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STAPLAg:一种适用于重症监护病房感染患者的便捷早期预警评分

STAPLAg: a convenient early warning score for use in infected patients in the intensive care unit.

作者信息

Zhang Keji, Lv Dan, Deng Yuxiao, Zhu Changqing, Gao Yuan, Huang Yuan, Xu Xinhui

机构信息

Department of Emergency.

Department of Surgery Intensive Care Unit, Ren Ji Hospital.

出版信息

Medicine (Baltimore). 2020 May 29;99(22):e20274. doi: 10.1097/MD.0000000000020274.

Abstract

Sepsis is a life-threatening disease in the intensive care unit (ICU). The current diagnostic criteria for sequential organ failure assessment (SOFA) scores do not reflect the current understanding of sepsis. We developed a novel and convenient score to aid early prognosis.Retrospective multivariable regression analysis of 185 infected emergency ICU (EICU) patients was conducted to identify independent variables associated with death, to develop the new "STAPLAg" score; STAPLAg was then validated in an internal cohort (n = 106) and an external cohort (n = 78) and its predictive efficacy was compared with that of the initial SOFA score.Age, and initial serum albumin, sodium, PLR, troponin, and lactate tests in the emergency department were independent predictors of death in infected EICU patients, and were used to establish the STAPLAg score (area under the curve [AUC] 0.865). The initial SOFA score on admission was predictive of death (AUC 0.782). Applying the above categories to the derivation cohort yielded mortality risks of 7.7% for grade I, 56.3% for grade II, and 75.0% for grade III. Internal (AUC 0.884) and external (AUC 0.918) cohort validation indicated that the score had good predictive power.The STAPLAg score can be determined early in infected EICU patients, and exhibited better prognostic capacity than the initial SOFA score on admission in both internal and external cohorts. STAPLAg constitutes a new resource for use in the clinical diagnosis of sepsis and can also predict mortality in infected EICU patients. REGISTRATION NUMBER:: ChinCTR-PNC-16010288.

摘要

脓毒症是重症监护病房(ICU)中一种危及生命的疾病。目前序贯器官衰竭评估(SOFA)评分的诊断标准并不能反映当前对脓毒症的认识。我们开发了一种新颖且便捷的评分系统以辅助早期预后评估。

对185例感染性急诊ICU(EICU)患者进行回顾性多变量回归分析,以确定与死亡相关的独立变量,从而开发新的“STAPLAg”评分;然后在内部队列(n = 106)和外部队列(n = 78)中对STAPLAg进行验证,并将其预测效能与初始SOFA评分的预测效能进行比较。

年龄、急诊科初始血清白蛋白、钠、血小板与淋巴细胞比值(PLR)、肌钙蛋白和乳酸检测是感染性EICU患者死亡的独立预测因素,并用于建立STAPLAg评分(曲线下面积[AUC]为0.865)。入院时的初始SOFA评分可预测死亡(AUC为0.782)。将上述类别应用于推导队列,I级的死亡风险为7.7%,II级为56.3%,III级为75.0%。内部队列(AUC为0.884)和外部队列(AUC为0.918)验证表明该评分具有良好的预测能力。

STAPLAg评分可在感染性EICU患者早期确定,并且在内部和外部队列中均显示出比入院时的初始SOFA评分更好的预后能力。STAPLAg构成了脓毒症临床诊断的一种新资源,也可预测感染性EICU患者的死亡率。注册号:ChinCTR-PNC-16010288

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/ba14/12245252/b56117134e4a/medi-99-e20274-g005.jpg

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