快速序贯器官衰竭评估评分在老年脓毒症 ICU 患者中的表现。

Performance of the quick SOFA in very old ICU patients admitted with sepsis.

机构信息

Department of Intensive Care, Diakonessenhuis Utrecht, Utrecht, the Netherlands.

Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.

出版信息

Acta Anaesthesiol Scand. 2020 Apr;64(4):508-516. doi: 10.1111/aas.13536. Epub 2020 Jan 9.

DOI:10.1111/aas.13536

PMID:31885070

Abstract

BACKGROUND

The number of very elderly ICU patients (abbreviated to VOPs; ≥80 years) with sepsis increases. Sepsis was redefined in 2016 (sepsis 3.0) using the quick SOFA (qSOFA) score. Since then, multiple studies have validated qSOFA for prognostication in different patient categories, but the prognostic value in VOPs with sepsis is still unknown.

METHODS

Retrospective cohort study including patients admitted to Dutch ICUs with sepsis, in the period 2012 to 2016, evaluating the outcome and the performance of qSOFA, an extended qSOFA model, SOFA, SAPS II, and APACHE IV for hospital mortality.

RESULTS

5969 patients were included, of which 935 VOPs. Crude hospital mortality rates were 19%, 28%, and 39% for patients aged 18-65, 65-80, and ≥80 years respectively. Discriminative performance of qSOFA for in-hospital mortality in VOPs was poor (AUC 0.596) and lower than that of SOFA, APACHE IV, and SAPS II (0.704, 0.722, and 0.780 respectively). A qSOFA model extended with several other characteristics (AUC 0.643) was non-inferior to the full SOFA, but still inferior to APACHE IV and SAPS II, for all age groups. The Hosmer-Lemeshow goodness-of-fit test showed non-significant p-values for all models. Accuracy for both qSOFA and the extended qSOFA was lower compared to APACHE IV and SAPS II (Brier scores 0.227, 0.223, 0.184, and 0.183 respectively).

CONCLUSION

The qSOFA showed worse discriminative performance to predict mortality than SOFA, APACHE IV, and SAPS II in both VOPs and younger patients admitted with sepsis.

摘要

背景

患有脓毒症的超高龄 ICU 患者（缩写为 VOPs；≥80 岁）数量增加。2016 年（脓毒症 3.0）对脓毒症进行了重新定义，使用了快速 SOFA（qSOFA）评分。此后，多项研究已经验证了 qSOFA 在不同患者类别中的预后预测价值，但在患有脓毒症的 VOPs 中的预后价值仍不清楚。

方法

这是一项回顾性队列研究，纳入了 2012 年至 2016 年期间荷兰 ICU 中患有脓毒症的患者，评估了 qSOFA、扩展 qSOFA 模型、SOFA、SAPS II 和 APACHE IV 对医院死亡率的预后预测能力。

结果

共纳入 5969 例患者，其中 935 例为 VOPs。年龄在 18-65 岁、65-80 岁和≥80 岁的患者的粗死亡率分别为 19%、28%和 39%。qSOFA 对 VOPs 院内死亡率的判别性能较差（AUC 为 0.596），低于 SOFA、APACHE IV 和 SAPS II（分别为 0.704、0.722 和 0.780）。一个扩展了其他几个特征的 qSOFA 模型（AUC 为 0.643）与完整的 SOFA 相比没有差异，但仍低于 APACHE IV 和 SAPS II，适用于所有年龄组。Hosmer-Lemeshow 拟合优度检验显示所有模型的 p 值均无统计学意义。qSOFA 和扩展 qSOFA 的准确性均低于 APACHE IV 和 SAPS II（Brier 评分分别为 0.227、0.223、0.184 和 0.183）。