Guo Qi, Li Hai-Yan, Song Wei-Dong, Liu Hui, Yu Hai-Qiong, Li Yan-Hong, Lü Zhong-Dong, Liang Li-Hua, Zhao Qing-Zhou, Jiang Mei
Department of Pulmonary and Critical Care Medicine, Shenzhen Hospital, Peking University, Shenzhen, 518036, Guangdong, China; Department of Pulmonary and Critical Care Medicine, The Eighth Affiliated Hospital (Shenzhen Futian), Sun Yat-sen University, Shenzhen, 518033, Guangdong, China.
Department of General Medicine, The Eighth Affiliated Hospital (Shenzhen Futian), Sun Yat-sen University, Shenzhen, 518033, Guangdong, China.
Am J Emerg Med. 2022 Feb;52:1-7. doi: 10.1016/j.ajem.2021.11.029. Epub 2021 Nov 24.
Limited data are available on the discriminatory capacity of quick sequential [sepsis-related] organ failure assessment (qSOFA) versus IDSA/ATS minor criteria for predicting mortality in patients with community-acquired pneumonia (CAP).
An observational prospective cohort study of 2116 patients with CAP was performed. Construct validity was determined using Cronbach α. Discrimination was assessed using the area under the receiver operating characteristic curve (AUROC) and net reclassification improvement (NRI).
Overall in-hospital mortality was 6.43%. Mortality was 25.96% for patients with a qSOFA score of 2 or higher versus 3.05% for those with a qSOFA score less than 2 (odds ratio for mortality 6.57, P < 0.0001), and 13.85% for patients with at least 3 minor criteria versus 2.03% for those with 2 or fewer minor criteria (odds ratio for mortality 2.27, P < 0.0001). qSOFA had a higher correlation with mortality than minor criteria, as well as higher internal consistency (Cronbach alpha 0.43 versus 0.14) and diagnostic values of individual elements (larger AUROCs and higher Youden's indices). qSOFA ≥2 was less sensitive but more specific for predicting mortality than ≥3 minor criteria (qSOFA sensitivity 59.6%, specificity 88.3% and positive likelihood ratio 5.11 versus ≥3 minor criteria sensitivity 80.1%, specificity 65.8% and positive likelihood ratio 2.34). The predictive validity of qSOFA was good for mortality (AUROC = 0.868), was statistically greater than minor criteria, was equal to pneumonia severity index, and was inferior compared with CURB-65 (AUROC, 0.824, 0.902, 0.919; NRI, 0.088, -0.068, -0.103; respectively).
The qSOFA predicted mortality in CAP better than IDSA/ATS minor criteria and worse than CURB-65 with robust elements and higher convergence. qSOFA as a bedside prompt might be positioned as a proxy for minor criteria and increase the recognition and thus merit more appropriate management of CAP patients likely to fare poorly, which might have implications for more accurate clinical triage decisions.
关于快速序贯[脓毒症相关]器官功能衰竭评估（qSOFA）与美国感染病学会（IDSA）/美国胸科学会（ATS）轻症标准在预测社区获得性肺炎（CAP）患者死亡率方面的鉴别能力，现有数据有限。
对2116例CAP患者进行了一项前瞻性观察队列研究。使用Cronbach α系数确定结构效度。采用受试者工作特征曲线下面积（AUROC）和净重新分类改善率（NRI）评估鉴别能力。
总体院内死亡率为6.43%。qSOFA评分≥2分的患者死亡率为25.96%，而qSOFA评分＜2分的患者死亡率为3.05%（死亡比值比为6.57，P＜0.0001）；至少有3条轻症标准的患者死亡率为13.85%，而有2条或更少轻症标准的患者死亡率为2.03%（死亡比值比为2.27，P＜0.0001）。与轻症标准相比，qSOFA与死亡率的相关性更高，内部一致性也更高（Cronbach α系数分别为0.43和0.14），且各单项指标的诊断价值更高（AUROC更大，约登指数更高）。qSOFA≥2分在预测死亡率方面的敏感性低于≥3条轻症标准，但特异性更高（qSOFA敏感性为59.6%，特异性为88.3%，阳性似然比为5.11；≥3条轻症标准敏感性为80.1%，特异性为65.8%，阳性似然比为2.34）。qSOFA对死亡率的预测效度良好（AUROC = 0.868），在统计学上优于轻症标准，与肺炎严重程度指数相当，但不如CURB - 65（AUROC分别为0.824、0.902、0.919；NRI分别为0.088、 - 0.068、 - 0.103）。
qSOFA在预测CAP患者死亡率方面优于IDSA/ATS轻症标准，但不如CURB - 65，其要素稳健，一致性更高。qSOFA作为床边快速评估指标，可作为轻症标准的替代指标，提高对可能预后不良的CAP患者的识别，从而有助于做出更恰当的管理决策，这可能对更准确的临床分诊决策具有重要意义。
