Kilinc Toker Aysin, Kose Sukran, Turken Melda
Department of Infectious Diseases and Clinical Microbiology, Kayseri City Hospital, Kayseri, Turkey.
Department of Infectious Diseases and Clinical Microbiology, Tepecik Training and Education Hospital, Izmir, Turkey.
Eurasian J Med. 2021 Feb;53(1):40-47. doi: 10.5152/eurasianjmed.2021.20081.
Sepsis has been defined as a life-threatening organ dysfunction that develops as a result of impaired host response to infection. This study aimed to investigate sequential organ failure assessment (SOFA) score, systemic inflammatory response syndrome (SIRS), quick SOFA (qSOFA), and qSOFA + lactate criteria (qSOFA+L) in the diagnosis and prognosis of sepsis.
A retrospective study was performed that included all patients diagnosed with sepsis between January 1, 2013 and December 31, 2017 in Izmir Tepecik Training and Research Hospital Infectious Diseases and Clinical Microbiology Clinic.
A total of 976 patients diagnosed with sepsis (mean age 72.5±13.7 years, 52.7% women) over five years were included in this study. Of all patients admitted to the emergency department and diagnosed with sepsis, 37.4% (n=365) were hospitalized and 52.3% (n=191) of these patients died. Emergency department mortality was 12.5% (n=122). The mortality rate was higher in patients with qSOFA and qSOFA+L criteria ≥2 in the emergency department. There was no statistically significant difference in terms of SIRS, qSOFA, or qSOFA+L criteria among patients who died in the hospital. The SOFA score (area under receiver operator characteristic curve, AUC=0.89) was highly discriminative in predicting sepsis. When the SOFA score was>11, its sensitivity and negative predictive values were both 100%. The SOFA score (AUC=0.75 and 0.72, respectively) was also highly discriminative in predicting emergency and in-hospital mortality. When the SOFA score was>11, the sensitivity and specificity of predicting emergency department mortality were 63.5% and 78.8%, respectively. The sensitivity was 65.8% and the specificity was 75.5% when describing in-hospital mortality for SOFA scores>9.
The SOFA score was highly sensitive and predictive in the diagnosis of sepsis. The SOFA score had a high discriminative ability to predict emergency and in-hospital mortality.
脓毒症被定义为因宿主对感染的反应受损而发展的危及生命的器官功能障碍。本研究旨在探讨序贯器官衰竭评估（SOFA）评分、全身炎症反应综合征（SIRS）、快速SOFA（qSOFA）以及qSOFA+乳酸标准（qSOFA+L）在脓毒症诊断和预后中的作用。
进行了一项回顾性研究，纳入了2013年1月1日至2017年12月31日期间在伊兹密尔泰佩奇克培训与研究医院传染病与临床微生物学诊所被诊断为脓毒症的所有患者。
本研究共纳入了976例在五年内被诊断为脓毒症的患者（平均年龄72.5±13.7岁，女性占52.7%）。在所有入住急诊科并被诊断为脓毒症的患者中，37.4%（n=365）住院治疗，其中52.3%（n=191）的患者死亡。急诊科死亡率为12.5%（n=122）。在急诊科qSOFA和qSOFA+L标准≥2的患者死亡率更高。在医院死亡的患者中，SIRS、qSOFA或qSOFA+L标准方面无统计学显著差异。SOFA评分（受试者操作特征曲线下面积，AUC=0.89）在预测脓毒症方面具有高度鉴别力。当SOFA评分>11时，其敏感性和阴性预测值均为100%。SOFA评分（AUC分别为0.75和0.72）在预测急诊科和院内死亡率方面也具有高度鉴别力。当SOFA评分>11时，预测急诊科死亡率的敏感性和特异性分别为63.5%和78.8%。当描述SOFA评分>9时的院内死亡率时，敏感性为65.8%，特异性为75.5%。
SOFA评分在脓毒症诊断中具有高度敏感性和预测性。SOFA评分在预测急诊科和院内死亡率方面具有很高的鉴别能力。
