University of California Los Angeles David Geffen School of Medicine, 855 Tiverton Dr, Los Angeles, CA, USA; Department of Pulmonary and Critical Care Medicine, Department of Medicine, Intermountain Medical Center, 5121 South Cottonwood St, Murray, UT, USA.
Department of Pulmonary and Critical Care Medicine, Department of Medicine, Intermountain Medical Center, 5121 South Cottonwood St, Murray, UT, USA; Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Utah School of Medicine, 30 N 1900 E, Salt Lake City, UT, USA.
Am J Emerg Med. 2024 Nov;85:140-147. doi: 10.1016/j.ajem.2024.08.037. Epub 2024 Sep 2.
This study sought to externally validate and compare proposed methods for stratifying sepsis risk at emergency department (ED) triage.
This nested case/control study enrolled ED patients from four hospitals in Utah and evaluated the performance of previously-published sepsis risk scores amenable to use at ED triage based on their area under the precision-recall curve (AUPRC, which balances positive predictive value and sensitivity) and area under the receiver operator characteristic curve (AUROC, which balances sensitivity and specificity). Score performance for predicting whether patients met Sepsis-3 criteria in the ED was compared to patients' assigned ED triage score (Canadian Triage Acuity Score [CTAS]) with adjustment for multiple comparisons.
Among 2000 case/control patients, 981 met Sepsis-3 criteria on final adjudication. The best performing sepsis risk scores were the Predict Sepsis version #3 (AUPRC 0.183, 95 % CI 0.148-0.256; AUROC 0.859, 95 % CI 0.843-0.875) and Borelli scores (AUPRC 0.127, 95 % CI 0.107-0.160, AUROC 0.845, 95 % CI 0.829-0.862), which significantly outperformed CTAS (AUPRC 0.038, 95 % CI 0.035-0.042, AUROC 0.650, 95 % CI 0.628-0.671, p < 0.001 for all AUPRC and AUROC comparisons). The Predict Sepsis and Borelli scores exhibited sensitivity of 0.670 and 0.678 and specificity of 0.902 and 0.834, respectively, at their recommended cutoff values and outperformed Systemic Inflammatory Response Syndrome (SIRS) criteria (AUPRC 0.083, 95 % CI 0.070-0.102, p = 0.052 and p = 0.078, respectively; AUROC 0.775, 95 % CI 0.756-0.795, p < 0.001 for both scores).
The Predict Sepsis and Borelli scores exhibited improved performance including increased specificity and positive predictive values for sepsis identification at ED triage compared to CTAS and SIRS criteria.
本研究旨在对急诊科分诊时脓毒症风险分层的建议方法进行外部验证和比较。
本巢式病例对照研究纳入了来自犹他州 4 家医院的急诊科患者，并根据精确召回曲线下面积（AUPRC，平衡阳性预测值和灵敏度）和受试者工作特征曲线下面积（AUROC，平衡灵敏度和特异性）评估了先前发表的可用于急诊科分诊的脓毒症风险评分的性能。比较了预测评分对预测患者是否符合急诊科 Sepsis-3 标准的表现与患者的急诊分诊评分（加拿大分诊 acuity 评分[CTAS]），并进行了多次比较调整。
在 2000 例病例对照患者中，981 例经最终裁决符合 Sepsis-3 标准。表现最好的脓毒症风险评分是 Predict Sepsis 版本#3（AUPRC 0.183，95%CI 0.148-0.256；AUROC 0.859，95%CI 0.843-0.875）和 Borelli 评分（AUPRC 0.127，95%CI 0.107-0.160，AUROC 0.845，95%CI 0.829-0.862），这两项评分显著优于 CTAS（AUPRC 0.038，95%CI 0.035-0.042，AUROC 0.650，95%CI 0.628-0.671，p<0.001）。Predict Sepsis 和 Borelli 评分在其推荐的临界值处分别表现出 0.670 和 0.678 的灵敏度和 0.902 和 0.834 的特异性，优于全身炎症反应综合征（SIRS）标准（AUPRC 0.083，95%CI 0.070-0.102，p=0.052 和 p=0.078，分别；AUROC 0.775，95%CI 0.756-0.795，p<0.001）。
与 CTAS 和 SIRS 标准相比，Predict Sepsis 和 Borelli 评分在急诊科分诊时对脓毒症的识别具有更高的特异性和阳性预测值，从而提高了性能。
