Professor and Head;Corresponding Author.
Postgraduate Student.
J Assoc Physicians India. 2022 Aug;70(8):11-12. doi: 10.5005/japi-11001-0062.
OBJECTIVES: Sepsis-3 criteria define sepsis as ≥2 points rise of Sequential Organ Failure Assessment (SOFA) score, either from zero or a known baseline. We compared the efficacies of quick Sequential Organ Failure Assessment (qSOFA), SOFA, and Systemic Inflammatory Response Syndrome (SIRS) scores to predict sepsis mortality. METHODS: Prospective, hospital-based study was undertaken to determine the efficacies of various sepsis-scoring systems to predict mortality in sepsis. The "Sepsis-2" criteria of "severe sepsis" and "septic shock" were used as selection criteria as they correspond to "sepsis" and "septic shock" of "Sepsis-3". Statistical analysis was done by SPSS Statistics version-16. Mortality predictions were made using receiver operator characteristic curve testing. RESULTS: We included 122 sepsis patients diagnosed by "Sepsis-2" definition; 78.68% (n = 98) of whom met "Sepsis-3" criteria for sepsis. All-cause mortality was 50%. On univariate analysis, we found age over 60 years [odds ratio (OR) = 4.244, 95% confidence interval (CI) = 1.309-13.764, p = 0.016], invasive mechanical ventilation (OR = 7.0076, 95% CI = 3.053-16.0809, p<0.0001), and presence of acute respiratory distress syndrome (ARDS) (OR = 2.757, 95% CI = 1.0091-7.535, p = 0.048) were significant predictors of mortality. The SOFA score yielded the best result with "area under the curve" (AUC) of "receiver operating characteristic" (ROC) curve of 0.868. On comparing AUCs between these scores difference between both SOFA and qSOFA was highly significant (p < 0.0001) compared to SIRS. However, such statistical difference was not found between AUCs of SOFA and qSOFA. CONCLUSIONS: Both SOFA and qSOFA are superior prognostication tools compared to SIRS to predict sepsis mortality; SOFA being better than qSOFA.
目的:Sepsis-3 标准将序贯器官衰竭评估(SOFA)评分≥2 分的升高定义为败血症,无论是从零分还是已知的基线升高。我们比较了快速序贯器官衰竭评估(qSOFA)、SOFA 和全身炎症反应综合征(SIRS)评分预测败血症死亡率的效果。
方法:进行了一项前瞻性的基于医院的研究,以确定各种败血症评分系统预测败血症死亡率的效果。使用“Sepsis-2”标准的“严重败血症”和“感染性休克”作为选择标准,因为它们对应于“Sepsis-3”的“败血症”和“感染性休克”。统计分析使用 SPSS Statistics 版本 16 进行。使用受试者工作特征曲线(ROC)测试进行死亡率预测。
结果:我们纳入了 122 例根据“Sepsis-2”定义诊断为败血症的患者;其中 78.68%(n=98)符合“Sepsis-3”败血症标准。全因死亡率为 50%。单因素分析发现,年龄大于 60 岁[比值比(OR)=4.244,95%置信区间(CI)=1.309-13.764,p=0.016]、有创机械通气(OR=7.0076,95%CI=3.053-16.0809,p<0.0001)和急性呼吸窘迫综合征(ARDS)(OR=2.757,95%CI=1.0091-7.535,p=0.048)是死亡率的显著预测因素。SOFA 评分的“受试者工作特征”(ROC)曲线下面积(AUC)为 0.868,效果最好。比较这些评分的 AUC 之间的差异,SOFA 和 qSOFA 之间的差异具有高度显著性(p < 0.0001),而 SOFA 和 qSOFA 之间的 AUC 没有统计学差异。
结论:与 SIRS 相比,SOFA 和 qSOFA 都是预测败血症死亡率的更好预后工具;SOFA 优于 qSOFA。
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2017-2