Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research.
Division of Emergency Medicine.
Eur J Emerg Med. 2019 Jun;26(3):174-179. doi: 10.1097/MEJ.0000000000000535.
Sepsis is acute organ dysfunction in the setting of infection. An accurate diagnosis is important to guide treatment and disposition. Tissue oxygen saturation (StO2) can be estimated noninvasively by near-infrared spectroscopy (NIRS), and may be an indicator of microcirculatory dysfunction in early sepsis. We aimed to determine the utility of StO2 for sepsis recognition and outcome prediction among patients presenting to the emergency department (ED) with infection.
A multicentre, prospective, observational cohort study recruited patients who were being admitted to hospital with infection. StO2 was measured in the ED using a handheld NIRS device, Inspectra 300. Outcomes were sepsis, defined as an increase in sequential organ failure assessment score of at least 2 points within 72 h, and composite in-hospital mortality/ICU admission at least 3 days.
A cohort of 323 participants, median age 64 (interquartile range: 47-77) years, was recruited at three Australian hospitals. 143 (44%) fulfilled the criteria for sepsis and 22 (7%) died within 30 days. The mean ± SD StO2 was 74 ± 8% in sepsis and 78 ± 7% in nonsepsis (P < 0.0001). StO2 correlated with the peak sequential organ failure assessment score (Spearman's ρ -0.27, P < 0.0001). Area under the receiver operating characteristic curve was 0.66 (95% confidence interval: 0.60-0.72) for sepsis and 0.66 (0.58-0.75) for the composite outcome. StO2 less than 75% had an odds ratio of 2.67 (1.45-4.94; P = 0.002), for the composite outcome compared with StO2 at least 75%.
NIRS-derived StO2 correlates with organ failure and is associated with outcome in sepsis. However, its ability to differentiate sepsis among ED patients with infection is limited. NIRS cannot be recommended for this purpose.
败血症是感染背景下的急性器官功能障碍。准确的诊断对于指导治疗和处置非常重要。组织氧饱和度（StO2）可以通过近红外光谱（NIRS）无创估计，并且可能是早期败血症微循环功能障碍的指标。我们旨在确定 StO2 在急诊科（ED）因感染就诊的患者中识别败血症和预测预后的效用。
一项多中心、前瞻性、观察性队列研究招募了因感染住院的患者。在 ED 使用手持式 NIRS 设备 Inspectra 300 测量 StO2。结局是败血症，定义为在 72 小时内序贯器官衰竭评估评分至少增加 2 分，以及至少 3 天内住院死亡率/入住 ICU 的复合结局。
在澳大利亚的 3 家医院共招募了 323 名中位年龄为 64（四分位距：47-77）岁的参与者。143 名（44%）符合败血症标准，22 名（7%）在 30 天内死亡。败血症的平均 StO2 ± 标准差为 74 ± 8%，非败血症为 78 ± 7%（P < 0.0001）。StO2 与峰值序贯器官衰竭评估评分相关（Spearman's ρ -0.27，P < 0.0001）。败血症的受试者工作特征曲线下面积为 0.66（95%置信区间：0.60-0.72），复合结局为 0.66（0.58-0.75）。与 StO2 至少为 75%相比，StO2 小于 75%的复合结局的优势比为 2.67（1.45-4.94；P = 0.002）。
NIRS 衍生的 StO2 与器官衰竭相关，与败血症的结局相关。然而，它在区分 ED 感染患者中的败血症的能力有限。因此，不能推荐 NIRS 用于该目的。
