Shahsavarinia Kavous, Moharramzadeh Payman, Arvanagi Reza Jamal, Mahmoodpoor Ata
Kavous Shahsavarinia, Associate Professor, Road Traffic Injury Research Center, Department of Emergency Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
Payman Moharramzadeh, Associate Professor, Department of Emergency Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
Pak J Med Sci. 2020 May-Jun;36(4):668-672. doi: 10.12669/pjms.36.4.2031.
The third international consensus definition for sepsis and septic shock (sepsis 3) task force recently introduced qSOFA (quick sequential organ failure assessment) as a score for detection of patients at risk of sepsis outside of intensive care units. We performed this study to evaluate the validity of qSOFA for early detection and risk stratification of septic patients in emergency department.
We conducted this study in an emergency department of the largest university affiliated hospital in northwest of Iran from Sept 2015 to Sept 2016. One hundred and forty patients who were SIRS positive with a suspected infection without alternative diagnosis and a microbiological proven infection were enrolled in this study. qSOFA was calculated for each patient and correlated with sepsis grades and mortality.
From 140 patients 84 (60%) had positive qSOFA score and 56 (40%) patients had negative qSOFA score. Our results showed that near half of patients with positive qSOFA expired during their stay in hospital while this was about 5% for patients with negative qSOFA. ROC curve of study regarding prediction of outcome with qSOFA showed an area under curve of 0.59. ( value: 0.04). Time spent to sepsis detection was 16 minutes shorter with qSOFA score compared to SIRS criteria in this study.
In patients with suspected sepsis, qSOFA has acceptable value for risk stratification of severity, multi organ failure and mortality. It seems that education of medical staff and frequent screening of patients for warning signs can help to increase the value of qSOFA in prediction of mortality in critically ill septic patients.
脓毒症和脓毒性休克的第三次国际共识定义（脓毒症3）工作组最近引入了qSOFA（快速序贯器官衰竭评估）作为在重症监护病房之外检测有脓毒症风险患者的评分系统。我们开展本研究以评估qSOFA在急诊科对脓毒症患者进行早期检测和风险分层的有效性。
我们于2015年9月至2016年9月在伊朗西北部最大的大学附属医院的急诊科开展了本研究。140例符合全身炎症反应综合征（SIRS）阳性、疑似感染且无其他诊断、微生物学证实感染的患者纳入本研究。计算每位患者的qSOFA评分，并将其与脓毒症分级和死亡率相关联。
140例患者中，84例（60%）qSOFA评分阳性，56例（40%）患者qSOFA评分阴性。我们的结果显示，qSOFA评分阳性的患者近一半在住院期间死亡，而qSOFA评分阴性的患者这一比例约为5%。本研究中关于用qSOFA预测结局的ROC曲线显示曲线下面积为0.59（P值：0.04）。与SIRS标准相比，本研究中使用qSOFA评分检测脓毒症的时间缩短了16分钟。
在疑似脓毒症患者中，qSOFA在严重程度、多器官衰竭和死亡率的风险分层方面具有可接受的价值。对医务人员进行教育以及对患者进行频繁的警示体征筛查似乎有助于提高qSOFA在预测重症脓毒症患者死亡率方面的价值。
