Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Shock. 2021 Sep 1;56(3):368-373. doi: 10.1097/SHK.0000000000001754.
Sepsis screening in the emergency department (ED) is challenging. The quick Sequential Organ Failure Assessment (qSOFA) score had poor accuracy for predicting mortality in both the intensive care unit and ED. High lactate levels were associated with an increased mortality. However, a previous study using lactate levels in combination with the qSOFA score did not observe a meaningful improvement in predictive accuracy. This study assessed the prognostic accuracy of venous lactate levels plus the qSOFA (VqSOFA) score for predicting 28-day mortality.
Patients who visited the Ramathibodi ED with suspected sepsis were enrolled. The VqSOFA, qSOFA, and Sequential Organ Failure Assessment (SOFA) scores were calculated using the initial vital signs and laboratory values. Prognostic accuracy was measured using the area under the receiver operating characteristic (AUROC) curve of the VqSOFA score and Sepsis-3 criteria for predicting 28-day mortality.
In total, 1,139 patients were enrolled, 118 of whom died within 28 days of admission. The AUROCs of the VqSOFA, qSOFA, and SOFA scores were 0.851 (95% CI 0.813-0.889), 0.813 (95% CI 0.772-0.854), and 0.728 (95% CI 0.671-0.784), respectively. Using VqSOFA score ≥ 3 as the cutoff, the sensitivity, specificity, and positive likelihood ratio were 74.6%, 82.5%, and 4.25%, respectively. VqSOFA ≥ 3 was linked to a low probability of 28-day survival and higher odds of vasopressor and ventilator use within 24 h.
VqSOFA was more predictive of 28-day mortality and vasopressor and mechanical ventilator use than the qSOFA and SOFA scores.
急诊科（ED）的脓毒症筛查具有挑战性。快速序贯器官衰竭评估（qSOFA）评分对 ICU 和 ED 死亡率的预测准确性均较差。高乳酸水平与死亡率增加相关。然而，先前使用乳酸水平结合 qSOFA 评分的研究并未观察到预测准确性有明显提高。本研究评估了静脉乳酸水平加 qSOFA（VqSOFA）评分预测 28 天死亡率的预后准确性。
纳入因疑似脓毒症就诊于 Ramathibodi ED 的患者。使用初始生命体征和实验室值计算 VqSOFA、qSOFA 和序贯器官衰竭评估（SOFA）评分。使用 VqSOFA 评分和 Sepsis-3 标准预测 28 天死亡率的受试者工作特征（ROC）曲线下面积（AUROC）来衡量预后准确性。
共纳入 1139 例患者，其中 118 例在入院后 28 天内死亡。VqSOFA、qSOFA 和 SOFA 评分的 AUROCs 分别为 0.851（95%CI 0.813-0.889）、0.813（95%CI 0.772-0.854）和 0.728（95%CI 0.671-0.784）。使用 VqSOFA 评分≥3 作为截断值，灵敏度、特异性和阳性似然比分别为 74.6%、82.5%和 4.25%。VqSOFA≥3 与 28 天生存率低和 24 小时内使用血管加压药和呼吸机的几率高相关。
VqSOFA 比 qSOFA 和 SOFA 评分更能预测 28 天死亡率以及血管加压药和机械通气的使用。
