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应用快速序贯器官衰竭评估(Quick-SOFA)评分预测急诊科老年流感患者的死亡率

Quick-SOFA score to predict mortality among geriatric patients with influenza in the emergency department.

作者信息

Chang Su-Hen, Yeh Chien-Chun, Chen Yen-An, Hsu Chien-Chin, Chen Jiann-Hwa, Chen Wei-Lung, Huang Chien-Cheng, Chung Jui-Yuan

机构信息

Department of Emergency Medicine, Cathay General Hospital.

Department of Emergency Medicine, Chi-Mei Medical Center.

出版信息

Medicine (Baltimore). 2019 Jun;98(23):e15966. doi: 10.1097/MD.0000000000015966.

Abstract

The quick sequential organ failure assessment (qSOFA) score is widely used to assess the risk of sepsis and predict in-hospital mortality in patients with suspected infection. However, its ability to predict mortality among geriatric patients with influenza in the emergency department (ED) remains unclear. Therefore, this study was conducted to delineate this issue.A retrospective case-control study was conducted on geriatric patients (age ≥65 years) with influenza who visited the ED of a medical center between January 01, 2010, and December 31, 2015. Demographic data, vital signs, past histories, influenza subtypes, and treatment outcomes were included in the analysis. We assessed the accuracy of the qSOFA score in predicting 30-day mortality via logistic regression. Covariate adjustment of the area under the receiver operating characteristic curve (AUROC) via regression modeling was performed too.In total, 409 geriatric ED patients with mean age of 79.5 years and nearly equal sex ratio were recruited. The mean qSOFA score was 0.55 ± 0.7. The Hosmer-Lemeshow goodness-of-fit test was 0.79 for qSOFA score. Patients with qSOFA score of ≥2 (odds ratio, 4.21; 95% confidence interval [CI], 1.56-11.40) had increased in-hospital mortality. qSOFA score of ≥2 also had excellent in-hospital mortality discrimination with an adjusted AUROC of 0.81 (95% CI, 0.71-0.90). A qSOFA of ≥2 had prominent specificity of 0.89 (95% CI, 0.86-0.92).An increase in qSOFA score of 2 greatly predicts mortality in geriatric patients with influenza.

摘要

快速序贯器官衰竭评估(qSOFA)评分被广泛用于评估脓毒症风险及预测疑似感染患者的院内死亡率。然而,其预测急诊科(ED)老年流感患者死亡率的能力仍不明确。因此,开展本研究以阐明该问题。

对2010年1月1日至2015年12月31日期间就诊于某医疗中心急诊科的老年(年龄≥65岁)流感患者进行了一项回顾性病例对照研究。分析纳入了人口统计学数据、生命体征、既往史、流感亚型及治疗结果。我们通过逻辑回归评估qSOFA评分预测30天死亡率的准确性。还通过回归模型对受试者工作特征曲线下面积(AUROC)进行了协变量调整。

共纳入409例平均年龄为79.5岁且性别比接近相等的老年急诊科患者。qSOFA评分均值为0.55±0.7。qSOFA评分的Hosmer-Lemeshow拟合优度检验值为0.79。qSOFA评分≥2的患者(比值比,4.21;95%置信区间[CI],1.56 - 11.40)院内死亡率增加。qSOFA评分≥2对院内死亡率也具有出色的鉴别能力,调整后的AUROC为0.81(95%CI,0.71 - 0.90)。qSOFA≥2具有突出的特异性,为0.89(95%CI,0.86 - 0.92)。

qSOFA评分增加2能显著预测老年流感患者的死亡率。

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