[序贯器官衰竭评估（SOFA）、快速序贯器官衰竭评估（qSOFA）评分及传统评估指标对脓毒症预后的预测价值]
[Predictive value of SOFA, qSOFA score and traditional evaluation index on sepsis prognosis].
作者信息
Wang Ying, Wang Difen, Fu Jiangquan, Liu Ying
机构信息
Department of Critical Care Medicine, Affiliated Hospital of Guizhou Medical University, Guiyang 550004, Guizhou, China. Corresponding author: Wang Difen, Email:
出版信息
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2017 Aug;29(8):700-704. doi: 10.3760/cma.j.issn.2095-4352.2017.08.006.
OBJECTIVE
Assess the value of several biomarkers and disease severity scores for the prognostic assessment of sepsis.
METHODS
The clinical data of adult patients, who met the diagnostic criteria for Sepsis-3 and admitted to the intensive care unit (ICU) of Affiliated Hospital of Guizhou Medical University from January 2015 to December 2016 were retrospectively analyzed. These patients were divided into survival group and death group. The levels of serum lactate (Lac), lactate clearance rate of 24 hours later (24 h LCR), procalcitonin (PCT), quick sequential organ failure assessment (qSOFA) score, SOFA score, simplified acute physiology score II (SAPS II), acute physiology and chronic health evaluation scoring system II (APACHE II) score were determined, and the receiver operating characteristic curve (ROC) were used to analyze the prognostic value of the indicators above.
RESULTS
110 of 152 sepsis patients survived, while the others died. Compared with survival group, serum Lac, PCT, SOFA score, qSOFA score, SAPS II score, APACHE II score of death group were increased, and 24 h LCR was decreased. SAPS II [area under the ROC curve (AUC) = 0.877, P = 0.000, when threshold value was 41.50, sensitivity was 94.3%, specificity was 68.5%], 24 h LCR (AUC = 0.869, P = 0.000, when threshold value was 40.2%, sensitivity was 92.1%, specificity was 75.5%) and SOFA score (AUC = 0.815, P = 0.000, when threshold value was 7.60, sensitivity was 79.9%, specificity was 78.5%) showed better predictive value of sepsis. However, the predictive value of PCT (AUC = 0.759), Lac (AUC = 0.725), qSOFA (AUC = 0.701) and APACHE II score (AUC = 0.680) were poorer (AUC = 0.6-0.8). For sepsis caused by abdominal cavity infection, the most accurate index was SOFA score (AUC = 0.889, P = 0.000, when threshold value was 9.50, sensitivity was 81.2%, specificity was 83.5%), and for sepsis caused by pneumonia, the most accurate index was PCT (AUC = 0.891, P = 0.001, when threshold value was 3.95 mg/L, sensitivity was 84.7%, specificity was 94.1%).
CONCLUSIONS
SOFA score and qSOFA score cannot take the place of traditional evaluation index for the evaluation of the prognosis of patients with sepsis.
目的
评估多种生物标志物和疾病严重程度评分对脓毒症预后评估的价值。
方法
回顾性分析2015年1月至2016年12月在贵州医科大学附属医院重症监护病房（ICU）住院、符合Sepsis-3诊断标准的成年患者的临床资料。将这些患者分为存活组和死亡组。测定血清乳酸（Lac）水平、24小时后乳酸清除率（24 h LCR）、降钙素原（PCT）、快速序贯器官衰竭评估（qSOFA）评分、序贯器官衰竭评估（SOFA）评分、简化急性生理学评分II（SAPS II）、急性生理学与慢性健康状况评估评分系统II（APACHE II）评分，并采用受试者工作特征曲线（ROC）分析上述指标的预后价值。
结果
152例脓毒症患者中110例存活，其余死亡。与存活组相比，死亡组血清Lac、PCT、SOFA评分、qSOFA评分、SAPS II评分、APACHE II评分升高，24 h LCR降低。SAPS II[ROC曲线下面积（AUC）=0.877，P=0.000，阈值为41.50时，灵敏度为94.3%，特异度为68.5%]、24 h LCR（AUC=0.869，P=0.000，阈值为40.2%时，灵敏度为92.1%，特异度为75.5%）和SOFA评分（AUC=0.815，P=0.000，阈值为7.60时，灵敏度为79.9%，特异度为78.5%）对脓毒症显示出较好的预测价值。然而，PCT（AUC=0.759）、Lac（AUC=0.725）、qSOFA（AUC=0.701）和APACHE II评分（AUC=
Zotero 插件