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中华重症医学电子杂志 ›› 2023, Vol. 09 ›› Issue (02) : 143 -148. doi: 10.3877/cma.j.issn.2096-1537.2023.02.004

所属专题: 重症医学

临床研究

eSOFA,qSOFA,SIRS对于脓毒症患者预后预测价值的比较:一项基于非ICU住院患者的前瞻性队列研究
刁世童, 王伊帆, 董润, 彭劲民, 何淑华, 翁利(), 杜斌   
  1. 100730 北京,北京协和医学院 中国医学科学院北京协和医院内科ICU 疑难重症和罕见病国家重点实验室
  • 收稿日期:2022-12-09 出版日期:2023-05-28
  • 通信作者: 翁利
  • 基金资助:
    中国医学科学院医学与健康科技创新工程(2021-I2M-1-062); 国家重点研发计划项目(2022YFC2304601)

Comparison of the prognostic prediction of eSOFA, qSOFA, SIRS in sepsis patients: a prospective cohort study based on non-ICU inpatients

Shitong Diao, Yifan Wang, Run Dong, Jinmin Peng, Shuhua He, Li Weng(), Bin Du   

  1. Department of Medical Intensive Care Unit, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 100730, China
  • Received:2022-12-09 Published:2023-05-28
  • Corresponding author: Li Weng
引用本文:

刁世童, 王伊帆, 董润, 彭劲民, 何淑华, 翁利, 杜斌. eSOFA,qSOFA,SIRS对于脓毒症患者预后预测价值的比较:一项基于非ICU住院患者的前瞻性队列研究[J/OL]. 中华重症医学电子杂志, 2023, 09(02): 143-148.

Shitong Diao, Yifan Wang, Run Dong, Jinmin Peng, Shuhua He, Li Weng, Bin Du. Comparison of the prognostic prediction of eSOFA, qSOFA, SIRS in sepsis patients: a prospective cohort study based on non-ICU inpatients[J/OL]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2023, 09(02): 143-148.

目的

评价电子序贯器官衰竭评估(eSOFA)、快速序贯器官衰竭评估(qSOFA)及全身炎症反应综合征(SIRS)评分系统在非ICU环境中预测脓毒症患者预后的价值。

方法

前瞻性分析2016年10月至2017年3月收治于北京协和医院10个非ICU病区的脓毒症患者,以入院后28 d患者临床结局作为预后指标,计算入组患者eSOFA、qSOFA及SIRS评分,使用受试者工作特征曲线(ROC)评价eSOFA、qSOFA及SIRS评分预测患者预后的能力。

结果

研究期间共193例符合Sepsis-3脓毒症诊断标准。eSOFA、qSOFA及SIRS评分预测脓毒症患者预后的ROC的曲线下面积(AUC)分别为0.766(95%CI:0.700~0.824),0.798(95%CI:0.700~0.896),0.589(95%CI:0.475~0.703)。其中qSOFA预测效能最佳,但与eSOFA比较差异无统计学意义,SIRS预测效能最差。

结论

非ICU环境下,qSOFA对脓毒症患者预后的预测效能最佳,eSOFA次之,SIRS最差。

Objective

To evaluate the value of electric sequential organ failure assessment (eSOFA), quick sequential organ failure assessment (qSOFA) and system inflammatory reaction syndrome (SIRS) scoring system in predicting the prognosis of patients with sepsis in the non-ICU environment.

Methods

Patients with sepsis in 10 non-ICU wards of Peking Union Medical College Hospital from October 2016 to March 2017 were prospectively analyzed. The clinical outcome of survival status 28 days after admission was taken as the prognostic index. The eSOFA, qSOFA and SIRS scores of the patients were calculated and the ROC curve was used to evaluate the prognostic value of eSOFA, qSOFA and SIRS scores.

Results

A total of 193 patients met the Sepsis-3 diagnosis criteria. The AUROC of eSOFA, qSOFA and SIRS scores for predicting the prognosis of sepsis patients were 0.766 (95%CI: 0.700-0.824), 0.798 (95%CI: 0.700-0.896) and 0.589 (95%CI: 0.475-0.703) respectively. Among them, qSOFA had the best predictive performance, and both of qSOFA and eSOFA were better than SIRS.

