Prognostic accuracy of the serum lactate level, the SOFA score and the qSOFA score for mortality among adults with Sepsis
Prognostic accuracy of the serum lactate level, the SOFA score and the qSOFA score for mortality among adults with Sepsis
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DOI：
10.1186/s13049-019-0609-3
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发表时间：
2019-04-30
影响因子：
3.3
通讯作者：
Wu, Heshui
中科院分区：
文献类型：
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作者：
Liu, Zhiqiang;Meng, Zibo;Wu, Heshui
背景：脓毒症是一种常见的危重疾病，由机体对某些感染因子的过度反应引起。许多生物标志物，包括血清乳酸水平，已被用于脓毒症的诊断和指导治疗。最近，第三次脓毒症和脓毒性休克国际共识定义（脓毒症-3）推荐序贯器官衰竭评估（SOFA）和快速SOFA（qSOFA）而不是乳酸筛查脓毒症和评估预后。在这里，我们的目的是探讨和比较的预后准确性的乳酸水平，SOFA评分和qSOFA评分的死亡率在脓毒症患者使用公共医疗信息市场重症监护III数据库（MIMIC III）。方法：基线特征，实验室检查结果和结果脓毒症患者检索MIMIC III。采用Kaplan-Meier法分析生存率。进行单因素和多因素分析，以确定预后的预测因素。采用受试者工作特征曲线（ROC）分析乳酸与SOFA及qSOFA评分的关系。分析队列包括1865例患者。收集24 h平均乳酸水平和ICU入院前24 h的最差评分。高乳酸组患者的死亡率高于低乳酸组。乳酸是脓毒症预后的独立预测因子。乳酸的AUROC（AUROC，0.664 [95%CI，0.639 - 0.689]）显著高于qSOFA的AUROC（AUROC，0.547 [95%CI，0.521 - 0.574]），与SOFA的AUROC（AUROC，0.686 [95%CI，0.661 - 0.710]）相似。但乳酸相对于SOFA和qSOFA评分的时间不一致。结论：乳酸是脓毒症患者死亡率的独立预后预测因子。它具有上级判别能力，优于qSOFA，并显示出与SOFA相似的判别能力。
Background: Sepsis is a common critical condition caused by the body's overwhelming response to certain infective agents. Many biomarkers, including the serum lactate level, have been used for sepsis diagnosis and guiding treatment. Recently, the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) recommended the Sequential Organ Failure Assessment (SOFA) and the quick SOFA (qSOFA) rather than lactate for screening sepsis and assess prognosis. Here, we aim to explore and compare the prognostic accuracy of the lactate level, the SOFA score and the qSOFA score for mortality in septic patients using the public Medical Information Mart for Intensive Care III database (MIMIC III).Methods: The baseline characteristics, laboratory test results and outcomes for sepsis patients were retrieved from MIMIC III. Survival was analysed by the Kaplan-Meier method. Univariate and multivariate analysis was performed to identify predictors of prognosis. Receiver operating characteristic curve (ROC) analysis was conducted to compare lactate with SOFA and qSOFA scores.Results: A total of 3713 cases were initially identified. The analysis cohort included 1865 patients. The 24-h average lactate levels and the worst scores during the first 24h of ICU admission were collected. Patients in the higher lactate group had higher mortality than those in the lower lactate group. Lactate was an independent predictor of sepsis prognosis. The AUROC of lactate (AUROC, 0.664 [95% CI, 0.639-0.689]) was significantly higher than that of qSOFA (AUROC, 0.547 [95% CI, 0.521-0.574]), and it was similar to the AUROC of SOFA (AUROC, 0.686 [95% CI, 0.661-0.710]). But the timing of lactate relative to SOFA and qSOFA scores was inconsistent.Conclusion: Lactate is an independent prognostic predictor of mortality for patients with sepsis. It has superior discriminative power to qSOFA, and shows discriminative ability similar to that of SOFA.