持续的高脓毒症诱导性凝血障碍和序贯性器官衰竭评估评分可预测脓毒症患者的 28 天死亡率：一项前瞻性研究。
Persistent high sepsis-induced coagulopathy and sequential organ failure assessment scores can predict the 28-day mortality of patients with sepsis: A prospective study.
机构信息
Department of Emergency Medicine, Beijing Chao-Yang Hospital, Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation, Capital Medical University, Beijing, China.
Department of Emergency Medicine, Capital Medical University School of Rehabilitation Medicine, Beijing Bo'Ai Hospital, China Rehabilitation Research Center , Beijing, China.
出版信息
BMC Infect Dis. 2024 Mar 4;24(1):282. doi: 10.1186/s12879-024-09154-x.
BACKGROUND
The performance of the sepsis-induced coagulopathy (SIC) and sequential organ failure assessment (SOFA) scores in predicting the prognoses of patients with sepsis has been validated. This study aimed to investigate the time course of SIC and SOFA scores and their association with outcomes in patients with sepsis.
METHODS
This prospective study enrolled 209 patients with sepsis admitted to the emergency department. The SIC and SOFA scores of the patients were assessed on days 1, 2, and 4. Patients were categorized into survivor or non-survivor groups based on their 28-day survival. We conducted a generalized estimating equation analysis to evaluate the time course of SIC and SOFA scores and the corresponding differences between the two groups. The predictive value of SIC and SOFA scores at different time points for sepsis prognosis was evaluated.
RESULTS
In the non-survivor group, SIC and SOFA scores gradually increased during the first 4 days (P < 0.05). In the survivor group, the SIC and SOFA scores on day 2 were significantly higher than those on day 1 (P < 0.05); however, they decreased on day 4, dropping below the levels observed on day 1 (P < 0.05). The non-survivors showed higher SIC scores on days 2 (P < 0.05) and 4 (P < 0.001) than the survivors, whereas no significant differences were found between the two groups on day 1 (P > 0.05). The performance of SIC scores on day 4 for predicting mortality was more accurate than that on day 2, with areas under the curve of 0.749 (95% confidence interval [CI]: 0.674-0.823), and 0.601 (95% CI: 0.524-0.679), respectively. The SIC scores demonstrated comparable predictive accuracy for 28-day mortality to the SOFA scores on days 2 and 4. Cox proportional hazards models indicated that SIC on day 4 (hazard ratio [HR] = 3.736; 95% CI: 2.025-6.891) was an independent risk factor for 28-day mortality.
CONCLUSIONS
The time course of SIC and SOFA scores differed between surviving and non-surviving patients with sepsis, and persistent high SIC and SOFA scores can predict 28-day mortality.
背景
脓毒症诱导的凝血障碍（SIC）和序贯器官衰竭评估（SOFA）评分在预测脓毒症患者预后方面的性能已得到验证。本研究旨在探讨 SIC 和 SOFA 评分的时间过程及其与脓毒症患者结局的关系。
方法
这项前瞻性研究纳入了 209 名因脓毒症入住急诊科的患者。患者在第 1、2 和 4 天接受 SIC 和 SOFA 评分评估。根据 28 天的生存情况，将患者分为存活组和非存活组。我们使用广义估计方程分析来评估 SIC 和 SOFA 评分的时间过程以及两组之间的相应差异。评估 SIC 和 SOFA 评分在不同时间点对脓毒症预后的预测价值。
结果
在非存活组中，SIC 和 SOFA 评分在第 4 天逐渐升高（P < 0.05）。在存活组中，第 2 天的 SIC 和 SOFA 评分明显高于第 1 天（P < 0.05）；然而，第 4 天它们下降，低于第 1 天的水平（P < 0.05）。第 2 天（P < 0.05）和第 4 天（P < 0.001）的非存活者 SIC 评分均高于存活者，而第 1 天两组间无显著差异（P > 0.05）。SIC 评分在第 4 天预测死亡率的性能比第 2 天更准确，曲线下面积分别为 0.749（95%置信区间[CI]：0.674-0.823）和 0.601（95% CI：0.524-0.679）。第 4 天 SIC 评分对 28 天死亡率的预测准确性与第 2 天和第 4 天的 SOFA 评分相当。Cox 比例风险模型表明，第 4 天的 SIC（风险比[HR] = 3.736；95% CI：2.025-6.891）是 28 天死亡率的独立危险因素。
结论
存活和非存活脓毒症患者的 SIC 和 SOFA 评分时间过程不同，持续高 SIC 和 SOFA 评分可预测 28 天死亡率。
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