切换至 "中华医学电子期刊资源库"

第五届中国出版政府奖音像电子网络出版物奖提名奖

中国科技核心期刊

中国科学引文数据库(CSCD)来源期刊

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

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]. 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]. 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
1
Zhou J, Tian H, Du X, et al; China Critical Care Clinical Trials Group (CCCCTG). Population-based epidemiology of sepsis in a subdistrict of Beijing [J]. Crit Care Med, 2017, 45(7): 1168-1176.
2
Tian HC, Zhou JF, Weng L, et al. Epidemiology of Sepsis-3 in a sub-district of Beijing: secondary analysis of a population-based database [J]. Chin Med J (Engl), 2019, 132(17): 2039-2045.
3
Rudd KE, Johnson SC, Agesa KM, et al. Global, regional, and national sepsis incidence and mortality, 1990-2017: analysis for the Global Burden of Disease Study [J]. Lancet, 2020, 395(10219): 200-211.
4
Esteban A, Frutos-Vivar F, Ferguson ND, et al. Sepsis incidence and outcome: contrasting the Intensive Care Unit with the hospital ward [J]. Crit Care Med, 2007, 35(5): 1284-1289.
5
Angus DC, Linde-Zwirble WT, Lidicker J, et al. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care [J]. Crit Care Med, 2001, 29(7): 1303-1310.
6
Wang JY, Chen YX, Guo SB, et al. Predictive performance of quick sepsis-related organ failure assessment for mortality and ICU admission in patients with infection at the ED [J]. Am J Emerg Med, 2016, 34(9): 1788-1793.
7
Churpek MM, Snyder A, Han X, et al. Quick sepsis-related organ failure assessment, systemic inflammatory response syndrome, and early warning scores for detecting clinical deterioration in infected patients outside the Intensive Care Unit [J]. Am J Respir Crit Care Med, 2017, 195(7): 906-911.
8
Bone RC, Balk RA, Cerra FB, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine [J]. Chest, 1992, 101(6): 1644-1655.
9
Seymour CW, Liu VX, Iwashyna TJ, et al. Assessment of clinical criteria for sepsis: for the third international consensus definitions for sepsis and septic shock (Sepsis-3) [J]. JAMA, 2016, 315(8): 762.
10
Sadaka F, Ethmane Abou El Maali C, Cytron MA, et al. Predicting mortality of patients with sepsis: a comparison of APACHE Ⅱ and APACHE Ⅲ scoring systems [J]. J Clin Med Res, 2017, 9(11): 907-910.
11
Rhee C, Dantes RB, Epstein L, et al. Using objective clinical data to track progress on preventing and treating sepsis: CDC's new 'Adult Sepsis Event' surveillance strategy [J]. BMJ Qual Saf, 2019, 28(4): 305-309.
12
Purcarea A, Sovaila S. Sepsis, a 2020 review for the internist [J]. Rom J Intern Med, 2020, 58(3): 129-137.
13
Weng L, Xu Y, Yin P, et al. National incidence and mortality of hospitalized sepsis in China [J]. Crit Care, 2023, 27(1): 84.
14
Brink A, Alsma J, Verdonschot RJCG, et al. Predicting mortality in patients with suspected sepsis at the Emergency Department, A retrospective cohort study comparing qSOFA, SIRS and National Early Warning Score [J]. PLoS One, 2019, 14(1): e0211133.
15
