快速序贯器官衰竭评估（qSOFA）评分对越南重症监护病房脓毒症患者死亡率的预测效度。
Predictive validity of the quick Sequential Organ Failure Assessment (qSOFA) score for the mortality in patients with sepsis in Vietnamese intensive care units.
机构信息
Center for Critical Care Medicine, Bach Mai Hospital, Hanoi, Vietnam.
Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam.
出版信息
PLoS One. 2022 Oct 14;17(10):e0275739. doi: 10.1371/journal.pone.0275739. eCollection 2022.
BACKGROUND
The simple scoring systems for predicting the outcome of sepsis in intensive care units (ICUs) are few, especially for limited-resource settings. Therefore, this study aimed to evaluate the accuracy of the quick Sequential (Sepsis-Related) Organ Failure Assessment (qSOFA) score in predicting the mortality of ICU patients with sepsis in Vietnam.
METHODS
We did a multicenter cross-sectional study of patients with sepsis (≥18 years old) presenting to 15 adult ICUs throughout Vietnam on the specified days (i.e., 9th January, 3rd April, 3rd July, and 9th October) representing the different seasons of 2019. The primary and secondary outcomes were the hospital and ICU all-cause mortalities, respectively. The area under the receiver operating characteristic curve (AUROC) was calculated to determine the discriminatory ability of the qSOFA score for deaths in the hospital and ICU. The cut-off value of the qSOFA scores was determined by the receiver operating characteristic curve analysis. Upon ICU admission, factors associated with the hospital and ICU mortalities were assessed in univariable and multivariable logistic models.
RESULTS
Of 252 patients, 40.1% died in the hospital, and 33.3% died in the ICU. The qSOFA score had a poor discriminatory ability for both the hospital (AUROC: 0.610 [95% CI: 0.538 to 0.681]; cut-off value: ≥2.5; sensitivity: 34.7%; specificity: 84.1%; PAUROC = 0.003) and ICU (AUROC: 0.619 [95% CI: 0.544 to 0.694]; cutoff value: ≥2.5; sensitivity: 36.9%; specificity: 83.3%; PAUROC = 0.002) mortalities. However, multivariable logistic regression analyses show that the qSOFA score of 3 was independently associated with the increased risk of deaths in both the hospital (adjusted odds ratio, AOR: 3.358; 95% confidence interval, CI: 1.756 to 6.422) and the ICU (AOR: 3.060; 95% CI: 1.651 to 5.671).
CONCLUSION
In our study, despite having a poor discriminatory value, the qSOFA score seems worthwhile in predicting mortality in ICU patients with sepsis in limited-resource settings.
CLINICAL TRIAL REGISTRATION
Clinical trials registry-India: CTRI/2019/01/016898.
背景
用于预测重症监护病房（ICU）中脓毒症结局的简单评分系统很少，尤其是在资源有限的情况下。因此，本研究旨在评估快速序贯（脓毒症相关）器官衰竭评估（qSOFA）评分在预测越南 ICU 中脓毒症患者死亡率方面的准确性。
方法
我们对 2019 年指定日期（即 1 月 9 日、4 月 3 日、7 月 3 日和 10 月 9 日）在越南 15 家成人 ICU 就诊的≥18 岁脓毒症（sepsis）患者进行了一项多中心横断面研究。主要和次要结局分别为医院和 ICU 的全因死亡率。计算接受者操作特征曲线（ROC）下的面积（AUROC）以确定 qSOFA 评分对医院和 ICU 死亡的区分能力。通过 ROC 曲线分析确定 qSOFA 评分的截断值。在 ICU 入院时，在单变量和多变量逻辑模型中评估与医院和 ICU 死亡率相关的因素。
结果
在 252 名患者中，40.1%的患者在医院死亡，33.3%的患者在 ICU 死亡。qSOFA 评分对医院（AUROC：0.610 [95%CI：0.538 至 0.681]；截断值：≥2.5；灵敏度：34.7%；特异性：84.1%；PAUROC = 0.003）和 ICU（AUROC：0.619 [95%CI：0.544 至 0.694]；截断值：≥2.5；灵敏度：36.9%；特异性：83.3%；PAUROC = 0.002）死亡率的区分能力较差。然而，多变量逻辑回归分析表明，qSOFA 评分 3 与医院（调整后的优势比，AOR：3.358；95%置信区间，CI：1.756 至 6.422）和 ICU（AOR：3.060；95%CI：1.651 至 5.671）死亡率增加的风险独立相关。
结论
在我们的研究中，尽管 qSOFA 评分的区分值较差，但在资源有限的情况下，它似乎对预测 ICU 中脓毒症患者的死亡率有用。
临床试验注册
印度临床试验注册处：CTRI/2019/01/016898。
Zotero 插件