Department of Emergency Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 111 Moo 14, Bang Pla, Bang Phli, Samut Prakarn, Thailand.
BMC Emerg Med. 2024 Sep 4;24(1):161. doi: 10.1186/s12873-024-01078-8.
Sepsis is a severe medical condition that can be life-threatening. If sepsis progresses to septic shock, the mortality rate increases to around 40%, much higher than the 10% mortality observed in sepsis. Diabetes increases infection and sepsis risk, making management complex. Various scores of screening tools, such as Modified Early Warning Score (MEWS), Simplified Acute Physiology Score (SAPS II), Sequential Organ Failure Assessment Score (SOFA), and Acute Physiology and Chronic Health Evaluation (APACHE II), are used to predict the severity or mortality rate of disease. Our study aimed to compare the effectiveness and optimal cutoff points of these scores. We focused on the early prediction of septic shock in patients with diabetes in the Emergency Department (ED).
We conducted a retrospective cohort study to collect data on patients with diabetes. We collected prediction factors and MEWS, SOFA, SAPS II and APACHE II scores to predict septic shock in these patients. We determined the optimal cutoff points for each score. Subsequently, we compared the identified scores with the gold standard for diagnosing septic shock by applying the Sepsis-3 criteria.
Systolic blood pressure (SBP), peripheral oxygen saturation (SpO2), Glasgow Coma Scale (GCS), pH, and lactate concentrations were significant predictors of septic shock (p < 0.001). The SOFA score performed well in predicting septic shock in patients with diabetes. The area under the receiver operating characteristics (ROC) curve for the SOFA score was 0.866 for detection within 48 h and 0.840 for detection after 2 h of admission to the ED, with the optimal cutoff score of ≥ 6.
SBP, SpO2, GCS, pH, and lactate concentrations are crucial for the early prediction of septic shock in patients with diabetes. The SOFA score is a superior predictor for the onset of septic shock in patients with diabetes compared with MEWS, SAPS II, and APACHE II scores. Specifically, a cutoff of ≥ 6 in the SOFA score demonstrates high accuracy in predicting shock within 48 h post-ED visit and as early as 2 h after ED admission.
败血症是一种严重的医疗状况，可能危及生命。如果败血症发展为感染性休克，死亡率上升至约 40%，远高于败血症的 10%死亡率。糖尿病增加了感染和败血症的风险，使得管理变得复杂。各种评分筛查工具，如改良早期预警评分（MEWS）、简化急性生理学评分（SAPS II）、序贯器官衰竭评估评分（SOFA）和急性生理学和慢性健康评估（APACHE II），用于预测疾病的严重程度或死亡率。我们的研究旨在比较这些评分的有效性和最佳截断点。我们专注于在急诊科（ED）中预测糖尿病患者感染性休克的早期。
我们进行了一项回顾性队列研究，收集了糖尿病患者的数据。我们收集了预测因素和 MEWS、SOFA、SAPS II 和 APACHE II 评分，以预测这些患者的感染性休克。我们确定了每个评分的最佳截断点。随后，我们通过应用败血症-3 标准将识别出的评分与诊断感染性休克的金标准进行比较。
收缩压（SBP）、外周血氧饱和度（SpO2）、格拉斯哥昏迷评分（GCS）、pH 值和乳酸浓度是感染性休克的显著预测因素（p < 0.001）。SOFA 评分在预测糖尿病患者感染性休克方面表现良好。SOFA 评分在 48 小时内检测的受试者工作特征（ROC）曲线下面积为 0.866，在 ED 就诊后 2 小时内检测的 ROC 曲线下面积为 0.840，最佳截断值为≥6。
SBP、SpO2、GCS、pH 值和乳酸浓度对糖尿病患者感染性休克的早期预测至关重要。SOFA 评分是预测糖尿病患者感染性休克发生的更好指标，优于 MEWS、SAPS II 和 APACHE II 评分。具体来说，SOFA 评分≥6 时，在 ED 就诊后 48 小时内和就诊后 2 小时内预测休克具有较高的准确性。
