Mellhammar Lisa, Linder Adam, Tverring Jonas, Christensson Bertil, Boyd John H, Sendi Parham, Åkesson Per, Kahn Fredrik
Department of Clinical Sciences, Division of Infection Medicine, Lund University, 221 00 Lund, Sweden.
Department of Infectious Diseases, Skåne University Hospital, 22242 Lund, Sweden.
J Clin Med. 2019 Jul 29;8(8):1128. doi: 10.3390/jcm8081128.
Early administration of antibiotics is associated with better survival in sepsis, thus screening and early detection for sepsis is of clinical importance. Current risk stratification scores used for bedside detection of sepsis, for example Quick Sequential Organ Failure Assessment (qSOFA) and National Early Warning Score 2 (NEWS2), are primarily validated for death and intensive care. The primary aim of this study was to compare the diagnostic accuracy of qSOFA and NEWS2 for a composite outcome of sepsis with organ dysfunction, infection-related mortality within <72 h, or intensive care due to an infection. Retrospective analysis of data from two prospective, observational, multicentre, convenience trials of sepsis biomarkers at emergency departments were performed. Cohort A consisted of 526 patients with a diagnosed infection, 288 with the composite outcome. Cohort B consisted of 645 patients, of whom 269 had a diagnosed infection and 191 experienced the composite outcome. In Cohort A and B, NEWS2 had significantly higher area under receiver operating characteristic curve (AUC), 0.80 (95% CI 0.75-0.83) and 0.70 (95% CI 0.65-0.74), than qSOFA, AUC 0.70 (95% CI 0.66-0.75) and 0.62 (95% CI 0.57-0.67) < 0.01 and, = 0.02, respectively for the composite outcome. NEWS2 was superior to qSOFA for screening for sepsis with organ dysfunction, infection-related mortality or intensive care due to an infection both among infected patients and among undifferentiated patients at emergency departments.
早期使用抗生素与脓毒症患者更好的生存率相关，因此脓毒症的筛查和早期检测具有临床重要性。目前用于床边检测脓毒症的风险分层评分，例如快速序贯器官衰竭评估（qSOFA）和国家早期预警评分2（NEWS2），主要在死亡和重症监护方面得到验证。本研究的主要目的是比较qSOFA和NEWS2对脓毒症合并器官功能障碍、72小时内感染相关死亡率或因感染入住重症监护病房这一复合结局的诊断准确性。对急诊科两项关于脓毒症生物标志物的前瞻性、观察性、多中心、便利性试验的数据进行了回顾性分析。队列A包括526例确诊感染患者，其中288例出现复合结局。队列B包括645例患者，其中269例确诊感染，191例出现复合结局。在队列A和队列B中，对于复合结局，NEWS2的受试者操作特征曲线下面积（AUC）显著高于qSOFA，分别为0.80（95%CI 0.75 - 0.83）和0.70（95%CI 0.65 - 0.74），而qSOFA的AUC分别为0.70（95%CI 0.66 - 0.75）和0.62（95%CI 0.57 - 0.67），P分别<0.01和 = 0.02。在急诊科的感染患者和未分化患者中，NEWS2在筛查合并器官功能障碍、感染相关死亡率或因感染入住重症监护病房的脓毒症方面优于qSOFA。
