García-Villalba Eva, Cano-Sánchez Alfredo, Alcaraz-García Antonia, Cinesi-Gómez César, Piñera-Salmerón Pascual, Marín Irene, Muñoz Ángeles, Vicente Vera Tomás, Bernal-Morell Enrique
Sección de Enfermedades Infecciosas, Hospital General Universitario Reína Sofía de Murcia, España.
Servicio de Urgencias, Hospital General Universitario Reína Sofía, Murcia, España.
Emergencias. 2017;29(2):81-86.
To develop a nomograph to predict a poor outcome (death during hospitalization or a hospital stay longer than 15 days) in emergency patients with sepsis and at low risk of organ damage according to Sepsis-related Organ Failure Assessment (SOFA).
Prospective, observational study carried out in a single universitary hospital. All patients admitted from the emergency department with sepsis and SOFA scores of 6 or lower were enrolled. We used bivariate logistic regression analysis to develop a predictive nomogram.
A total of 174 patients were included. Seventeen patients (9.8%) died during hospitalization and the average hospital stay was greater than 15 days in 29 (16.7%) patient. The outcome was poor in a total of 42 patients (24.1%);. Independent variables that were significantly associated with a poor outcome were SOFA score (odds ratio [OR], 1.3; 95% CI, 1.06-1.71; P<.05), C-reactive protein (CRP) concentration (OR, 1.04; 95% CI, 1.0-1.09; P<.05), N-terminal fragment of brain natriuretic peptide (NT-proBNP) concentration over 1330 ng/mL (OR, 2.64; 95% CI, 1.17-6.22; P<.05), and septic shock (OR, 8.3; 95% CI, 1.16-166.5; P<.05). For a SOFA score of 2 or more the crude OR was 4.44 (95%, CI, 1.91-10.34) and the OR adjusted for other variables was 3.08 (95% CI, 1.24-7.69).
A high percentage of patients predicted to be at low risk of organ failure had poor outcomes, associated with SOFA score, the presence of septic shock, CRP concentration, and elevated NT-proBNP concentration. The SOFA score by itself is an inadequate prognostic tool in patients at low risk of organ damage. Other clinical and analytical variables are required to complement the SOFA score.
根据脓毒症相关器官功能衰竭评估（SOFA），制定一种列线图，以预测脓毒症且器官损害风险较低的急诊患者的不良结局（住院期间死亡或住院时间超过15天）。
在一家大学医院进行的前瞻性观察性研究。纳入所有从急诊科收治的脓毒症且SOFA评分≤6分的患者。我们采用二元逻辑回归分析来制定预测列线图。
共纳入174例患者。17例患者（9.8%）在住院期间死亡，29例患者（16.7%）的平均住院时间超过15天。共有42例患者（24.1%）结局不佳。与不良结局显著相关的独立变量为SOFA评分（比值比[OR]，1.3；95%置信区间[CI]，1.06 - 1.71；P <.05）、C反应蛋白（CRP）浓度（OR，1.04；95% CI，1.0 - 1.09；P <.05）、脑钠肽N端片段（NT-proBNP）浓度超过1330 ng/mL（OR，2.64；95% CI，1.17 - 6.22；P <.05）以及脓毒性休克（OR，8.3；95% CI，1.16 - 166.5；P <.05）。对于SOFA评分≥2分，粗OR为4.44（95% CI，1.91 - 10.34），经其他变量校正后的OR为3.08（95% CI，1.24 - 7.69）。
预测器官衰竭风险较低的患者中有很大比例结局不佳，这与SOFA评分、脓毒性休克的存在、CRP浓度以及NT-proBNP浓度升高有关。对于器官损害风险较低的患者，仅SOFA评分本身是一种不充分的预后工具。需要其他临床和分析变量来补充SOFA评分。
