Enhanced bedside mortality prediction combining point-of-care lactate and the quick Sequential Organ Failure Assessment (qSOFA) score in patients hospitalised with suspected infection in southeast Asia: a cohort study.
Enhanced bedside mortality prediction combining point-of-care lactate and the quick Sequential Organ Failure Assessment (qSOFA) score in patients hospitalised with suspected infection in southeast Asia: a cohort study.
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DOI：
10.1016/s2214-109x(22)00277-7
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发表时间：
2022-09
影响因子：
34.3
通讯作者：
Limmathurotsakul, Direk
中科院分区：
文献类型：
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作者：
Wright, Shelton W.;Hantrakun, Viriya;Rudd, Kristina E.;Lau, Chuen-Yen;Lie, Khie Chen;Nguyen Van Vinh Chau;Teparrukkul, Prapit;West, T. Eoin;Limmathurotsakul, Direk
在低资源环境中对感染相关死亡率进行简单的床边预测对于分诊和资源利用决策至关重要。我们的目的是通过结合护理点静脉乳酸和快速序贯器官衰竭评估（qSOFA）评分来评估东南亚住院疑似感染的成年患者的死亡率预测。我们进行了一项队列研究，前瞻性地招募了在泰国乌汶拉查他尼Sunpasitthiprasong医院（衍生队列）的18岁或以上的患者，这些患者在过去24小时内因疑似感染而入院（根据2012年存活脓毒症运动，至少有三种记录的全身感染表现）。静脉乳酸浓度由即时护理装置测定，并进行多重评分。然后，我们结合qSOFA和乳酸评分评估候选28天死亡率预测模型。将最终模型与qSOFA评分、乳酸评分和改进的序贯器官衰竭评估（SOFA）评分进行比较，使用受试者工作特征曲线下面积（AUROC）进行死亡率区分。然后在东南亚的一个外部、前瞻性招募的多国队列中验证了qsofa -乳酸评分的死亡率歧视。2013年3月1日至2017年1月26日期间，5001例患者被纳入衍生队列；4980人有可获得的护理点乳酸数据，符合分析条件，816人在入组28天内死亡。结合qSOFA评分和乳酸评分对28天死亡率预测的鉴别性优于单独使用qSOFA评分（AUROC为0.78 [95% CI为0.76 - 0.80]vs 0.68 [0.67 - 0.70]; p< 0.0001），与修改后的SOFA评分相似（0.77 [0.75 - 0.78];p= 0.088）。与qSOFA评分相比，单独使用乳酸评分具有更强的辨别力（AUROC为0.76 [95% CI 0.74-0.78]; p< 0.0001）。815名患者被纳入外部验证队列，792名患者具有护理点乳酸数据并被纳入分析；与单独使用qSOFA评分（0.69 [0.63 - 0.74],p< 0.0001）相比，qSOFA-乳酸评分（AUROC 0.77 [95% CI 0.73 - 0.82]）显著改善了28天死亡率歧视。在东南亚，基于护理点乳酸浓度结合qSOFA评分的快速床边评估可以比单独使用qSOFA评分更准确地识别脓毒症相关死亡风险患者，并且与修改后的SOFA评分具有相似的准确性。国家卫生研究院，惠康基金会。
Simple, bedside prediction of infection-related mortality in low-resource settings is crucial for triage and resource-utilisation decisions. We aimed to evaluate mortality prediction by combining point-of-care venous lactate with the quick Sequential Organ Failure Assessment (qSOFA) score in adult patients admitted to hospital with suspected infection in southeast Asia. We performed a cohort study by prospectively enrolling patients aged 18 years or older who had been admitted to hospital within the previous 24 h for suspected infection (with at least three documented systemic manifestations of infection according to the 2012 Surviving Sepsis Campaign) at Sunpasitthiprasong Hospital in Ubon Ratchathani, Thailand (derivation cohort). Venous lactate concentration was determined by a point-of-care device and multiple scores were developed. We then evaluated candidate 28-day mortality prediction models combining qSOFA and the lactate scores. A final model was compared with the qSOFA score, a lactate score, and a modified Sequential Organ Failure Assessment (SOFA) score for mortality discrimination using the area under the receiver operating characteristic curve (AUROC). Mortality discrimination of the qSOFA-lactate score was then verified in an external, prospectively enrolled, multinational cohort in southeast Asia. Between March 1, 2013, and Jan 26, 2017, 5001 patients were enrolled in the derivation cohort; 4980 had point-of-care lactate data available and were eligible for analysis, and 816 died within 28 days of enrolment. The discrimination for 28-day mortality prediction of a qSOFA-lactate score combining the qSOFA score and a lactate score was superior to that of the qSOFA score alone (AUROC 0·78 [95% CI 0·76–0·80] vs 0·68 [0·67–0·70]; p<0·0001) and similar to a modified SOFA score (0·77 [0·75–0·78]; p=0·088). A lactate score alone had superior discrimination compared with the qSOFA score (AUROC 0·76 [95% CI 0.74–0.78]; p<0·0001). 815 patients were enrolled in the external validation cohort and 792 had point-of-care lactate data and were included in the analysis; the qSOFA-lactate score (AUROC 0·77 [95% CI 0·73–0·82]) showed significantly improved 28-day mortality discrimination compared with the qSOFA score alone (0·69 [0·63–0·74]; p<0·0001). In southeast Asia, rapid, bedside assessments based on point-of-care lactate concentration combined with the qSOFA score can identify patients at risk of sepsis-related mortality with greater accuracy than the qSOFA score alone, and with similar accuracy to a modified SOFA score. National Institutes of Health, Wellcome Trust.