院前qSOFA参数评估与早期脓毒症靶向治疗相关吗？一项回顾性队列研究。
Is Prehospital Assessment of qSOFA Parameters Associated with Earlier Targeted Sepsis Therapy? A Retrospective Cohort Study.
作者信息
Dankert André, Kraxner Jochen, Breitfeld Philipp, Bopp Clemens, Issleib Malte, Doehn Christoph, Bathe Janina, Krause Linda, Zöllner Christian, Petzoldt Martin
机构信息
Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20251 Hamburg, Germany.
Department of Anesthesiology and Intensive Care Medicine, German Military Hospital Hamburg, Lesserstrasse 180, 22049 Hamburg, Germany.
出版信息
J Clin Med. 2022 Jun 17;11(12):3501. doi: 10.3390/jcm11123501.
BACKGROUND
This study aimed to determine whether prehospital qSOFA (quick sequential organ failure assessment) assessment was associated with a shortened 'time to antibiotics' and 'time to intravenous fluid resuscitation' compared with standard assessment.
METHODS
This retrospective study included patients who were referred to our Emergency Department between 2014 and 2018 by emergency medical services, in whom sepsis was diagnosed during hospitalization. Two multivariable regression models were fitted, with and without qSOFA parameters, for 'time to antibiotics' (primary endpoint) and 'time to intravenous fluid resuscitation'.
RESULTS
In total, 702 patients were included. Multiple linear regression analysis showed that antibiotics and intravenous fluids were initiated earlier if infections were suspected and emergency medical services involved emergency physicians. A heart rate above 90/min was associated with a shortened time to antibiotics. If qSOFA parameters were added to the models, a respiratory rate ≥ 22/min and altered mentation were independent predictors for earlier antibiotics. A systolic blood pressure ≤ 100 mmHg and altered mentation were independent predictors for earlier fluids. When qSOFA parameters were added, the explained variability of the model increased by 24% and 38%, respectively (adjusted R² 0.106 versus 0.131 for antibiotics and 0.117 versus 0.162 for fluids).
CONCLUSION
Prehospital assessment of qSOFA parameters was associated with a shortened time to a targeted sepsis therapy.
背景
本研究旨在确定与标准评估相比，院前快速序贯器官衰竭评估（qSOFA）是否与缩短“抗生素使用时间”和“静脉液体复苏时间”相关。
方法
这项回顾性研究纳入了2014年至2018年间由紧急医疗服务机构转诊至我院急诊科、住院期间被诊断为脓毒症的患者。针对“抗生素使用时间”（主要终点）和“静脉液体复苏时间”，拟合了两个多变量回归模型，一个包含qSOFA参数，另一个不包含。
结果
总共纳入了702例患者。多元线性回归分析表明，如果怀疑感染且紧急医疗服务涉及急诊医生，则抗生素和静脉输液的开始时间会更早。心率高于90次/分钟与抗生素使用时间缩短相关。如果将qSOFA参数添加到模型中，呼吸频率≥22次/分钟和意识改变是抗生素使用更早的独立预测因素。收缩压≤100 mmHg和意识改变是液体复苏更早的独立预测因素。添加qSOFA参数后，模型的可解释变异性分别增加了24%和38%（抗生素使用时间的调整R²为0.106对0.131，液体复苏时间的调整R²为0.117对0.162）。
结论
院前评估qSOFA参数与缩短脓毒症靶向治疗时间相关。
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