改良脓毒症心血管 SOFA 评分：开发及内部和外部验证。

Modified cardiovascular SOFA score in sepsis: development and internal and external validation.

机构信息

Department of Emergency Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea.

Department of Emergency Medicine, Hanyang University College of Medicine, Seoul, South Korea.

出版信息

BMC Med. 2022 Aug 22;20(1):263. doi: 10.1186/s12916-022-02461-7.

DOI:10.1186/s12916-022-02461-7

PMID:35989336

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9394016/

Abstract

BACKGROUND

The Sepsis-3 criteria introduced the system that uses the Sequential Organ-Failure Assessment (SOFA) score to define sepsis. The cardiovascular SOFA (CV SOFA) scoring system needs modification due to the change in guideline-recommended vasopressors. In this study, we aimed to develop and to validate the modified CV SOFA score.

METHODS

We developed, internally validated, and externally validated the modified CV SOFA score using the suspected infection cohort, sepsis cohort, and septic shock cohort. The primary outcome was 28-day mortality. The modified CV SOFA score system was constructed with consideration of the recently recommended use of the vasopressor norepinephrine with or without lactate level. The predictive validity of the modified SOFA score was evaluated by the discrimination for the primary outcome. Discrimination was assessed using the area under the receiver operating characteristics curve (AUC). Calibration was assessed using the calibration curve. We compared the prognostic performance of the original CV/total SOFA score and the modified CV/total SOFA score to detect mortality in patients with suspected infection, sepsis, or septic shock.

RESULTS

We identified 7,393 patients in the suspected cohort, 4038 patients in the sepsis cohort, and 3,107 patients in the septic shock cohort in seven Korean emergency departments (EDs). The 28-day mortality rates were 7.9%, 21.4%, and 20.5%, respectively, in the suspected infection, sepsis, and septic shock cohorts. The model performance is higher when vasopressor and lactate were used in combination than the vasopressor only used model. The modified CV/total SOFA score was well-developed and internally and externally validated in terms of discrimination and calibration. Predictive validity of the modified CV SOFA was significantly higher than that of the original CV SOFA in the development set (0.682 vs 0.624, p < 0.001), test set (0.716 vs 0.638), and all other cohorts (0.648 vs 0.557, 0.674 vs 0.589). Calibration was modest. In the suspected infection cohort, the modified model classified more patients to sepsis (66.0 vs 62.5%) and identified more patients at risk of septic mortality than the SOFA score (92.6 vs 89.5%).

CONCLUSIONS

Among ED patients with suspected infection, sepsis, and septic shock, the newly-developed modified CV/total SOFA score had higher predictive validity and identified more patients at risk of septic mortality.

摘要

背景

Sepsis-3 标准引入了使用序贯器官衰竭评估（SOFA）评分来定义败血症的系统。心血管 SOFA（CV SOFA）评分系统需要修改，因为指南推荐的血管加压药发生了变化。在这项研究中，我们旨在开发和验证改良的 CV SOFA 评分。

方法

我们使用疑似感染队列、败血症队列和感染性休克队列开发、内部验证和外部验证改良的 CV SOFA 评分。主要结局为 28 天死亡率。改良的 CV SOFA 评分系统考虑到最近推荐使用去甲肾上腺素加或不加乳酸水平的血管加压药。通过对主要结局的区分来评估改良 SOFA 评分的预测有效性。通过接受者操作特征曲线下的面积（AUC）来评估区分。通过校准曲线评估校准。我们比较了原始 CV/总 SOFA 评分和改良 CV/总 SOFA 评分在检测疑似感染、败血症或感染性休克患者死亡率方面的预后性能。

结果

在七个韩国急诊科中，我们在疑似队列中确定了 7393 名患者，在败血症队列中确定了 4038 名患者，在感染性休克队列中确定了 3107 名患者。疑似感染、败血症和感染性休克队列的 28 天死亡率分别为 7.9%、21.4%和 20.5%。当同时使用血管加压药和乳酸时，该模型的性能高于仅使用血管加压药的模型。改良的 CV/总 SOFA 评分在区分度和校准度方面在内部和外部均得到了很好的发展和验证。改良的 CV SOFA 的预测有效性在开发集（0.682 比 0.624，p<0.001）、测试集（0.716 比 0.638）和所有其他队列（0.648 比 0.557，0.674 比 0.589）中均显著高于原始 CV SOFA。校准度适中。在疑似感染队列中，改良模型将更多患者分类为败血症（66.0%比 62.5%），并比 SOFA 评分（92.6%比 89.5%）识别出更多有感染性死亡风险的患者。