Department of Anaesthesia, Intensive Care and Pain Medicine, Division of Population Medicine, Cardiff University, UK.
Anaesthetic Directorate, Aneurin Bevan University Health Board, Royal Gwent Hospital, Newport, Gwent, UK.
Anaesthesia. 2018 Feb;73(2):195-204. doi: 10.1111/anae.14062. Epub 2017 Nov 17.
Our aim was to prospectively determine the predictive capabilities of SEPSIS-1 and SEPSIS-3 definitions in the emergency departments and general wards. Patients with National Early Warning Score (NEWS) of 3 or above and suspected or proven infection were enrolled over a 24-h period in 13 Welsh hospitals. The primary outcome measure was mortality within 30 days. Out of the 5422 patients screened, 431 fulfilled inclusion criteria and 380 (88%) were recruited. Using the SEPSIS-1 definition, 212 patients had sepsis. When using the SEPSIS-3 definitions with Sequential Organ Failure Assessment (SOFA) score ≥ 2, there were 272 septic patients, whereas with quickSOFA score ≥ 2, 50 patients were identified. For the prediction of primary outcome, SEPSIS-1 criteria had a sensitivity (95%CI) of 65% (54-75%) and specificity of 47% (41-53%); SEPSIS-3 criteria had a sensitivity of 86% (76-92%) and specificity of 32% (27-38%). SEPSIS-3 and SEPSIS-1 definitions were associated with a hazard ratio (95%CI) 2.7 (1.5-5.6) and 1.6 (1.3-2.5), respectively. Scoring system discrimination evaluated by receiver operating characteristic curves was highest for Sequential Organ Failure Assessment score (0.69 (95%CI 0.63-0.76)), followed by NEWS (0.58 (0.51-0.66)) (p < 0.001). Systemic inflammatory response syndrome criteria (0.55 (0.49-0.61)) and quickSOFA score (0.56 (0.49-0.64)) could not predict outcome. The SEPSIS-3 definition identified patients with the highest risk. Sequential Organ Failure Assessment score and NEWS were better predictors of poor outcome. The Sequential Organ Failure Assessment score appeared to be the best tool for identifying patients with high risk of death and sepsis-induced organ dysfunction.
我们的目的是前瞻性地确定 SEPSIS-1 和 SEPSIS-3 定义在急诊科和普通病房的预测能力。在 13 家威尔士医院，对 National Early Warning Score（NEWS）为 3 或更高且疑似或确诊感染的患者进行了为期 24 小时的筛查。主要观察指标为 30 天内的死亡率。在筛选的 5422 名患者中，有 431 名符合纳入标准，有 380 名（88%）被纳入。使用 SEPSIS-1 定义，有 212 名患者患有败血症。当使用 SEPSIS-3 定义并结合 Sequential Organ Failure Assessment（SOFA）评分≥2 时，有 272 名败血症患者，而当使用 quickSOFA 评分≥2 时，有 50 名患者被识别。对于主要结局的预测，SEPSIS-1 标准的敏感性（95%CI）为 65%（54-75%），特异性为 47%（41-53%）；SEPSIS-3 标准的敏感性为 86%（76-92%），特异性为 32%（27-38%）。SEPSIS-3 和 SEPSIS-1 定义的风险比（95%CI）分别为 2.7（1.5-5.6）和 1.6（1.3-2.5）。通过接收者操作特征曲线评估的评分系统鉴别力，SOFA 评分最高（0.69（95%CI 0.63-0.76）），其次是 NEWS（0.58（0.51-0.66））（p<0.001）。全身炎症反应综合征标准（0.55（0.49-0.61））和 quickSOFA 评分（0.56（0.49-0.64））均不能预测结局。SEPSIS-3 定义确定了风险最高的患者。SOFA 评分和 NEWS 是不良预后的更好预测指标。SOFA 评分似乎是识别高死亡风险和脓毒症引起的器官功能障碍患者的最佳工具。
