Bidart João P M, Rosa Regis G, Bessel Marina, Pedrotti Luana G, Goldani Luciano Z
Emergency Department, Moinhos de Vento Hospital, 910, Ramiro Barcelos Street, Porto Alegre, Zip code, 90035-001, Brazil.
Internal Medicine Department, Moinhos de Vento Hospital, Ramiro Barcelos, 630, Porto Alegre, 90035- 001, Brazil.
Int J Emerg Med. 2024 Jun 17;17(1):74. doi: 10.1186/s12245-024-00655-9.
Sepsis remains a worldwide major cause of hospitalization, mortality, and morbidity. To enhance the identification of patients with suspected sepsis at high risk of mortality and adverse outcomes in the emergency department (ED), the use of mortality predictors is relevant. This study aims to establish whether quick sofa (qSOFA) and the severity criteria applied in patients with suspicion of sepsis in a monitored ED are in fact predictors of mortality.
We performed a retrospective cohort study among adult patients with suspicion of sepsis at the ED of a tertiary care hospital in Brazil between January 1st, 2019 and December 31, 2020. All adult patients (ages 18 and over) with suspected sepsis that scored two or more points on qSOFA score or at least one point on the severity criteria score were included in the study.
The total of patients included in the study was 665 and the average age of the sample was 73 ± 19 years. The ratio of men to women was similar. Most patients exhibited qSOFA ≥ 2 (58.80%) and 356 patients (53.61%) scored one point in the severity criteria at admission. The overall mortality rate was 19.7% (131 patients) with 98 patients (14.74%) having positive blood cultures, mainly showing Escherichia coli as the most isolated bacteria. Neither scores of qSOFA nor the severity criteria were associated with mortality rates, but scoring any point on qSOFA was considered as an independent factor for intensive care unit (ICU) admission (qSOFA = 1 point, p = 0.02; qSOFA = 2 points, p = 0.03, and qSOFA = 3 points, p = 0.04). Positive blood cultures (RR, 1.63;95% CI, 1.10 to 2.41) and general administration of vasopressors at the ED (RR, 2.14;95% CI, 1.44 to 3.17) were associated with 30-day mortality. The administration of vasopressors at the ED (RR, 2.25; CI 95%, 1.58 to 3.21) was found to be a predictor of overall mortality.
Even though an association was found between qSOFA and ICU admission, there was no association of qSOFA or the severity criteria with mortality. Therefore, patients with a tendency toward greater severity could be identified and treated more quickly and effectively in the emergency department. Further studies are necessary to assess novel scores or biomarkers to predict mortality in sepsis patients admitted to the ED's initial care.
脓毒症仍然是全球范围内住院、死亡和发病的主要原因。为了加强在急诊科（ED）对疑似脓毒症且有高死亡风险和不良结局患者的识别，使用死亡率预测指标具有重要意义。本研究旨在确定快速序贯器官衰竭评估（qSOFA）以及在监测的急诊科中应用于疑似脓毒症患者的严重程度标准是否实际上是死亡率的预测指标。
我们在2019年1月1日至2020年12月31日期间，对巴西一家三级护理医院急诊科疑似脓毒症的成年患者进行了一项回顾性队列研究。所有qSOFA评分达到两分或以上或严重程度标准评分至少一分的疑似脓毒症成年患者（年龄18岁及以上）均纳入本研究。
纳入研究的患者总数为665例，样本的平均年龄为73±19岁。男女比例相似。大多数患者qSOFA≥2（58.80%），356例患者（53.61%）入院时严重程度标准评分为一分。总体死亡率为19.7%（131例患者），98例患者（14.74%）血培养阳性，主要分离出的细菌为大肠杆菌。qSOFA评分和严重程度标准均与死亡率无关，但qSOFA评分为任何一分均被视为入住重症监护病房（ICU）的独立因素（qSOFA = 1分，p = 0.02；qSOFA = 2分，p = 0.03；qSOFA = 3分，p = 0.04）。血培养阳性（相对危险度，1.63；95%置信区间，1.10至2.41）和在急诊科常规使用血管升压药（相对危险度，2.14；95%置信区间，1.44至3.17）与30天死亡率相关。在急诊科使用血管升压药（相对危险度，2.25；95%置信区间，1.58至3.21）被发现是总体死亡率的一个预测指标。
尽管发现qSOFA与入住ICU之间存在关联，但qSOFA或严重程度标准与死亡率并无关联。因此，在急诊科可以更快、更有效地识别和治疗病情更严重的患者。有必要进行进一步研究以评估新的评分或生物标志物，来预测入住急诊科接受初始治疗的脓毒症患者的死亡率。
