Christensen Erik E, Prebensen Christian H, Martinsen Anders B, Stiff Elisabeth T, Hoff Rune, Kvale Dag, Holten Aleksander R
Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway.
Crit Care Explor. 2023 Feb 21;5(2):e0865. doi: 10.1097/CCE.0000000000000865. eCollection 2023 Feb.
The Sequential Organ Failure Assessment (SOFA) was chosen in the definition of sepsis due to superior validity in predicting mortality. However, few studies have assessed the contributions of acute versus chronic organ failures to SOFA for mortality prediction.
The main objective in this study was to assess the relative importance of chronic and acute organ failures in mortality prediction in patients with suspected sepsis at hospital admission. We also evaluated how the presence of infection influenced the ability of SOFA to predict 30-day mortality.
Single-center prospective cohort study including 1,313 adult patients with suspected sepsis in rapid response teams in the emergency department.
The main outcome was 30-day mortality. We measured the maximum total SOFA score during admission (SOFATotal), whereas preexisting chronic organ failure SOFA (SOFAChronic) score was assessed by chart review, allowing calculation of the corresponding acute SOFA (SOFAAcute) score. Likelihood of infection was determined post hoc as "No infection" or "Infection."
SOFAAcute and SOFAChronic were both associated with 30-day mortality, adjusted for age and sex (adjusted odds ratios [AORs], 1.3; 95% CI, 1.3-14 and 1.3; 1.2-1.7), respectively. Presence of infection was associated with lower 30-day mortality (AOR, 0.4; 95% CI, 0.2-0.6), even when corrected for SOFA. In "No infection" patients, SOFAAcute was not associated with mortality (AOR, 1.1; 95% CI, 1.0-1.2), and in this subgroup, neither SOFAAcute greater than or equal to 2 (relative risk [RR], 1.1; 95% CI, 0.6-1.8) nor SOFATotal greater than or equal to 2 (RR, 3.6; 95% CI, 0.9-14.1) was associated with higher mortality.
Chronic and acute organ failures were equally associated with 30-day mortality in suspected sepsis. A substantial part of the total SOFA score was due to chronic organ failure, calling for caution when using total SOFA in defining sepsis and as an outcome in intervention studies. SOFA's mortality prediction ability was highly dependent on actual presence of infection.
由于在预测死亡率方面具有更高的有效性，序贯器官衰竭评估（SOFA）被用于脓毒症的定义中。然而，很少有研究评估急性与慢性器官衰竭对SOFA预测死亡率的贡献。
本研究的主要目的是评估慢性和急性器官衰竭在医院入院时疑似脓毒症患者死亡率预测中的相对重要性。我们还评估了感染的存在如何影响SOFA预测30天死亡率的能力。
设计、地点和参与者：单中心前瞻性队列研究，纳入了急诊科快速反应团队中的1313例疑似脓毒症的成年患者。
主要结局是30天死亡率。我们测量了入院期间的最大总SOFA评分（SOFATotal），而既往慢性器官衰竭SOFA（SOFAChronic）评分通过病历审查进行评估，从而可以计算相应的急性SOFA（SOFAAcute）评分。事后将感染可能性确定为“无感染”或“感染”。
SOFAAcute和SOFAChronic均与30天死亡率相关，在对年龄和性别进行调整后（调整后的优势比[AORs]分别为1.3；95%置信区间[CI]，1.3 - 14和1.3；1.2 - 1.7）。感染的存在与较低的30天死亡率相关（AOR，0.4；95%CI，0.2 - 0.6），即使在对SOFA进行校正后也是如此。在“无感染”患者中，SOFAAcute与死亡率无关（AOR，1.1；95%CI，1.0 - 1.2），并且在该亚组中，SOFAAcute大于或等于2（相对风险[RR]，1.1；95%CI，0.6 - 1.8）和SOFATotal大于或等于2（RR，3.6；95%CI，0.9 - 14.1）均与较高的死亡率无关。
在疑似脓毒症中，慢性和急性器官衰竭与30天死亡率的相关性相同。总SOFA评分的很大一部分归因于慢性器官衰竭，在使用总SOFA定义脓毒症以及作为干预研究的结局时需要谨慎。SOFA的死亡率预测能力高度依赖于实际感染的存在。
