Internal Medicine Department, INRCA-IRCCS Hospital, Osimo, Ancona, Italy.
Clinica Di Neurologia, Azienda Ospedaliero-Universitaria "Ospedali Riuniti" Di Ancona, Italy, Ancona, Italy.
Intern Emerg Med. 2021 Jun;16(4):981-988. doi: 10.1007/s11739-020-02610-x. Epub 2021 Jan 11.
Elderly patients affected by suspected infection and declining clinical conditions can be admitted to stepdown units (SDU), but a risk stratification is necessary to optimize their management. Admission troponin I (aTnI) has a prognostic role, however, one of the most commonly used stratification tools, the Sequential Organ Failure Assessment score (SOFA), does not consider myocardial injury. With this paper, we aimed to evaluate the prognostic accuracy of a new score, named SOFA-T, considering both SOFA score and aTnI in a cohort of elderly patients admitted to the stepdown beds of two Internal Medicine departments. Patients aged > 65 years admitted in SDU of two different hospitals of the same region in a 12-months timeframe were retrospectively assessed obtaining age, sex, days of admission, in-hospital death, SOFA, aTnI and comorbidities. The best aTnI cutoff for in-hospital death was calculated with ROC curve analysis; dichotomous variables were compared with chi-squared test; continuous variables were compared with t test or Mann-Whitney test. We obtained a cohort of 390 patients. The best aTnI cutoff was 0.31 ng/ml: patients with increased aTnI had higher risk of in-hospital death (OR: 1.834; 95% CI 1.160-2.900; p = 0.009), and higher SOFA (6.81 ± 2.71 versus 5.97 ± 3.10; p = 0.010). Adding aTnI to SOFA increased significantly the area under the curve (AUC = 0.68; 95% CI 0.64-0.73; AUC = 0.71; 95% CI 0.65-0.76; p = 0.0001), with a slight improvement of the prognostic performance. In elderly patients admitted to SDU for suspected infection, sepsis or septic shock, aTnI slightly improves the accuracy of SOFA score of the in-hospital death prediction.
老年疑似感染且临床状况恶化的患者可收入降阶梯治疗病房（stepdown unit，SDU），但需要进行风险分层以优化管理。入院肌钙蛋白 I（troponin I，aTnI）具有预后作用，然而，最常用的分层工具之一——序贯器官衰竭评估评分（Sequential Organ Failure Assessment score，SOFA）并未考虑心肌损伤。本文旨在评估一种新评分——SOFA-T 在两个内科部门 SDU 收治的老年患者队列中的预后准确性，该评分同时考虑 SOFA 评分和 aTnI。在 12 个月的时间内，回顾性评估了来自同一地区两个不同医院 SDU 的年龄≥65 岁的患者，获取年龄、性别、住院天数、院内死亡、SOFA、aTnI 和合并症。使用 ROC 曲线分析计算院内死亡的最佳 aTnI 截断值；使用卡方检验比较二分类变量；使用 t 检验或曼-惠特尼检验比较连续变量。我们获得了 390 例患者的队列。最佳的 aTnI 截断值为 0.31ng/ml：aTnI 升高的患者院内死亡风险更高（OR：1.834；95%CI 1.160-2.900；p=0.009），SOFA 评分也更高（6.81±2.71 与 5.97±3.10；p=0.010）。将 aTnI 加入 SOFA 后，曲线下面积（area under the curve，AUC）显著增加（AUC=0.68；95%CI 0.64-0.73；AUC=0.71；95%CI 0.65-0.76；p=0.0001），预测院内死亡的预后性能略有提高。在因疑似感染、败血症或感染性休克而收入 SDU 的老年患者中，aTnI 可略微提高 SOFA 评分对院内死亡的预测准确性。
