From the Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam (TKO, Y-TJ, S-HD, J-WH), and Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University, Seoul, Korea (Y-TJ, S-HD, J-WH).
Eur J Anaesthesiol. 2019 Sep;36(9):688-694. doi: 10.1097/EJA.0000000000000957.
The quick Sequential Organ Failure Assessment (qSOFA) is intended for the assessment of the prognosis and risk of sepsis. It may also help predict the mortality risk of nonseptic patients.
This study investigated the relationship between pre-operative qSOFA scores and 30-day mortality after major surgery. It also evaluated the predictive value of qSOFA scores combined with the American Society of Anesthesiologists (ASA) physical status and Charlson comorbidity index (CCI).
A retrospective observational study.
Single tertiary academic hospital.
Medical records of patients who underwent major surgery (estimated blood loss >500 ml; surgery time >2 h) between January 2010 and December 2017 were examined.
The qSOFA score was measured within 24 h before surgery, and its association with 30-day mortality was analysed using multivariable logistic regression. A receiver-operating characteristic curve analysis was used to investigate the predictive power of the pre-operative qSOFA scores combined with the ASA physical status and with CCI.
A total of 6336 patients were included in the final analysis, and 91 (1.4%) died within 30 days. The multivariable logistic regression analysis including all covariates indicated that 30-day mortality was 2.43-times higher for the score 1 group than for the score 0 group (P = 0.002), and it was 3.54-times higher for the score at least 2 group than for the score 0 group (P < 0.001). The area under the curve (AUC) of the pre-operative qSOFA, ASA physical status and CCI were 0.69, 0.55 and 0.57, respectively. When the pre-operative qSOFA score was combined with the ASA physical status or CCI, the AUCs were 0.73 and 0.72, respectively.
Higher pre-operative qSOFA scores within 24 h of surgery were associated with increased 30-day mortality. Pre-operative qSOFA scores have better predictive value for 30-day mortality when combined with the ASA physical status or CCI.
快速序贯器官衰竭评估（qSOFA）用于评估脓毒症的预后和风险。它也可能有助于预测非脓毒症患者的死亡风险。
本研究探讨了术前 qSOFA 评分与大手术后 30 天死亡率之间的关系。还评估了 qSOFA 评分与美国麻醉医师协会（ASA）身体状况和 Charlson 合并症指数（CCI）相结合的预测价值。
回顾性观察研究。
单一三级学术医院。
检查了 2010 年 1 月至 2017 年 12 月期间接受大手术（估计出血量>500ml；手术时间>2h）的患者的病历。
在手术前 24 小时内测量 qSOFA 评分，并使用多变量逻辑回归分析其与 30 天死亡率的关系。使用受试者工作特征曲线分析来研究术前 qSOFA 评分与 ASA 身体状况和 CCI 相结合的预测能力。
共有 6336 名患者纳入最终分析，其中 91 名（1.4%）在 30 天内死亡。包括所有协变量的多变量逻辑回归分析表明，评分 1 组的 30 天死亡率是评分 0 组的 2.43 倍（P=0.002），评分至少 2 组的 30 天死亡率是评分 0 组的 3.54 倍（P<0.001）。术前 qSOFA、ASA 身体状况和 CCI 的曲线下面积（AUC）分别为 0.69、0.55 和 0.57。当将术前 qSOFA 评分与 ASA 身体状况或 CCI 相结合时，AUC 分别为 0.73 和 0.72。
手术前 24 小时内较高的 qSOFA 评分与 30 天死亡率增加相关。术前 qSOFA 评分与 ASA 身体状况或 CCI 相结合时，对 30 天死亡率具有更好的预测价值。
