SOFA、qSOFA 和 SIRS 评分对疑似感染收入重症监护病房的癌症患者死亡率的准确性。
Accuracy of SOFA, qSOFA, and SIRS scores for mortality in cancer patients admitted to an intensive care unit with suspected infection.
机构信息
ICU, AC Camargo Cancer Center, São Paulo, R. Prof. Antônio Prudente, 211 Liberdade, São Paulo, SP 01509-010, Brazil.
ICU, AC Camargo Cancer Center, São Paulo, R. Prof. Antônio Prudente, 211 Liberdade, São Paulo, SP 01509-010, Brazil; Discipline of Clinical Emergency, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo (SP), Av. Dr. Enéas de Carvalho Aguiar, 255 Cerqueira César, São Paulo, SP 05403-000, Brazil.
出版信息
J Crit Care. 2018 Jun;45:52-57. doi: 10.1016/j.jcrc.2017.12.024. Epub 2018 Jan 4.
PURPOSE
To compare the prognostic accuracy of Sequential Organ Failure Assessment (SOFA) and quick SOFA (qSOFA) with systemic inflammatory response syndrome (SIRS) criteria in critically ill cancer patients with suspected infection.
METHODS
Data for 450 cancer patients admitted to an intensive care unit (ICU) in 2014 with a suspected infection were retrospectively analyzed. Sensitivity, specificity, and area under the receiver operating curve (AUC) values for SOFA, qSOFA, and SIRS criteria for ICU and hospital mortalities were calculated. Mortalities according to Sepsis-2 stratification (e.g., sepsis, severe sepsis, and septic shock) and Sepsis-3 stratification (e.g., infection, sepsis, and septic shock) were also compared.
RESULTS
SOFA outperformed SIRS in predicting mortalities for ICU [(AUC, 0.76; 95% confidence interval (CI) 95%, 0.71-0.81) vs. (AUC, 0.62; 95% CI, 0.56-0.67), p < .01] and hospital [(AUC, 0.69; 95% CI, 0.65-0.74) vs. (AUC, 0.58; 95% CI, 0.52-0.63), p < .01)] patients. Similarly, qSOFA outperformed SIRS for both settings [(AUC, 0.71; 95% CI, 0.65-0.76, p = .02) vs. (AUC, 0.69; 95% CI, 0.64-0.74; p < .01), respectively].
CONCLUSIONS
SOFA and qSOFA were more sensitive and accurate than SIRS in predicting ICU and hospital mortality for critically ill cancer patients with suspected infection.
目的
比较序贯器官衰竭评估（SOFA）和快速 SOFA（qSOFA）与全身炎症反应综合征（SIRS）标准在疑似感染的危重症癌症患者中的预后准确性。
方法
回顾性分析了 2014 年收治于重症监护病房（ICU）的 450 例疑似感染的癌症患者的数据。计算了 SOFA、qSOFA 和 SIRS 标准对 ICU 和医院死亡率的敏感性、特异性和受试者工作特征曲线（ROC）下面积（AUC）值。还比较了根据 Sepsis-2 分层（如脓毒症、严重脓毒症和脓毒性休克）和 Sepsis-3 分层（如感染、脓毒症和脓毒性休克）的死亡率。
结果
SOFA 在预测 ICU 死亡率方面优于 SIRS [AUC：0.76（95%置信区间（CI）95%，0.71-0.81）比 AUC：0.62（95% CI，0.56-0.67），p<0.01]和医院死亡率 [AUC：0.69（95% CI，0.65-0.74）比 AUC：0.58（95% CI，0.52-0.63），p<0.01]。同样，qSOFA 在这两种情况下也优于 SIRS [AUC：0.71（95% CI，0.65-0.76，p=0.02）比 AUC：0.69（95% CI，0.64-0.74，p<0.01）]。
结论
SOFA 和 qSOFA 在预测疑似感染的危重症癌症患者的 ICU 和医院死亡率方面比 SIRS 更敏感和准确。
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