Hu Hai, Jiang Jing-Yuan, Yao Ni
Emergency Office of West China Hospital, Sichuan University, Chengdu 610041, China.
China International Emergency Medical Team, Chengdu 610041, China.
World J Emerg Med. 2022;13(2):114-119. doi: 10.5847/wjem.j.1920-8642.2022.027.
The quick sequential organ failure assessment (qSOFA) is recommended to identify sepsis and predict sepsis mortality. However, some studies have recently shown its poor performance in sepsis mortality prediction. To enhance its effectiveness, researchers have developed various revised versions of the qSOFA by adding other parameters, such as the lactate-enhanced qSOFA (LqSOFA), the procalcitonin-enhanced qSOFA (PqSOFA), and the modified qSOFA (MqSOFA). This study aimed to compare the performance of these versions of the qSOFA in predicting sepsis mortality in the emergency department (ED).
This retrospective study analyzed data obtained from an electronic register system of adult patients with sepsis between January 1 and December 31, 2019. Receiver operating characteristic (ROC) curve analyses were performed to determine the area under the curve (AUC), with sensitivity, specificity, and positive and negative predictive values calculated for the various scores.
Among the 936 enrolled cases, there were 835 survivors and 101 deaths. The AUCs of the LqSOFA, MqSOFA, PqSOFA, and qSOFA were 0.740, 0.731, 0.712, and 0.705, respectively. The sensitivity of the LqSOFA, MqSOFA, PqSOFA, and qSOFA were 64.36%, 51.40%, 71.29%, and 39.60%, respectively. The specificity of the four scores were 70.78%, 80.96%, 61.68%, and 91.62%, respectively. The LqSOFA and MqSOFA were superior to the qSOFA in predicting in-hospital mortality.
Among patients with sepsis in the ED, the performance of the PqSOFA was similar to that of the qSOFA and the values of the LqSOFA and MqSOFA in predicting in-hospital mortality were greater compared to qSOFA. As the added parameter of the MqSOFA was more convenient compared to the LqSOFA, the MqSOFA could be used as a candidate for the revised qSOFA to increase the performance of the early prediction of sepsis mortality.
快速序贯器官衰竭评估（qSOFA）被推荐用于识别脓毒症并预测脓毒症死亡率。然而，最近一些研究表明其在预测脓毒症死亡率方面表现不佳。为提高其有效性，研究人员通过添加其他参数开发了各种修订版的qSOFA，如乳酸增强型qSOFA（LqSOFA）、降钙素原增强型qSOFA（PqSOFA）和改良型qSOFA（MqSOFA）。本研究旨在比较这些版本的qSOFA在急诊科（ED）预测脓毒症死亡率的性能。
这项回顾性研究分析了2019年1月1日至12月31日期间从成人脓毒症患者电子登记系统中获取的数据。进行受试者操作特征（ROC）曲线分析以确定曲线下面积（AUC），并计算各种评分的敏感性、特异性以及阳性和阴性预测值。
在936例纳入病例中，有835例存活者和101例死亡。LqSOFA、MqSOFA、PqSOFA和qSOFA的AUC分别为0.740、0.731、0.712和0.705。LqSOFA、MqSOFA、PqSOFA和qSOFA的敏感性分别为64.36%、51.40%、71.29%和39.60%。这四个评分的特异性分别为70.78%、80.96%、61.68%和91.62%。LqSOFA和MqSOFA在预测院内死亡率方面优于qSOFA。
在急诊科脓毒症患者中，PqSOFA的性能与qSOFA相似，LqSOFA和MqSOFA在预测院内死亡率方面的值比qSOFA更高。由于MqSOFA的添加参数比LqSOFA更方便，MqSOFA可作为修订版qSOFA的候选者，以提高脓毒症死亡率早期预测的性能。
