一项观察性队列研究比较了 REDS 评分与 SIRS 标准、NEWS2、CURB65、SOFA、MEDS 和 PIRO 评分在风险分层急诊疑似脓毒症方面的性能。

An observational cohort study of the performance of the REDS score compared to the SIRS criteria, NEWS2, CURB65, SOFA, MEDS and PIRO scores to risk-stratify emergency department suspected sepsis.

机构信息

Department of Emergency Medicine, St George's University Hospitals NHS Foundation Trust, London, UK.

出版信息

Ann Med. 2021 Dec;53(1):1863-1874. doi: 10.1080/07853890.2021.1992495.

DOI:10.1080/07853890.2021.1992495

PMID:34686088

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8547872/

Abstract

OBJECTIVE

To compare the performance of the Risk-stratification of Emergency Department suspected Sepsis (REDS) score to the SIRS criteria, NEWS2, CURB65, SOFA, MEDS and PIRO scores, to risk-stratify Emergency Department (ED) suspected sepsis patients for mortality.

METHOD

A retrospective observational cohort study of prospectively collected data. Adult patients admitted from the ED after receiving intravenous antibiotics for suspected sepsis in the year 2020, were studied. Patients with COVID-19 were excluded. The scores stated above were calculated for each patient. Receiver operator characteristics (ROC) curves were constructed for each score for the primary outcome measure, all-cause in-hospital mortality. The area under the ROC (AUROC) curves and cut-off points were identified by the statistical software. Scores above the cut-off point were deemed high-risk. The test characteristics of the high-risk groups were calculated. Comparisons were based on the AUROC curve and sensitivity for mortality of the high-risk groups. Previously published cut-off points were also studied. Calibration was also studied.

RESULTS

Of the 2594 patients studied, 332 (12.8%) died. The AUROC curve for the REDS score 0.73 (95% confidence interval [CI] 0.72-0.75) was significantly greater than the AUROC curve for the SIRS criteria 0.51 (95% CI 0.49-0.53), < .0001 and the NEWS2 score 0.69 (95% CI 0.67-0.70), = .005, and similar to all other scores studied. Sensitivity for mortality at the respective cut-off points identified (REDS ≥3, NEWS2 ≥ 8, CURB65 ≥ 3, SOFA ≥3, MEDS ≥10 and PIRO ≥10) was greatest for the REDS score at 80.1% (95% CI 75.4-84.3) and significantly greater than the other scores. The sensitivity for mortality for an increase of two points from baseline in the SOFA score was 63% (95% CI 57.5-68.2).

CONCLUSIONS

In this single centre study, the REDS score had either a greater AUROC curve or sensitivity for mortality compared to the comparator scores, at the respective cut-off points identified.KEY MESSAGESThe REDS score is a simple and objective scoring system to risk-stratify for mortality in emergency department (MED) patients with suspected sepsis.The REDS score is better or equivalent to existing scoring systems in its discrimination for mortality.

摘要

目的

比较风险分层急诊疑似脓毒症（REDS）评分与全身炎症反应综合征（SIRS）标准、NEWS2、CURB65、SOFA、MEDS 和 PIRO 评分对急诊（ED）疑似脓毒症患者死亡率的预测性能。

方法

这是一项回顾性观察队列研究，对前瞻性收集的数据进行了研究。2020 年，在接受静脉抗生素治疗疑似脓毒症后从 ED 入院的成年患者被纳入研究。排除 COVID-19 患者。为每位患者计算上述评分。绘制每个评分的受试者工作特征（ROC）曲线，作为主要结局指标的全因住院死亡率。使用统计软件确定 ROC 曲线下面积（AUROC）和截断值。截断值以上的评分被视为高风险。计算高风险组的测试特征。比较基于高风险组的 AUROC 曲线和死亡率。还研究了先前发表的截断值。还研究了校准。

结果

在 2594 名研究患者中，332 人（12.8%）死亡。REDS 评分 0.73（95%置信区间 [CI] 0.72-0.75）的 AUROC 曲线明显大于 SIRS 标准 0.51（95% CI 0.49-0.53）， < .0001 和 NEWS2 评分 0.69（95% CI 0.67-0.70）， = .005，与研究的其他评分相似。在各自确定的截断值（REDS ≥3、NEWS2 ≥8、CURB65 ≥3、SOFA ≥3、MEDS ≥10 和 PIRO ≥10）处，死亡率的敏感性以 REDS 评分的 80.1%（95% CI 75.4-84.3）最高，明显高于其他评分。SOFA 评分从基线增加两分的死亡率敏感性为 63%（95% CI 57.5-68.2）。