Tropical and Infectious Disease Unit, Royal Liverpool University Hospital, Liverpool, UK.
Department of Biostatistics, University of Liverpool, Liverpool, UK.
Emerg Med J. 2018 Jun;35(6):345-349. doi: 10.1136/emermed-2017-207120. Epub 2018 Feb 21.
The third international consensus definition for sepsis recommended use of a new prognostic tool, the quick Sequential Organ Failure Assessment (qSOFA), based on its ability to predict inhospital mortality and prolonged intensive care unit (ICU) stay in patients with suspected infection. While several studies have compared the prognostic accuracy of qSOFA to the Systemic Inflammatory Response Syndrome (SIRS) criteria in suspected sepsis, few have compared qSOFA and SIRS to the widely used National Early Warning Score (NEWS).
This was a retrospective cohort study carried out in a UK tertiary centre. The study population comprised emergency admissions in whom sepsis was suspected and treated. The accuracy for predicting inhospital mortality and ICU admission was calculated and compared for qSOFA, SIRS and NEWS.
Among 1818 patients, 53 were admitted to ICU (3%) and 265 died in hospital (15%). For predicting inhospital mortality, the area under the receiver operating characteristics curve for NEWS (0.65, 95% CI 0.61 to 0.68) was similar to qSOFA (0.62, 95% CI 0.59 to 0.66) (test for difference, P=0.18) and superior to SIRS (P<0.001), which was not predictive. The sensitivity of NEWS≥5 (74%, 95% CI 68% to 79%) was similar to SIRS≥2 (80%, 95% CI 74% to 84%) and higher than qSOFA≥2 (37%, 95% CI 31% to 43%). The specificity of NEWS≥5 (43%, 95% CI 41% to 46%) was higher than SIRS≥2 (21%, 95% CI 19% to 23%) and lower than qSOFA≥2 (79%, 95% CI 77% to 81%). The negative predictive value was 88% (86%-90%) for qSOFA, 86% (82%-89%) for SIRS and 91% (88%-93%) for NEWS. Results were similar for the secondary outcome of ICU admission.
NEWS has equivalent or superior value for most test characteristics relative to SIRS and qSOFA, calling into question the rationale of adopting qSOFA in institutions where NEWS is already in use.
第三届国际脓毒症定义共识建议使用新的预后工具——快速序贯器官衰竭评估（qSOFA），因为它能够预测疑似感染患者的住院死亡率和 ICU 住院时间延长。虽然有几项研究比较了 qSOFA 与全身炎症反应综合征（SIRS）标准在疑似脓毒症中的预后准确性，但很少有研究比较 qSOFA 和 SIRS 与广泛使用的国家早期预警评分（NEWS）。
这是一项在英国三级中心进行的回顾性队列研究。研究人群包括疑似并接受治疗的急诊入院患者。计算并比较 qSOFA、SIRS 和 NEWS 预测住院死亡率和 ICU 入住的准确性。
在 1818 例患者中，53 例患者入住 ICU（3%），265 例患者死亡（15%）。对于预测住院死亡率，NEWS 的受试者工作特征曲线下面积（AUC）为 0.65（95%置信区间 0.61 至 0.68），与 qSOFA（0.62，95%置信区间 0.59 至 0.66）相似（检验差异，P=0.18），优于 SIRS（P<0.001），后者无预测价值。NEWS≥5 的敏感性（74%，95%置信区间 68%至 79%）与 SIRS≥2（80%，95%置信区间 74%至 84%）相似，高于 qSOFA≥2（37%，95%置信区间 31%至 43%）。NEWS≥5 的特异性（43%，95%置信区间 41%至 46%）高于 SIRS≥2（21%，95%置信区间 19%至 23%），低于 qSOFA≥2（79%，95%置信区间 77%至 81%）。qSOFA 的阴性预测值为 88%（86%-90%），SIRS 为 86%（82%-89%），NEWS 为 91%（88%-93%）。次要结果 ICU 入住的结果相似。
与 SIRS 和 qSOFA 相比，NEWS 在大多数测试特征方面具有同等或更高的价值，这使得在已经使用 NEWS 的机构中采用 qSOFA 的理由受到质疑。
