快速序贯器官衰竭评估对疑似感染患者死亡率的预后准确性：系统评价和荟萃分析。

Prognostic Accuracy of the Quick Sequential Organ Failure Assessment for Mortality in Patients With Suspected Infection: A Systematic Review and Meta-analysis.

机构信息

University of Ottawa, Ottawa, Ontario, Canada (S.M.F., A.T.).

University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (M.T., A.J.S., J.J.P.).

出版信息

Ann Intern Med. 2018 Feb 20;168(4):266-275. doi: 10.7326/M17-2820. Epub 2018 Feb 6.

DOI:10.7326/M17-2820

PMID:29404582

Abstract

BACKGROUND

The quick Sequential Organ Failure Assessment (qSOFA) has been proposed for prediction of mortality in patients with suspected infection.

PURPOSE

To summarize and compare the prognostic accuracy of qSOFA and the systemic inflammatory response syndrome (SIRS) criteria for prediction of mortality in adult patients with suspected infection.

DATA SOURCES

Four databases from inception through November 2017.

STUDY SELECTION

English-language studies using qSOFA for prediction of mortality (in-hospital, 28-day, or 30-day) in adult patients with suspected infection in the intensive care unit (ICU), emergency department (ED), or hospital wards.

DATA EXTRACTION

Two investigators independently extracted data and assessed study quality using standard criteria.

DATA SYNTHESIS

Thirty-eight studies were included (n = 385 333). qSOFA was associated with a pooled sensitivity of 60.8% (95% CI, 51.4% to 69.4%) and a pooled specificity of 72.0% (CI, 63.4% to 79.2%) for mortality. The SIRS criteria were associated with a pooled sensitivity of 88.1% (CI, 82.3% to 92.1%) and a pooled specificity of 25.8% (CI, 17.1% to 36.9%). The pooled sensitivity of qSOFA was higher in the ICU population (87.2% [CI, 75.8% to 93.7%]) than the non-ICU population (51.2% [CI, 43.6% to 58.7%]). The pooled specificity of qSOFA was higher in the non-ICU population (79.6% [CI, 73.3% to 84.7%]) than the ICU population (33.3% [CI, 23.8% to 44.4%]).

LIMITATION

Potential risk of bias in included studies due to qSOFA interpretation and patient selection.

CONCLUSION

qSOFA had poor sensitivity and moderate specificity for short-term mortality. The SIRS criteria had sensitivity superior to that of qSOFA, supporting their use for screening of patients and as a prompt for treatment initiation.

PRIMARY FUNDING SOURCE

Canadian Association of Emergency Physicians. (PROSPERO: CRD42017075964).

摘要

背景

快速序贯器官衰竭评估（qSOFA）已被提出用于预测疑似感染患者的死亡率。

目的

总结并比较 qSOFA 与全身炎症反应综合征（SIRS）标准对预测疑似感染的成年患者死亡率的预后准确性。

数据来源

从创建到 2017 年 11 月的四个数据库。

研究选择

使用 qSOFA 预测疑似感染患者在重症监护病房（ICU）、急诊部（ED）或医院病房中死亡率（住院、28 天或 30 天）的英语语言研究。

数据提取

两名调查员独立提取数据并使用标准标准评估研究质量。

数据综合

纳入了 38 项研究（n=385333）。qSOFA 与死亡率的汇总敏感性为 60.8%（95%CI，51.4%至 69.4%），汇总特异性为 72.0%（CI，63.4%至 79.2%）。SIRS 标准与死亡率的汇总敏感性为 88.1%（CI，82.3%至 92.1%）和汇总特异性为 25.8%（CI，17.1%至 36.9%）。qSOFA 的 ICU 人群的汇总敏感性（87.2%[CI，75.8%至 93.7%]）高于非 ICU 人群（51.2%[CI，43.6%至 58.7%]）。qSOFA 的汇总特异性在非 ICU 人群（79.6%[CI，73.3%至 84.7%]）高于 ICU 人群（33.3%[CI，23.8%至 44.4%]）。