Usman OA, Usman AA, Ward MA, Comparison of SIRS, qSOFA, and NEWS for the early identification of sepsis in the Emergency Department [J]. Am J Emerg Med, 2019, 37(8): 1490-1497.
16
Lo RSL, Leung LY, Brabrand M, et al. qSOFA is a poor predictor of short-term mortality in all patients: a systematic review of 410,000 patients [J]. J Clin Med, 2019, 8(1): 61.
17
Finkelsztein EJ, Jones DS, Ma KC, et al. Comparison of qSOFA and SIRS for predicting adverse outcomes of patients with suspicion of sepsis outside the Intensive Care Unit [J]. Crit Care, 2017, 21(1): 73.
18
Samaraweera SA, Gibbons B, Gour A, et al. Arterial versus venous lactate: a measure of sepsis in children [J]. Eur J Pediatr, 2017, 176(8): 1055-1060.
19
Rhee C, Zhang Z, Kadri SS, et al. Sepsis surveillance using adult sepsis events simplified eSOFA criteria versus Sepsis-3 sequential organ failure assessment criteria [J]. Crit Care Med, 2019, 47(3): 307-314.
20
Shi Q, Xu Y, Zhang B, et al. External validation and comparison of two versions of simplified sequential organ failure assessment scores to predict prognosis of septic patients [J]. Int J Clin Pract, 2021, 75(12): e14865.
21
Dong R, Tian H, Zhou J, et al; China Critical Care Clinical Trials Group (CCCCTG). External validity of Adult Sepsis Event's simplified eSOFA criteria: a retrospective analysis of patients with confirmed infection in China [J]. Ann Intensive Care, 2020, 10(1): 14.
22
Raith EP, Udy AA, Bailey M, et al. Prognostic accuracy of the SOFA score, SIRS criteria, and qSOFA score for in-hospital mortality among adults with suspected infection admitted to the Intensive Care Unit [J]. JAMA, 2017, 317(3): 290-300.
[1] 孟建标, 张庚, 焦燕娜. 脓毒症合并心功能障碍患者早期肠道微生态改变的探讨[J]. 中华危重症医学杂志(电子版), 2023, 16(04): 279-285.
[2] 陈宇, 冯芳, 张露, 刘健. 基于生物信息学分析筛选脓毒症心肌病关键致病基因[J]. 中华危重症医学杂志(电子版), 2023, 16(04): 286-291.
[3] 韩媛媛, 热孜亚·萨贝提, 冒智捷, 穆福娜依·艾尔肯, 陆晨, 桑晓红, 阿尔曼·木拉提, 张丽. 组合式血液净化治疗对脓毒症患者血清炎症因子水平和临床预后的影响[J]. 中华危重症医学杂志(电子版), 2023, 16(04): 272-278.
[4] 莫小乔, 胡喆莹, 廖冬花, 谢天. 脓毒症继发急性肾损伤患者死亡风险预测模型构建及评估[J]. 中华危重症医学杂志(电子版), 2023, 16(03): 198-206.
[5] 作者. 脓毒症与脓毒性休克[J]. 中华危重症医学杂志(电子版), 2023, 16(03): 0-.
[6] 张晓燕, 肖东琼, 高沪, 陈琳, 唐发娟, 李熙鸿. 转录因子12过表达对脓毒症相关性脑病大鼠大脑皮质的保护作用及其机制[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(05): 540-549.
[7] 魏徐, 张鸽, 伍金林. 新生儿脓毒症相关性凝血病的监测和治疗[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(04): 379-386.
[8] 姚咏明. 如何精准评估烧伤脓毒症患者免疫状态[J]. 中华损伤与修复杂志(电子版), 2023, 18(06): 552-552.
[9] 窦上文, 邓欢, 刘邦锋, 岳高远志, 朱华财, 刘永达. 术前复查尿培养在预测微通道经皮肾镜取石术相关感染并发症中的作用[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(04): 361-366.
[10] 李伟, 卓剑, 黄川, 黄有攀. Lac、HO-1、sRAGE、CRP/ALB表达及脓毒症并发ARDS危险因素分析[J]. 中华肺部疾病杂志(电子版), 2023, 16(04): 514-516.
[11] 苗软昕, 乔晞. Toll样受体在脓毒症性急性肾损伤中的作用[J]. 中华肾病研究电子杂志, 2023, 12(04): 210-214.
[12] 李世明, 黄蔚, 刘玲. HMGB1介导脓毒症相关凝血功能障碍的作用机制及其治疗进展[J]. 中华重症医学电子杂志, 2023, 09(03): 269-273.
[13] 高超, 巢杰, 邱海波. T-bet:脓毒症免疫失衡中Th17细胞的新型调节分子[J]. 中华重症医学电子杂志, 2023, 09(03): 280-285.
[14] 谭睿, 王晶, 於江泉, 郑瑞强. 脓毒症中高密度脂蛋白、载脂蛋白A-I和血清淀粉样蛋白A的作用研究进展[J]. 中华临床医师杂志(电子版), 2023, 17(06): 749-753.
[15] 蔡荇, 郑瑞强. 肝素结合蛋白在脓毒症中的应用及研究进展[J]. 中华临床医师杂志(电子版), 2023, 17(04): 487-490.
阅读次数
全文


摘要