Dong Run, Tian Hongcheng, Zhou Jianfang, Weng Li, Hu Xiaoyun, Peng Jinmin, Wang Chunyao, Jiang Wei, Du Xueping, Xi Xiuming, An Youzhong, Duan Meili, Du Bin
Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, 1 Shuai Fu Yuan, Beijing, 100730, People's Republic of China.
Department of Critical Care Medicine, China Rehabilitation Research Center, Capital Medical University, 10 Jiaomen Beilu, Fengtai District, Beijing, 100068, People's Republic of China.
Ann Intensive Care. 2020 Feb 4;10(1):14. doi: 10.1186/s13613-020-0629-1.
The US Centers for Disease Control and Prevention (CDC) recently released simplified eSOFA organ dysfunction criteria of Adult Sepsis Event for sepsis surveillance in the US. Our study aimed to compare the prevalence, characteristics, and outcomes of sepsis patients identified by eSOFA criteria versus Sequential Organ Failure Assessment (SOFA) Score (Sepsis-3) and assess the external validity of eSOFA criteria in China.
We conducted a retrospective cohort study of adult residents of Yuetan Subdistrict, Beijing, China, who were hospitalized from July 1, 2012 to June 30, 2014. Among patients with infection, sepsis was identified if there was a concurrent rise in SOFA score by 2 or more points (Sepsis-3) or the presence of 1 or more eSOFA criteria: vasopressor initiation, mechanical ventilation initiation, doubling in creatinine, doubling in bilirubin to 2.0 mg/dL or above, 50% or greater decrease in platelet count to less than 100 cells/μL, or lactate equal to or above 2.0 mmol/L. Areas under the receiver operating characteristic curves (AUROCs) for in-hospital mortality were compared between sepsis patients detected by the two criteria, adjusting for baseline characteristics.
Of 1716 hospitalized patients with infection, 935 (54.5%) met Sepsis-3 criteria, 573 (33.4%) met eSOFA criteria, while 475 (27.7%) met both criteria. Demographic and clinical characteristics of sepsis patients meeting Sepsis-3 or eSOFA criteria were similar. In-hospital mortality was higher with eSOFA criteria versus Sepsis-3 (46.6% vs. 32.0%, p < 0.001). eSOFA criteria had high PPV (82.9%), but low sensitivity (50.8%) for the diagnosis of Sepsis-3. Patients meeting both criteria had the highest in-hospital mortality rate (52.8%, all p < 0.001), while patients who only met eSOFA criteria had higher mortality rate than those meeting Sepsis-3 alone (16.3% vs. 10.4%, p = 0.097). The predicted probability for in-hospital mortality was higher with eSOFA criteria versus Sepsis-3 (AUROC 0.830 vs. 0.795, p = 0.001) adjusting for baseline characteristics.
The CDC Adult Sepsis Event's eSOFA criteria identify a smaller, more severely ill cohort of sepsis patients with similar demographic and clinical characteristics as the more complex Sepsis-3 SOFA score. These results suggest similar performance of eSOFA criteria across diverse populations, with low sensitivity and high specificity for the diagnosis of Sepsis-3.
美国疾病控制与预防中心（CDC）近期发布了用于美国脓毒症监测的成人脓毒症事件简化版序贯器官衰竭评估（eSOFA）器官功能障碍标准。我们的研究旨在比较根据eSOFA标准与序贯器官衰竭评估（SOFA）评分（脓毒症-3）识别出的脓毒症患者的患病率、特征及转归，并评估eSOFA标准在中国的外部效度。
我们对2012年7月1日至2014年6月30日在中国北京月坛街道住院的成年居民进行了一项回顾性队列研究。在感染患者中，如果SOFA评分同时升高2分或更多（脓毒症-3），或者存在1项或更多eSOFA标准，即开始使用血管活性药物、开始机械通气、肌酐翻倍、胆红素翻倍至2.0mg/dL或更高、血小板计数降低50%或更多至低于100×10⁹/L，或乳酸水平等于或高于2.0mmol/L，则诊断为脓毒症。比较两种标准检测出的脓毒症患者院内死亡的受试者工作特征曲线下面积（AUROCs），并对基线特征进行校正。
在1716例住院感染患者中，935例（54.5%）符合脓毒症-3标准，573例（33.4%）符合eSOFA标准，475例（27.7%）同时符合两种标准。符合脓毒症-3或eSOFA标准的脓毒症患者的人口统计学和临床特征相似。与脓毒症-3相比，eSOFA标准的院内死亡率更高（46.6%对32.0%，p<0.001）。eSOFA标准对脓毒症-3诊断的阳性预测值（PPV）较高（82.9%），但敏感性较低（50.8%）。同时符合两种标准的患者院内死亡率最高（52.8%，所有p<0.001），而仅符合eSOFA标准的患者死亡率高于仅符合脓毒症-3标准的患者（16.3%对10.4%，p=0.097）。校正基线特征后，eSOFA标准预测院内死亡的概率高于脓毒症-3（AUROC 0.830对0.795，p=0.001）。
CDC成人脓毒症事件的eSOFA标准识别出的脓毒症患者队列规模较小，但病情更严重，其人口统计学和临床特征与更复杂的脓毒症-3 SOFA评分相似。这些结果表明eSOFA标准在不同人群中的表现相似，但对脓毒症-3诊断的敏感性较低，特异性较高。
