queensland, Brisbane, QLD, Australia.
Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia; School of Medicine, University of Queensland, Brisbane, QLD, Australia.
Chest. 2017 Mar;151(3):586-596. doi: 10.1016/j.chest.2016.10.057. Epub 2016 Nov 19.
A proposed revision of sepsis definitions has abandoned the systemic inflammatory response syndrome (SIRS), defined organ dysfunction as an increase in total Sequential Organ Function Assessment (SOFA) score of ≥ 2, and conceived "qSOFA" (quick SOFA) as a bedside indicator of organ dysfunction. We aimed to (1) determine the prognostic impact of SIRS, (2) compare the diagnostic accuracy of SIRS and qSOFA for organ dysfunction, and (3) compare standard (Sepsis-2) and revised (Sepsis-3) definitions for organ dysfunction in ED patients with infection.
Consecutive ED patients admitted with presumed infection were prospectively enrolled over 3 years. Sufficient observational data were collected to calculate SIRS, qSOFA, SOFA, comorbidity, and mortality.
We enrolled 8,871 patients, with SIRS present in 4,176 (47.1%). SIRS was associated with increased risk of organ dysfunction (relative risk [RR] 3.5) and mortality in patients without organ dysfunction (OR 3.2). SIRS and qSOFA showed similar discrimination for organ dysfunction (area under the receiver operating characteristic curve, 0.72 vs 0.73). qSOFA was specific but poorly sensitive for organ dysfunction (96.1% and 29.7%, respectively). Mortality for patients with organ dysfunction was similar for Sepsis-2 and Sepsis-3 (12.5% and 11.4%, respectively), although 29% of patients with Sepsis-3 organ dysfunction did not meet Sepsis-2 criteria. Increasing numbers of Sepsis-2 organ system dysfunctions were associated with greater mortality.
SIRS was associated with organ dysfunction and mortality, and abandoning the concept appears premature. A qSOFA score ≥ 2 showed high specificity, but poor sensitivity may limit utility as a bedside screening method. Although mortality for organ dysfunction was comparable between Sepsis-2 and Sepsis-3, more prognostic and clinical information is conveyed using Sepsis-2 regarding number and type of organ dysfunctions. The SOFA score may require recalibration.
脓毒症定义的一项拟议修订摒弃了全身炎症反应综合征（SIRS），将器官功能障碍定义为序贯器官功能评估（SOFA）总分增加≥2，并将“快速SOFA（qSOFA）”视为器官功能障碍的床边指标。我们旨在：（1）确定SIRS的预后影响；（2）比较SIRS和qSOFA对器官功能障碍的诊断准确性；（3）比较感染的急诊患者中器官功能障碍的标准（脓毒症-2）和修订（脓毒症-3）定义。
连续3年前瞻性纳入因疑似感染而入院的急诊患者。收集了足够的观察数据以计算SIRS、qSOFA、SOFA、合并症和死亡率。
我们纳入了8871例患者，其中4176例（47.1%）存在SIRS。SIRS与器官功能障碍风险增加（相对风险[RR]3.5）以及无器官功能障碍患者的死亡率增加相关（比值比[OR]3.2）。SIRS和qSOFA对器官功能障碍的辨别能力相似（受试者工作特征曲线下面积分别为0.72和0.73）。qSOFA对器官功能障碍具有特异性，但敏感性较差（分别为96.1%和29.7%）。脓毒症-2和脓毒症-3中器官功能障碍患者的死亡率相似（分别为12.5%和11.4%），尽管29%的脓毒症-3器官功能障碍患者不符合脓毒症-2标准。脓毒症-2器官系统功能障碍数量增加与更高的死亡率相关。
SIRS与器官功能障碍和死亡率相关，摒弃这一概念似乎为时过早。qSOFA评分≥2显示出高特异性，但较差的敏感性可能会限制其作为床边筛查方法的效用。尽管脓毒症-2和脓毒症-3中器官功能障碍的死亡率相当，但脓毒症-2在器官功能障碍的数量和类型方面传达了更多的预后和临床信息。SOFA评分可能需要重新校准。
