Department of Emergency Medicine, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA.
Department of Emergency Medicine, University of Mississippi Medical Center, Jackson, MS, USA.
J Intensive Care Med. 2020 Aug;35(8):810-817. doi: 10.1177/0885066618795400. Epub 2018 Aug 30.
Early organ dysfunction in sepsis confers a high risk of in-hospital mortality, but the relative contribution of specific types of organ failure to overall mortality is unclear. The objective of this study was to assess the predictive ability of individual types of organ failure to in-hospital mortality or prolonged intensive care.
Retrospective cohort study of adult emergency department patients with sepsis from October 1, 2013, to November 10, 2015. Multivariable regression was used to assess the odds ratios of individual organ failure types for the outcomes of in-hospital death (primary) and in-hospital death or ICU stay ≥ 3 days (secondary).
Of 2796 patients, 283 (10%) experienced in-hospital mortality, and 748 (27%) experienced in-hospital mortality or an ICU stay ≥ 3 days. The following components of Sequential Organ Failure Assessment (SOFA) score were most predictive of in-hospital mortality (descending order): coagulation (odds ratio [OR]: 1.60, 95% confidence interval [CI]: 1.32-1.93), hepatic (1.58, 95% CI: 1.32-1.90), respiratory (OR: 1.33, 95% CI: 1.21-1.47), neurologic (OR: 1.20, 95% CI: 1.07-1.35), renal (OR: 1.14, 95% CI: 1.02-1.27), and cardiovascular (OR: 1.13, 95% CI: 1.01-1.25). For mortality or ICU stay ≥3 days, the most predictive SOFA components were respiratory (OR: 1.97, 95% CI: 1.79-2.16), neurologic (OR: 1.72, 95% CI: 1.54-1.92), cardiovascular (OR: 1.38, 95% CI: 1.23-1.54), coagulation (OR: 1.31, 95% CI: 1.10-1.55), and renal (OR: 1.19, 95% CI: 1.08-1.30) while hepatic SOFA (OR: 1.16, 95% CI: 0.98-1.37) did not reach statistical significance ( = .092).
In this retrospective study, SOFA score components demonstrated varying predictive abilities for mortality in sepsis. Elevated coagulation or hepatic SOFA scores were most predictive of in-hospital death, while an elevated respiratory SOFA was most predictive of death or ICU stay >3 days.
脓毒症早期器官功能障碍预示着院内死亡率高，但特定类型的器官衰竭对总死亡率的相对贡献尚不清楚。本研究的目的是评估各类型器官衰竭对院内死亡或延长重症监护的预测能力。
这是一项回顾性队列研究，纳入了 2013 年 10 月 1 日至 2015 年 11 月 10 日期间急诊科脓毒症成年患者。多变量回归用于评估各器官衰竭类型对院内死亡（主要结局）和院内死亡或 ICU 住院时间≥3 天（次要结局）的比值比。
在 2796 例患者中，283 例（10%）发生院内死亡，748 例（27%）发生院内死亡或 ICU 住院时间≥3 天。序贯器官衰竭评估（SOFA）评分的以下组成部分对院内死亡率的预测性最高（降序排列）：凝血功能（比值比[OR]：1.60，95%置信区间[CI]：1.32-1.93）、肝脏（1.58，95%CI：1.32-1.90）、呼吸（OR：1.33，95%CI：1.21-1.47）、神经（OR：1.20，95%CI：1.07-1.35）、肾脏（OR：1.14，95%CI：1.02-1.27）和心血管（OR：1.13，95%CI：1.01-1.25）。对于死亡或 ICU 住院时间≥3 天，最具预测性的 SOFA 组成部分是呼吸（OR：1.97，95%CI：1.79-2.16）、神经（OR：1.72，95%CI：1.54-1.92）、心血管（OR：1.38，95%CI：1.23-1.54）、凝血功能（OR：1.31，95%CI：1.10-1.55）和肾脏（OR：1.19，95%CI：1.08-1.30），而肝脏 SOFA（OR：1.16，95%CI：0.98-1.37）未达到统计学意义（ =.092）。
在这项回顾性研究中，SOFA 评分组成部分对脓毒症患者的死亡率具有不同的预测能力。升高的凝血或肝脏 SOFA 评分最能预测院内死亡，而升高的呼吸 SOFA 评分最能预测死亡或 ICU 住院时间>3 天。
