Osgood A-M, Hollenbeck D, Yankin I
Emergency & Critical Care Department, Texas A&M University, College Station, Texas, USA.
Texas A&M University Veterinary Medical Teaching Hospital, College Station, Texas, USA.
J Small Anim Pract. 2022 Oct;63(10):739-746. doi: 10.1111/jsap.13522. Epub 2022 Jul 9.
To evaluate the prognostic utility of the quick sequential organ failure assessment score in dogs with severe sepsis and septic shock presenting to an emergency service, and evaluate the clinical value of the quick sequential organ failure assessment score to predict severe sepsis and septic shock.
The quick sequential organ failure assessment score was calculated by evaluating respiratory rate (>22 breaths per minute), arterial systolic blood pressure (≤100 mmHg) and altered mentation. The quick sequential organ failure assessment scores with respiratory rate cut-offs of greater than 22, greater than 30 and greater than 40 were compared. Cases were defined as dogs presented to the emergency room and met at least 2 systemic inflammatory response syndrome criteria, had documented infection, and at least one organ dysfunction. A control population of dogs included animals with non-infectious systemic inflammatory response syndrome.
Forty-five dogs with severe sepsis and septic shock and 45 dogs with non-infectious systemic inflammatory response syndrome were included in the final analysis. The quick sequential organ failure assessment provided poor discrimination between survivors and non-survivors for severe sepsis and septic shock (area under receiving operating characteristic curve, 0.51; 95% confidence interval, 0.35 to 0.67). Discrimination remained poor when quick sequential organ failure assessment greater than 30 and quick sequential organ failure assessment greater than 40 scores were calculated (area under receiving operating characteristic curve, 0.56; 95% confidence interval, 0.39 to 0.72, and 0.54; 95% confidence interval, 0.36 to 0.71). The quick sequential organ failure assessment of at least 2, quick sequential organ failure assessment greater than 30 of at least 2 and quick sequential organ failure assessment greater than 40 of at least 2 produced sensitivity and specificity to detect severe sepsis and septic shock of 66.7% and 64.5%, 62.2% and 71.1%, 44.4% and 80%, respectively.
Scoring systems utilised in emergency rooms should have high sensitivity to reduce missed sepsis cases and treatment delays. The use of the quick sequential organ failure assessment for severe sepsis and septic shock demonstrated poor mortality prediction and low sensitivity to detect canine patients with severe sepsis and septic shock and should not be used alone when screening for sepsis.
评估快速序贯器官衰竭评估（qSOFA）评分在就诊于急诊的重症脓毒症和脓毒性休克犬中的预后效用，并评估qSOFA评分预测重症脓毒症和脓毒性休克的临床价值。
通过评估呼吸频率（>22次/分钟）、动脉收缩压（≤100mmHg）和精神状态改变来计算qSOFA评分。比较呼吸频率截断值分别大于22、大于30和大于40时的qSOFA评分。病例定义为就诊于急诊室且符合至少2条全身炎症反应综合征标准、有感染记录且至少存在1个器官功能障碍的犬。对照组犬包括患有非感染性全身炎症反应综合征的动物。
最终分析纳入了45只重症脓毒症和脓毒性休克犬以及45只非感染性全身炎症反应综合征犬。qSOFA评分对重症脓毒症和脓毒性休克的存活者与非存活者的区分能力较差（受试者工作特征曲线下面积，0.51；95%置信区间，0.35至0.67）。计算qSOFA评分大于30和qSOFA评分大于40时，区分能力仍然较差（受试者工作特征曲线下面积，0.56；95%置信区间，0.39至0.72，以及0.54；95%置信区间，0.36至0.71）。qSOFA评分至少为2、qSOFA评分大于30至少为2以及qSOFA评分大于40至少为2时，检测重症脓毒症和脓毒性休克的敏感性和特异性分别为66.7%和64.5%、62.2%和71.1%、44.4%和80%。
急诊室使用的评分系统应具有高敏感性，以减少脓毒症漏诊病例和治疗延误。qSOFA评分用于重症脓毒症和脓毒性休克时，死亡率预测能力较差，检测重症脓毒症和脓毒性休克犬的敏感性较低，筛查脓毒症时不应单独使用。
