Wroclaw Medical University, Wrocław, Poland.
Division of Emergency Medicine, Washington University in Saint Louis School of Medicine, St. Louis, Missouri.
J Emerg Med. 2020 Dec;59(6):977-983. doi: 10.1016/j.jemermed.2020.06.043. Epub 2020 Aug 20.
The concept of sepsis has recently been redefined by an International Task Force. The task force recommended the use of the quick Sequential Organ Failure Assessment (qSOFA) score instead of Systemic Inflammatory Response Syndrome (SIRS) criteria to identify patients at high risk of mortality from sepsis outside of the intensive care unit, including in emergency departments (EDs). However, the primary outcome for qSOFA is prediction of risk for mortality, which is not the principal outcome measure considered in the ED. From the ED perspective, the priorities are the identification (diagnosis) of the septic patient and then the initiation of time-sensitive, life-saving interventions.
We performed a structured review of PubMed from January 2012 to December 2018, limited to reports involving human subjects and written in English language and containing relevant keywords. The highest-quality studies were then reviewed in a structured format. We utilized these studies to estimate the sensitivity and specificity of SIRS and qSOFA for diagnosis of sepsis.
Thirteen unique articles were identified for further review, and the 11 highest-grade articles (C and D) were determined to be appropriate for inclusion in this review, and the two low-grade articles were excluded (E).
Based on multiple retrospective and few prospective studies, it appears that qSOFA performs poorly in comparison with SIRS as a diagnostic tool for ED patients who may have sepsis or septic shock. However, qSOFA does have a strong prognostic accuracy for mortality in those ED patients already diagnosed with sepsis or septic shock.
最近，一个国际工作组重新定义了脓毒症的概念。该工作组建议使用快速序贯器官衰竭评估（qSOFA）评分，而不是全身炎症反应综合征（SIRS）标准，来识别重症监护室外（包括急诊科）脓毒症死亡率高的患者。然而，qSOFA 的主要结局是预测死亡率风险，而这不是急诊科主要考虑的结局指标。从急诊科的角度来看，首要任务是识别（诊断）脓毒症患者，然后启动及时的、拯救生命的干预措施。
我们对 2012 年 1 月至 2018 年 12 月的 PubMed 进行了结构化审查，仅限于涉及人类受试者的报告，以英语撰写，并包含相关关键词。然后，我们以结构化的格式审查了高质量的研究。我们利用这些研究来估计 SIRS 和 qSOFA 对脓毒症诊断的敏感性和特异性。
确定了 13 篇独特的文章进行进一步审查，其中 11 篇最高质量的文章（C 和 D）被确定适合纳入本综述，而另外两篇低质量的文章（E）则被排除在外。
基于多项回顾性研究和少数前瞻性研究，qSOFA 在作为急诊科可能患有脓毒症或脓毒性休克的患者的诊断工具方面表现不佳，而 SIRS 则表现不佳。然而，qSOFA 在那些已经被诊断为脓毒症或脓毒性休克的急诊科患者中，对死亡率具有很强的预后准确性。
