Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston MA.
Department of Medicine, Brigham and Women's Hospital, Boston, MA.
Crit Care Med. 2019 Mar;47(3):307-314. doi: 10.1097/CCM.0000000000003521.
Sepsis-3 defines organ dysfunction as an increase in the Sequential Organ Failure Assessment score by greater than or equal to 2 points. However, some Sequential Organ Failure Assessment score components are not routinely recorded in all hospitals' electronic health record systems, limiting its utility for wide-scale sepsis surveillance. The Centers for Disease Control and Prevention recently released the Adult Sepsis Event surveillance definition that includes simplified organ dysfunction criteria optimized for electronic health records (eSOFA). We compared eSOFA versus Sequential Organ Failure Assessment with regard to sepsis prevalence, overlap, and outcomes.
Retrospective cohort study.
One hundred eleven U.S. hospitals in the Cerner HealthFacts dataset.
Adults hospitalized in 2013-2015.
None.
We identified clinical indicators of presumed infection (blood cultures and antibiotics) concurrent with either: 1) an increase in Sequential Organ Failure Assessment score by 2 or more points (Sepsis-3) or 2) 1 or more eSOFA criteria: vasopressor initiation, mechanical ventilation initiation, lactate greater than or equal to 2.0 mmol/L, doubling in creatinine, doubling in bilirubin to greater than or equal to 2.0 mg/dL, or greater than or equal to 50% decrease in platelet count to less than 100 cells/μL (Centers for Disease Control and Prevention Adult Sepsis Event). We compared area under the receiver operating characteristic curves for discriminating in-hospital mortality, adjusting for baseline characteristics. Of 942,360 patients in the cohort, 57,242 (6.1%) had sepsis by Sequential Organ Failure Assessment versus 41,618 (4.4%) by eSOFA. Agreement between sepsis by Sequential Organ Failure Assessment and eSOFA was good (Cronbach's alpha 0.81). Baseline characteristics and infectious diagnoses were similar, but mortality was higher with eSOFA (17.1%) versus Sequential Organ Failure Assessment (14.4%; p < 0.001) as was discrimination for mortality (area under the receiver operating characteristic curve, 0.774 vs 0.759; p < 0.001). Comparisons were consistent across subgroups of age, infectious diagnoses, and comorbidities.
The Adult Sepsis Event's eSOFA organ dysfunction criteria identify a smaller, more severely ill sepsis cohort compared with the Sequential Organ Failure Assessment score, but with good overlap and similar clinical characteristics. Adult Sepsis Events may facilitate wide-scale automated sepsis surveillance that tracks closely with the more complex Sepsis-3 criteria.
Sepsis-3 将器官功能障碍定义为 Sequential Organ Failure Assessment（SOFA）评分增加≥2 分。然而，并非所有医院的电子病历系统都常规记录 SOFA 评分的某些组成部分，这限制了其在广泛的脓毒症监测中的应用。疾病控制与预防中心最近发布了成人脓毒症事件监测定义，其中包括针对电子病历优化的简化器官功能障碍标准（eSOFA）。我们比较了 eSOFA 与 SOFA 在脓毒症患病率、重叠和结局方面的差异。
回顾性队列研究。
Cerner HealthFacts 数据集的 111 家美国医院。
2013 年至 2015 年住院的成年人。
无。
我们确定了疑似感染的临床指标（血培养和抗生素），同时存在以下情况之一：1）SOFA 评分增加≥2 分（Sepsis-3）或 2）符合以下 1 项或多项 eSOFA 标准：血管加压素开始使用、机械通气开始、乳酸≥2.0mmol/L、肌酐增加≥1 倍、胆红素增加≥2.0mg/dL 或血小板计数减少≥50%至＜100 细胞/μL（疾病控制与预防中心成人脓毒症事件）。我们比较了区分住院死亡率的受试者工作特征曲线下面积，同时调整了基线特征。在队列中的 942360 名患者中，57242 名（6.1%）患者根据 SOFA 被诊断为脓毒症，而根据 eSOFA 被诊断为脓毒症的患者有 41618 名（4.4%）。SOFA 和 eSOFA 对脓毒症的诊断一致性较好（Cronbach's alpha 0.81）。基线特征和感染诊断相似，但 eSOFA 组的死亡率更高（17.1% vs 14.4%；p＜0.001），死亡率的区分度也更高（受试者工作特征曲线下面积，0.774 比 0.759；p＜0.001）。在年龄、感染诊断和合并症的亚组中，比较结果一致。
与 SOFA 评分相比，成人脓毒症事件的 eSOFA 器官功能障碍标准确定了一个较小、病情更严重的脓毒症患者队列，但具有良好的重叠性和相似的临床特征。成人脓毒症事件可能有助于广泛的自动化脓毒症监测，该监测与更复杂的 Sepsis-3 标准密切相关。
