Mukhtar Osama, Lal Amos, Jentzer Jacob, Kashani Kianoush
Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA.
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.
J Community Hosp Intern Med Perspect. 2025 Jan 6;15(1):13-21. doi: 10.55729/2000-9666.1436. eCollection 2025.
This study evaluated the predictive value of SCAI shock staging for mortality in patients with sepsis and septic shock admitted to the medical ICU.
This is a single-center historical cohort study. We analyzed data for adults (≥18-year-old) admitted to the medical ICU at Mayo Clinic St. Mary's campus with sepsis between June 1, 2018, and December 31, 2021. Sepsis was identified using the Sepsis-III criteria. Patients were stratified based on SCAI shock staging. Our primary outcome was all-cause 30-day mortality.
We identified 3079 eligible adult patients with sepsis or septic shock. The distribution of SCAI shock stages A through E was 9%, 12%, 25%, 49%, and 5%, respectively. The overall 30-day mortality was 24%. There was progression in all outcomes including ICU, hospital and 30-day mortality across SCAI shock stages. However, only SCAI shock stages D and E, had statistically significant adjusted HRs of 1.6 and 3, respectively. When compared to SOFA score, SCAI shock staging performed similarly in predicting ICU mortality with no statistically significant difference in AUCs, -value of 0.07.
Our results support the use of SCAI shock staging in critically ill medical patients with sepsis and septic shock for risk stratification. We propose that the SCAI shock staging may be used as a universal system for grading the severity of shock in critically ill patients regardless of etiology.
本研究评估了SCAI休克分期对入住内科重症监护病房（ICU）的脓毒症和脓毒性休克患者死亡率的预测价值。
这是一项单中心回顾性队列研究。我们分析了2018年6月1日至2021年12月31日期间在梅奥诊所圣玛丽院区入住内科ICU的成年（≥18岁）脓毒症患者的数据。脓毒症采用Sepsis-III标准进行诊断。患者根据SCAI休克分期进行分层。我们的主要结局是全因30天死亡率。
我们确定了3079例符合条件的成年脓毒症或脓毒性休克患者。SCAI休克分期A至E的分布分别为9%、12%、25%、49%和5%。总体30天死亡率为24%。包括ICU、医院和30天死亡率在内的所有结局在SCAI休克分期中均有进展。然而，只有SCAI休克分期D和E的校正风险比分别具有统计学意义，为1.6和3。与序贯器官衰竭评估（SOFA）评分相比，SCAI休克分期在预测ICU死亡率方面表现相似，曲线下面积（AUC）无统计学显著差异，P值为0.07。
我们的结果支持将SCAI休克分期用于脓毒症和脓毒性休克危重症患者的风险分层。我们建议，SCAI休克分期可作为一种通用系统，用于对危重症患者休克的严重程度进行分级，而不考虑病因。