Conclusion

In non-ICU wards, qSOFA performed best in predicting prognosis of sepsis patients, eSOFA is the next and SIRS is the worst.

表1 脓毒症患者临床特征及不同预后的基线结果比较
基线资料 总体(193例) 存活组(170例) 死亡组(23例) 统计值 P
年龄[岁,MQ25Q75)] 55(43,66) 55(41,65) 53(45,68.5) Z=0.376 0.707
男性[例(%)] 105(54.4) 93(54.7) 12(52.2) χ2=0.052 0.819
Charlson合并症评分[例(%)]
0分 62(32.1) 57(33.5) 5(21.7) χ2=1.292 0.256
1分 27(14.0) 23(13.5) 4(17.4) χ2=0.206 0.616
2分 56(29.0) 50(29.4) 6(26.1) χ2=0.109 0.742
≥3分 48(24.9) 40(23.5) 8(34.8) χ2=1.373 0.241
感染来源[例(%)]
呼吸系统 124(64.2) 105(61.8) 19(82.6) χ2=3.832 0.050
泌尿系统 14(7.3) 12(7.1) 2(8.7) χ2=0.081 0.776
腹腔脏器 46(23.8) 42(24.7) 4(17.4) χ2=0.597 0.440
皮肤软组织 14(7.3) 12(7.1) 2(8.7) χ2=0.081 0.776
中枢神经系统 9(4.7) 8(4.7) 1(4.3) χ2=0.006 0.939
其他 40(20.7) 34(20.0) 6(26.1) χ2=0.457 0.499
血培养阳性[例(%)] 38(19.7) 33(19.4) 5(21.7) χ2=0.069 0.792
感染类型[例(%)]
社区感染 136(70.5) 121(71.2) 15(65.2) χ2=0.346 0.557
院内感染 57(29.5) 49(28.8) 8(34.8) χ2=0.346 0.557
入院途径[例(%)]
门诊入院 69(35.8) 65(38.2) 4(17.4) χ2=3.832 0.050
急诊入院 63(32.6) 52(30.6) 11(47.8) χ2=2.738 0.098
其他 61(31.6) 53(31.2) 8(34.8) χ2=0.122 0.727
患者来源[例(%)]
内科 168(87.0) 147(86.5) 19(82.6) χ2=0.251 0.616
外科 25(13.0) 23(13.5) 4(17.4) χ2=0.251 0.616
其他预后指标
感染性休克[例(%)] 22(11.4) 14(8.2) 8(34.8) χ2=14.137 0.000
住院时间[d,MQ25Q75)] 23(13,30) 24.5(15,32) 9(6,16) Z=4.384 0.000
住院总费用[1000人民币,MQ25Q75)] 48.2(19.3,84.3) 48.9(18.8,85.6) 45.7(26.4,90.0) Z=0.076 0.856
脓毒症相关评分[分,MQ25Q75)]
eSOFA 1(1,2) 1(0,2) 2(1,3) Z=4.384 0.000
qSOFA 1(1,2) 1(1,2) 2(2,3) Z=4.120 0.000
SIRS 3(3,4) 3(3,4) 4(3,4) Z=0.831 0.133
SOFA 4(3,5) 4(3,5) 9(6.5,12.5) Z=6.264 0.000
图1 根据eSOFA、qSOFA、SIRS评分系统脓毒症患者的预后分布情况。图a为eSOFA评分;图b为qSOFA评分;图c为SIRS评分注:eSOFA为电子序贯器官衰竭评估;qSOFA为快速序贯器官衰竭评估;SIRS为全身炎症反应综合征
表2 不同评分标准对脓毒症患者28 d病死率预测价值的ROC分析
表3 不同评分标准之间的ROC比较
图2 3种评分预测非ICU患者脓毒症28 d病死率的ROC曲线分析注:eSOFA为电子序贯器官衰竭评估;qSOFA为快速序贯器官衰竭评估;SIRS为全身炎症反应综合征;ROC为曲线下面积
表4 不同评分标准与SOFA评分的Spearman相关性检验
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