Department of Emergency Medicine, Cooper Medical School of Rowan University, One Cooper Plaza Camden, NJ 08103, United States of America.
Departments of Emergency Medicine and Anesthesiology & Critical Care, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, United States of America.
Am J Emerg Med. 2020 May;38(5):883-889. doi: 10.1016/j.ajem.2019.07.003. Epub 2019 Jul 4.
To determine if the addition of lactate to Quick Sequential Organ Failure Assessment (qSOFA) scoring improves emergency department (ED) screening of septic patients for critical illness.
This was a multicenter retrospective cohort study of consecutive adult patients admitted to the hospital from the ED with infectious disease-related illnesses. We recorded qSOFA criteria and initial lactate levels in the first 6 h of ED stay. Our primary outcome was a composite of hospital death, vasopressor use, and intensive care unit stay ≤72 h of presentation. Diagnostic test characteristics were determined for: 1) lactate levels ≥2 and ≥4; 2) qSOFA scores ≥1, ≥2, and =3; and 3) combinations of these.
Of 3743 patients, 2584 had a lactate drawn ≤6 h of ED stay and 18% met the primary outcome. The qSOFA scores were ≥1, ≥2, and =3 in 59.2%, 22.0%, and 5.3% of patients, respectively, and 34.4% had a lactate level ≥2 and 7.9% had a lactate level ≥4. The combination of qSOFA ≥1 OR Lactate ≥2 had the highest sensitivity, 94.0% (95% CI: 91.3-95.9).
The combination of qSOFA ≥1 OR Lactate ≥2 provides substantially improved sensitivity for the screening of critical illness compared to isolated lactate and qSOFA thresholds.
确定在快速序贯器官衰竭评估（qSOFA）评分中添加乳酸是否能改善急诊科（ED）对感染性疾病相关疾病患者进行危重病的筛查。
这是一项多中心回顾性队列研究，纳入了从 ED 入院的连续成年感染性疾病相关疾病患者。我们记录了 qSOFA 标准和 ED 留观前 6 小时内的初始乳酸水平。主要结局是包括医院死亡、血管加压素使用和 ICU 入住≤72 小时的复合结局。确定了以下诊断测试特征：1）乳酸水平≥2 和≥4；2）qSOFA 评分≥1、≥2 和=3；3）这些的组合。
在 3743 名患者中，有 2584 名在 ED 留观≤6 小时内抽取了乳酸，18%的患者符合主要结局。qSOFA 评分分别≥1、≥2 和=3的患者比例为 59.2%、22.0%和 5.3%，34.4%的患者乳酸水平≥2，7.9%的患者乳酸水平≥4。qSOFA≥1 或乳酸≥2 的组合具有最高的敏感性，为 94.0%（95%可信区间：91.3-95.9）。
与单独的乳酸和 qSOFA 阈值相比，qSOFA≥1 或乳酸≥2 的组合为危重病的筛查提供了更高的敏感性。
