University of California, San Diego School of Medicine, San Diego, California, USA.
Department of Urology, University of California, San Diego, San Diego, California, USA.
J Endourol. 2023 Aug;37(8):863-867. doi: 10.1089/end.2022.0677.
Recent retrospective literature suggests that the quick sequential organ failure assessment (qSOFA) scoring tool is a potentially superior tool over use of the systemic inflammatory response syndrome (SIRS) criteria to predict septic shock after percutaneous nephrolithotomy (PCNL) surgery. Here we examine use of qSOFA and SIRS to predict septic shock within data series collected prospectively on PCNL patients as part of a greater study of infectious complications. We performed a secondary analysis of two prospective multicenter studies including PCNL patients across nine institutions. Clinical signs informing SIRS and qSOFA scores were collected no later than postoperative day 1. The primary outcome was sensitivity and specificity of SIRS and qSOFA (high-risk score of greater-or-equal to two points) in predicting admission to the intensive care unit (ICU) for vasopressor support. A total of 218 cases at 9 institutions were analyzed. One patient required vasopressor support in the ICU. The sensitivity/specificity was 100%/72.4% (McNemar's test < 0.001) for SIRS and was 100%/90.8% (McNemar's test < 0.001) for qSOFA. Although positive predictive value for both qSOFA and SIRS in prediction of post-PCNL septic shock is low, prospectively collected data demonstrate use of qSOFA may offer greater specificity than SIRS criteria when predicting post-PCNL septic shock.
最近的回顾性文献表明，快速序贯器官衰竭评估（qSOFA）评分工具可能优于使用全身炎症反应综合征（SIRS）标准来预测经皮肾镜取石术（PCNL）术后感染性休克。在这里，我们检查了 qSOFA 和 SIRS 在预测 PCNL 患者感染性并发症更大研究系列中前瞻性收集的数据系列中的感染性休克的应用。我们对包括 9 个机构的 PCNL 患者在内的两项前瞻性多中心研究进行了二次分析。告知 SIRS 和 qSOFA 评分的临床体征在术后第 1 天之前采集。主要结局是 SIRS 和 qSOFA（风险评分大于或等于 2 分）预测入住 ICU 接受升压支持的敏感性和特异性。对 9 个机构的 218 例病例进行了分析。1 例患者在 ICU 需要升压支持。SIRS 的敏感性/特异性为 100%/72.4%（McNemar 检验 < 0.001），qSOFA 为 100%/90.8%（McNemar 检验 < 0.001）。尽管 qSOFA 和 SIRS 对预测 PCNL 后感染性休克的阳性预测值均较低，但前瞻性收集的数据表明，qSOFA 在预测 PCNL 后感染性休克时可能比 SIRS 标准具有更高的特异性。
