Moskowitz Ari, Patel Parth V, Grossestreuer Anne V, Chase Maureen, Shapiro Nathan I, Berg Katherine, Cocchi Michael N, Holmberg Mathias J, Donnino Michael W
1Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA. 2Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA. 3Division of Critical Care, Department of Anesthesia Critical Care, Beth Israel Deaconess Medical Center, Boston, MA. 4Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.
Crit Care Med. 2017 Nov;45(11):1813-1819. doi: 10.1097/CCM.0000000000002622.
The Sepsis III clinical criteria for the diagnosis of sepsis rely on scores derived to predict inhospital mortality. In this study, we introduce the novel outcome of "received critical care intervention" and investigate the related predictive performance of both the quick Sequential Organ Failure Assessment and the Systemic Inflammatory Response Syndrome criteria.
This was a single-center, retrospective analysis of electronic health records.
Tertiary care hospital in the United States.
Patients with suspected infection who presented to the emergency department and were admitted to the hospital between January 2010 and December 2014.
Systemic Inflammatory Response Syndrome and quick Sequential Organ Failure Assessment scores were calculated, and their relationships to the receipt of critical care intervention and inhospital mortality were determined.
A total of 24,164 patients were included of whom 6,693 (27.7%) were admitted to an ICU within 48 hours; 4,453 (66.5%) patients admitted to the ICU received a critical care intervention. Among those with quick Sequential Organ Failure Assessment less than 2, 13.4% received a critical care intervention and 3.5% died compared with 48.2% and 13.4%, respectively, for quick Sequential Organ Failure Assessment greater than or equal to 2. The area under the receiver operating characteristic was similar whether quick Sequential Organ Failure Assessment was used to predict receipt of critical care intervention or inhospital mortality (0.74 [95% CI, 0.73-0.74] vs 0.71 [0.69-0.72]). The area under the receiver operating characteristic of Systemic Inflammatory Response Syndrome for critical care intervention (0.69) and mortality (0.66) was lower than that for quick Sequential Organ Failure Assessment (p < 0.001 for both outcomes). The sensitivity of quick Sequential Organ Failure Assessment for predicting critical care intervention was 38%.
Emergency department patients with suspected infection and low quick Sequential Organ Failure Assessment scores frequently receive critical care interventions. The misclassification of these patients as "low risk," in combination with the low sensitivity of quick Sequential Organ Failure Assessment greater than or equal to 2, may diminish the clinical utility of the quick Sequential Organ Failure Assessment score for patients with suspected infection in the emergency department.
脓毒症3.0的脓毒症临床诊断标准依赖于用于预测住院死亡率的评分。在本研究中，我们引入了“接受重症监护干预”这一新的结果，并研究快速序贯器官衰竭评估（qSOFA）和全身炎症反应综合征（SIRS）标准的相关预测性能。
这是一项对电子健康记录的单中心回顾性分析。
美国的三级医疗中心。
2010年1月至2014年12月期间因疑似感染就诊于急诊科并入院的患者。
计算全身炎症反应综合征和快速序贯器官衰竭评估评分，并确定它们与接受重症监护干预和住院死亡率的关系。
共纳入24164例患者，其中6693例（27.7%）在48小时内入住重症监护病房（ICU）；入住ICU的患者中有4453例（66.5%）接受了重症监护干预。在qSOFA评分小于2分的患者中，13.4%接受了重症监护干预，3.5%死亡；相比之下，qSOFA评分大于或等于2分的患者中，这两个比例分别为48.2%和13.4%。无论使用qSOFA来预测接受重症监护干预还是住院死亡率，受试者工作特征曲线下面积相似（分别为0.74[95%CI，0.73 - 0.74]和0.71[0.69 - 0.72]）。SIRS用于预测重症监护干预（0.69）和死亡率（0.66）的受试者工作特征曲线下面积低于qSOFA（两种结果的p均<0.001）。qSOFA预测重症监护干预的敏感性为38%。
急诊科疑似感染且qSOFA评分低的患者经常接受重症监护干预。将这些患者错误分类为“低风险”，再加上qSOFA评分大于或等于2分时敏感性较低，可能会降低qSOFA评分在急诊科疑似感染患者中的临床实用性。
