Departments of Internal Medicine.
Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Eur J Emerg Med. 2022 Oct 1;29(5):348-356. doi: 10.1097/MEJ.0000000000000924. Epub 2022 Jun 23.
BACKGROUND AND IMPORTANCE: Sepsis is a common and potentially lethal syndrome, and early recognition is critical to prevent deterioration. Yet, currently available scores to facilitate recognition of sepsis lack prognostic accuracy. OBJECTIVE: To identify the optimal time-point to determine NEWS, qSOFA and SIRS for the prediction of clinical deterioration in early sepsis and to determine whether the change in these scores over time improves their prognostic accuracy. DESIGN: Post hoc analysis of prospectively collected data. SETTINGS AND PARTICIPANTS: This study was performed in the emergency department (ED) of a tertiary-care teaching hospital. Adult medical patients with (potential) sepsis were included. OUTCOME MEASURES AND ANALYSIS: The primary outcome was clinical deterioration within 72 h after admission, defined as organ failure development, the composite outcome of ICU-admission and death. Secondary outcomes were the composite of ICU-admission/death and a rise in SOFA at least 2. Scores were calculated at the ED with 30-min intervals. ROC analyses were constructed to compare the prognostic accuracy of the scores. RESULTS: In total, 1750 patients were included, of which 360 (20.6%) deteriorated and 79 (4.5%) went to the ICU or died within 72 h. The NEWS at triage (AUC, 0.62; 95% CI, 0.59-0.65) had a higher accuracy than qSOFA (AUC, 0.60; 95% CI, 0.56-0.63) and SIRS (AUC, 0.59; 95% CI, 0.56-0.63) for predicting deterioration. The AUC of the NEWS at 1 h (0.65; 95% CI, 0.63-0.69) and 150 min after triage (0.64; 95% CI, 0.61-0.68) was higher than the AUC of the NEWS at triage. The qSOFA had the highest AUC at 90 min after triage (0.62; 95% CI, 0.58-0.65), whereas the SIRS had the highest AUC at 60 min after triage (0.60; 95% CI, 0.56-0.63); both are not significantly different from triage. The NEWS had a better accuracy to predict ICU-admission/death <72 h compared with qSOFA (AUC difference, 0.092) and SIRS (AUC difference, 0.137). No differences were found for the prediction of a rise in SOFA at least 2 within 72 h between the scores. Patients with the largest improvement in any of the scores were more prone to deteriorate. CONCLUSION: NEWS had a higher prognostic accuracy to predict deterioration compared with SIRS and qSOFA; the highest accuracy was reached at 1 h after triage.
背景与重要性：脓毒症是一种常见且潜在致命的综合征，早期识别对于防止病情恶化至关重要。然而，目前用于识别脓毒症的评分方法缺乏预后准确性。 目的：确定最佳时间点以确定 NEWS、qSOFA 和 SIRS 在早期脓毒症中的预测临床恶化的能力，并确定这些评分随时间的变化是否提高其预后准确性。 设计：前瞻性收集数据的事后分析。 地点和参与者：本研究在一家三级教学医院的急诊科进行。纳入患有（潜在）脓毒症的成年内科患者。 主要结局指标和分析：主要结局是入院后 72 小时内的临床恶化，定义为器官功能衰竭的发展、入住 ICU 和死亡的复合结局。次要结局是 ICU 入住/死亡的复合结局和至少 2 分的 SOFA 升高。在急诊科每隔 30 分钟计算一次分数。构建 ROC 分析以比较评分的预后准确性。 结果：共纳入 1750 例患者，其中 360 例（20.6%）恶化，79 例（4.5%）在 72 小时内入住 ICU 或死亡。分诊时的 NEWS（AUC，0.62；95%CI，0.59-0.65）比 qSOFA（AUC，0.60；95%CI，0.56-0.63）和 SIRS（AUC，0.59；95%CI，0.56-0.63）更准确预测恶化。分诊后 1 小时（AUC，0.65；95%CI，0.63-0.69）和 150 分钟（AUC，0.64；95%CI，0.61-0.68）的 NEWS AUC 高于分诊时的 AUC。分诊后 90 分钟时 qSOFA 的 AUC 最高（0.62；95%CI，0.58-0.65），而 SIRS 在分诊后 60 分钟时的 AUC 最高（0.60；95%CI，0.56-0.63）；两者均与分诊时无显著差异。与 qSOFA（AUC 差异，0.092）和 SIRS（AUC 差异，0.137）相比，NEWS 对预测 72 小时内 ICU 入住/死亡的准确性更高。在预测 72 小时内 SOFA 至少升高 2 分方面，各评分之间没有差异。任何评分中改善最大的患者更容易恶化。 结论：与 SIRS 和 qSOFA 相比，NEWS 具有更高的预测恶化的预后准确性；最高的准确性在分诊后 1 小时达到。
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