Heidelberg University School of Medicine, Im Neuenheimer Feld 346, 69120 Heidelberg, Germany.
Emergency Medicine Department, National University Hospital, National University Health System, 5 Lower Kent Ridge Road, 119074, Singapore.
Am J Emerg Med. 2018 Nov;36(11):1957-1963. doi: 10.1016/j.ajem.2018.02.020. Epub 2018 Feb 27.
We aim to determine whether the combination of regional tissue oxygen saturation (StO) measurement using near-infrared spectroscopy (NIRS), inferior vena cava (IVC) collapsibility and ejection fraction (EF) is able to detect occult sepsis.
We included adult patients in the emergency department with at least one of the following: fever; any one component of the quick sepsis-related organ function assessment (SOFA) score; heart rate≥100 beats per minute; or white cell count <4.0×10/L or >12.0×10/L. StO parameters, IVC collapsibility and EF were assessed. Primary outcome was composite of admission to intensive care unit, hypotension requiring fluid resuscitation or vasopressor use, and antibiotic escalation.
We included 184 patients with mean age of 55.4years and slight male predominance (51.6%). Increase in temperature (adjusted odds ratio [aOR] 3.05; 95% confidence interval [CI] 1.16 to 8.02), higher white cell counts (aOR 1.10; 95% CI 1.03 to 1.19), increase in time taken to new StO baseline (aOR 1.03; 95% CI 1.01 to 1.06) and reduced EF (aOR 33.9; 95% CI 2.19 to 523.64) had higher odds of achieving the primary outcome.
Change in StO and time taken to reach new StO baseline, combined with EF could potentially predict sepsis among patients with infection.
我们旨在确定使用近红外光谱（NIRS）测量局部组织氧饱和度（StO）、下腔静脉（IVC）可塌陷性和射血分数（EF）的组合是否能够检测隐匿性脓毒症。
我们纳入了急诊科至少有以下一项表现的成年患者：发热；快速脓毒症相关器官功能衰竭评估（SOFA）评分的一个以上组成部分；心率≥100 次/分钟；或白细胞计数<4.0×10/L 或>12.0×10/L。评估 StO 参数、IVC 可塌陷性和 EF。主要结局是入住重症监护病房、需要液体复苏或血管加压药治疗的低血压以及抗生素升级的复合结局。
我们纳入了 184 名平均年龄为 55.4 岁且男性略占优势（51.6%）的患者。体温升高（调整后的优势比 [aOR] 3.05；95%置信区间 [CI] 1.16 至 8.02）、较高的白细胞计数（aOR 1.10；95% CI 1.03 至 1.19）、新 StO 基线达到时间的延长（aOR 1.03；95% CI 1.01 至 1.06）和 EF 降低（aOR 33.9；95% CI 2.19 至 523.64）与主要结局的发生具有更高的相关性。
StO 变化和达到新 StO 基线所需的时间以及 EF 的变化可能有助于预测感染患者的脓毒症。
