A targeted real-time early warning score (TREWScore) for septic shock
A targeted real-time early warning score (TREWScore) for septic shock
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DOI：
10.1126/scitranslmed.aab3719
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发表时间：
2015-08-05
影响因子：
17.1
通讯作者：
Saria, Suchi
中科院分区：
文献类型：
--
作者：
Henry, Katharine E.;Hager, David N.;Saria, Suchi
脓毒症是美国的主要死亡原因，在发生脓毒性休克的患者中死亡率最高。早期积极治疗可降低发病率和死亡率。尽管自动筛查工具可以检测出目前正在经历严重脓毒症和脓毒性休克的患者，但没有一种工具可以预测那些最有可能发生休克的患者。我们分析了重症监护病房患者常规可用的生理和实验室数据，并开发了“TREWScore”，这是一种有针对性的实时预警评分，可预测哪些患者将发生感染性休克。TREWScore在感染性休克发作前识别患者，ROC（受试者工作特征）曲线下面积（AUC）为0.83 [95%置信区间（CI），0.81至0.85]。在特异性为0.67时，TREWScore的灵敏度为0.85，确定患者发病前中位数为28.2 [四分位距（IQR），10.6至94.2]小时。在这些患者中，三分之二是在任何脓毒症相关器官功能障碍之前确定的。相比之下，临床上用于脓毒性休克预测的改良早期预警评分的AUC较低，为0.73（95% CI，0.71 - 0.76）。基于两个全身炎症反应综合征标准、疑似感染和低血压或高乳酸血症的常规筛查方案的敏感性较低，为0.74，特异性为0.64。从电子健康记录中连续采样数据并计算TREWScore可以使临床医生识别有感染性休克风险的患者，并提供早期干预措施，以预防或减轻相关的发病率和死亡率。
Sepsis is a leading cause of death in the United States, with mortality highest among patients who develop septic shock. Early aggressive treatment decreases morbidity and mortality. Although automated screening tools can detect patients currently experiencing severe sepsis and septic shock, none predict those at greatest risk of developing shock. We analyzed routinely available physiological and laboratory data from intensive care unit patients and developed "TREWScore," a targeted real-time early warning score that predicts which patients will develop septic shock. TREWScore identified patients before the onset of septic shock with an area under the ROC (receiver operating characteristic) curve (AUC) of 0.83 [95% confidence interval (CI), 0.81 to 0.85]. At a specificity of 0.67, TREWScore achieved a sensitivity of 0.85 and identified patients a median of 28.2 [interquartile range (IQR), 10.6 to 94.2] hours before onset. Of those identified, two-thirds were identified before any sepsis-related organ dysfunction. In comparison, the Modified Early Warning Score, which has been used clinically for septic shock prediction, achieved a lower AUC of 0.73 (95% CI, 0.71 to 0.76). A routine screening protocol based on the presence of two of the systemic inflammatory response syndrome criteria, suspicion of infection, and either hypotension or hyperlactatemia achieved a lower sensitivity of 0.74 at a comparable specificity of 0.64. Continuous sampling of data from the electronic health records and calculation of TREWScore may allow clinicians to identify patients at risk for septic shock and provide earlier interventions that would prevent or mitigate the associated morbidity and mortality.