Intensive Care Unit, Hospital Sao Rafael, Salvador, Brazil; Palliative Care Team, Hospital Sao Rafael, Salvador, Brazil.
Intensive Care Unit, Hospital Sao Rafael, Salvador, Brazil; Internal Medicine, Hospital Sao Rafael, Salvador, Brazil; Intensive Care Unit, Hospital Portugues, Salvador, Brazil.
J Crit Care. 2018 Oct;47:178-184. doi: 10.1016/j.jcrc.2018.07.008. Epub 2018 Jul 7.
Sepsis identification in older patients is challenging. We evaluated the performance of qSOFA across different age groups of patients with suspected infection outside the intensive care unit (ICU).
Retrospective cohort in a tertiary hospital in Brazil, from January 2016 to December 2016. Outcomes were hospital mortality, ICU admission and bacteremia. Performance of qSOFA was compared over three age groups: (1) reference: ≤65 years, (2) old: 65 to 79 years and (3) very old: ≥80 years.
There were 420 patients in the study, of which 259 (61.7%) were ≤65 years, 80 (19%) were 65 to 79 years and 81 (19.3%) were ≥80 years. Old and very old patients had higher qSOFA scores and lower SIRS scores. Overall, qSOFA ≥2 was associated to hospital mortality [OR (95% CI) = 5.8 (3.3-10.4), p < 0.001], ICU admission [OR (95% CI) = 2.7 (1.6-4.6), p < 0.001] and bacteremia [OR (95% CI) = 3.1 (1.7-5.8), p < 0.001]. Those associations were stronger in old and very old patients. qSOFA and SIRS demonstrated overall AUROCs for hospital mortality of 0.72 and 0.50, respectively.
qSOFA demonstrated good overall accuracy and was more strongly associated to outcomes in old and very old patients, when compared to younger patients.
老年患者脓毒症的识别具有挑战性。我们评估了 qSOFA 在重症监护病房（ICU）外疑似感染的不同年龄组患者中的表现。
这是巴西一家三级医院的回顾性队列研究，时间为 2016 年 1 月至 2016 年 12 月。结局为住院死亡率、入住 ICU 和菌血症。qSOFA 在三个年龄组（1）参考组：≤65 岁，（2）老年组：65-79 岁和（3）非常老年组：≥80 岁之间的表现进行了比较。
本研究共纳入 420 例患者，其中 259 例（61.7%）≤65 岁，80 例（19%）为 65-79 岁，81 例（19.3%）≥80 岁。老年和非常老年患者的 qSOFA 评分较高，SIRS 评分较低。总体而言，qSOFA≥2 与住院死亡率相关[比值比（95%可信区间）=5.8（3.3-10.4），p<0.001]、入住 ICU[比值比（95%可信区间）=2.7（1.6-4.6），p<0.001]和菌血症[比值比（95%可信区间）=3.1（1.7-5.8），p<0.001]。这些关联在老年和非常老年患者中更为强烈。qSOFA 和 SIRS 对住院死亡率的总体 AUROC 分别为 0.72 和 0.50。
与年轻患者相比，qSOFA 在老年和非常老年患者中表现出良好的总体准确性，与结局的相关性更强。
