Kim Kyung Su, Suh Gil Joon, Kim Kyuseok, Kwon Woon Yong, Shin Jonghwan, Jo You Hwan, Lee Jae Hyuk, Lee Huijai
Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea.
Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea.
Clin Exp Emerg Med. 2019 Mar;6(1):77-83. doi: 10.15441/ceem.17.294. Epub 2019 Mar 28.
To test the hypothesis that the quick Sepsis-related Organ Failure Assessment (qSOFA) score, derived from vital signs taken during triage and recommended by current sepsis guidelines for screening patients with infections for organ dysfunction, is not sensitive enough to predict the risk of mortality in emergency department (ED) sepsis patients.
Patients diagnosed with severe sepsis and septic shock using the old definition between May 2014 and April 2015 were retrospectively reviewed in three urban tertiary hospital EDs. The sensitivities of systemic inflammatory response syndrome (SIRS) criteria, qSOFA, and Sequential Organ Failure Assessment (SOFA) scores ≥2 were compared using McNemar's test. Diagnostic performances were evaluated using specificity, positive predictive value, and negative predictive value.
Among the 928 patients diagnosed with severe sepsis or septic shock using the old definition, 231 (24.9%) died within 28 days. More than half of the sepsis patients (493/928, 53.1%) and more than one-third of the mortality cases (88/231, 38.1%) had a qSOFA score <2. The sensitivity of a qSOFA score ≥2 was 61.9%, which was significantly lower than the sensitivity of SIRS ≥2 (82.7%, P<0.001) and SOFA ≥2 (99.1%, P<0.001). The specificity, positive predictive value, and negative predictive value of a qSOFA score ≥2 for 28-day mortality were 58.1%, 32.9%, and 82.2%, respectively.
The current clinical criteria of the qSOFA are less sensitive than the SIRS assessment and SOFA to predict 28-day mortality in ED patients with sepsis.
检验以下假设，即快速脓毒症相关器官功能衰竭评估（qSOFA）评分源于分诊时获取的生命体征，且被当前脓毒症指南推荐用于筛查感染患者的器官功能障碍，但对于预测急诊科（ED）脓毒症患者的死亡风险敏感性不足。
对2014年5月至2015年4月期间在三家城市三级医院急诊科使用旧定义诊断为严重脓毒症和脓毒性休克的患者进行回顾性研究。使用McNemar检验比较全身炎症反应综合征（SIRS）标准、qSOFA以及序贯器官衰竭评估（SOFA）评分≥2的敏感性。使用特异性、阳性预测值和阴性预测值评估诊断性能。
在928例使用旧定义诊断为严重脓毒症或脓毒性休克的患者中，231例（24.9%）在28天内死亡。超过一半的脓毒症患者（493/928，53.1%）和超过三分之一的死亡病例（88/231，38.1%）的qSOFA评分<2。qSOFA评分≥2的敏感性为61.9%，显著低于SIRS≥2的敏感性（82.7%，P<0.001）和SOFA≥2的敏感性（99.1%，P<0.001）。qSOFA评分≥2对28天死亡率的特异性、阳性预测值和阴性预测值分别为58.1%、32.9%和82.2%。
qSOFA的当前临床标准在预测急诊科脓毒症患者28天死亡率方面不如SIRS评估和SOFA敏感。
