University of Florida College of Medicine, Jacksonville, Department of Emergency Medicine, 1st Floor, Clinical Center, 655 West 8th Street, C506, Jacksonville, FL 32209, United States.
University of Florida College of Medicine, Jacksonville, Department of Emergency Medicine, 1st Floor, Clinical Center, 655 West 8th Street, C506, Jacksonville, FL 32209, United States.
J Crit Care. 2017 Dec;42:30-34. doi: 10.1016/j.jcrc.2017.06.024. Epub 2017 Jun 23.
Patients with severe sepsis who experience rapid, early deterioration and death are of particular concern. Our objective was to identify predictors of early death in Emergency Department (ED) patients with severe sepsis.
Secondary analysis of two prospective studies of adult ED patients with severe sepsis. The primary outcome was early death, defined as death within 24h of triage.
Out of 410 severe sepsis admissions, 20 patients experienced early death. These patients demonstrated significantly higher initial lactate (7.3 versus 3.3mmol/L, p<0.001) and modified SOFA (mSOFA) scores (10 vs 6, p<0.001), were less likely to normalize their lactate (p<0.001), had lower initial pH (p<0.001), and more frequently had early positive blood cultures (p=0.021). Multivariable logistic regression identified initial serum lactate level (OR 1.19, 95% CI 1.06-1.35) and mSOFA score (OR 1.17, 95% CI 1.00-1.36) as independent predictors of early death. A repeat lactate≥5mmol/L had a sensitivity of 55% and specificity of 89% for early death. There were no significant treatment differences between groups.
Initial serum lactate and mSOFA score were independent predictors of mortality within 24h of ED admission in patients with severe sepsis.
快速、早期恶化和死亡的严重脓毒症患者尤其令人关注。我们的目的是确定急诊科（ED）严重脓毒症患者早期死亡的预测因素。
对两项前瞻性研究中成人 ED 严重脓毒症患者进行二次分析。主要结局是早期死亡，定义为分诊后 24 小时内死亡。
在 410 例严重脓毒症患者中，有 20 例患者发生早期死亡。这些患者的初始乳酸（7.3 比 3.3mmol/L，p<0.001）和改良 SOFA（mSOFA）评分（10 比 6，p<0.001）显著更高，乳酸更不可能恢复正常（p<0.001），初始 pH 值更低（p<0.001），早期阳性血培养更常见（p=0.021）。多变量逻辑回归确定初始血清乳酸水平（OR 1.19，95%CI 1.06-1.35）和 mSOFA 评分（OR 1.17，95%CI 1.00-1.36）是早期死亡的独立预测因素。重复的乳酸≥5mmol/L 对早期死亡的敏感性为 55%，特异性为 89%。两组之间没有显著的治疗差异。
在急诊科严重脓毒症患者中，入院 24 小时内初始血清乳酸和 mSOFA 评分是死亡率的独立预测因素。
