Department of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Center for Resuscitation Science, Beth Israel Deaconess Medical Center, Boston, MA, USA.
J Intensive Care Med. 2021 Oct;36(10):1217-1222. doi: 10.1177/0885066620944879. Epub 2020 Aug 16.
In this study, we investigated whether the Sequential Organ Failure Assessment (SOFA) score performance differs based on the type of infection among patients admitted to the intensive care unit (ICU) with infection.
Single-center, retrospective study of adult ICU patients admitted with infection between January 2008 and April 2018 at an urban tertiary care center. Patients were uniquely classified into different infection types based on International Classification of Diseases, Ninth Revision () and codes. Infection types included were pneumonia, meningitis, bacteremia, cellulitis, cholangitis/cholecystitis, intestinal and diarrheal disease, endocarditis, urinary tract infection (UTI), and peritonitis. The SOFA score performance and mortality in relation to SOFA score were compared across infection types.
A total of 12 283 patients were included. Of these, 50.6% were female and the median age was 70 years (interquartile range: 57-82). The most common infection types were pneumonia (32.2%) and UTI (31.0%). Overall, 1703 (13.9%) patients died prior to hospital discharge. The median baseline SOFA score (within 24 hours of ICU admission) for the cohort was 5 (3-8). Patients with peritonitis had the highest median SOFA score, 7 (4-9), and patients with cellulitis and UTI had the lowest median SOFA score, 4 (2-7). The SOFA score discrimination to predict mortality was highest among patients with endocarditis (area under the receiver operating characteristic [AUC]: 0.79, 95% CI: 0.69-0.90) and lowest for patients with isolated bacteremia (AUC: 0.59, 95% CI: 0.49-0.70). Observed mortality by quartile of SOFA score differed substantially across infection types.
Type of infection is an important consideration when interpreting the SOFA score. This is relevant as SOFA emerges as an important tool in the definition and prognostication of sepsis.
本研究旨在探讨 ICU 内感染患者的序贯器官衰竭评估（SOFA）评分表现是否因感染类型而异。
这是一项单中心、回顾性研究，纳入了 2008 年 1 月至 2018 年 4 月期间在城市三级医疗中心因感染而入住 ICU 的成年患者。根据国际疾病分类第 9 版（ICD-9）和 代码，患者被独特地分为不同的感染类型。感染类型包括肺炎、脑膜炎、菌血症、蜂窝织炎、胆管炎/胆囊炎、肠道和腹泻疾病、心内膜炎、尿路感染（UTI）和腹膜炎。比较了不同感染类型之间 SOFA 评分表现与 SOFA 评分相关的死亡率。
共纳入 12283 例患者，其中 50.6%为女性，中位年龄为 70 岁（四分位距：57-82）。最常见的感染类型是肺炎（32.2%）和 UTI（31.0%）。总体而言，1703 例（13.9%）患者在出院前死亡。队列的基线 SOFA 评分中位数（入住 ICU 24 小时内）为 5（3-8）。患有腹膜炎的患者 SOFA 评分中位数最高，为 7（4-9），而患有蜂窝织炎和 UTI 的患者 SOFA 评分中位数最低，为 4（2-7）。SOFA 评分对预测死亡率的区分度在感染性心内膜炎患者中最高（接受者操作特征曲线下面积[AUC]：0.79，95%置信区间：0.69-0.90），在孤立菌血症患者中最低（AUC：0.59，95%置信区间：0.49-0.70）。SOFA 评分四分位数的观察死亡率在不同感染类型之间差异显著。
感染类型是解释 SOFA 评分时的一个重要考虑因素。这很重要，因为 SOFA 作为脓毒症的定义和预后的重要工具正在出现。
