The Sequential Organ Failure Assessment score for predicting outcome in patients with severe sepsis and evidence of hypoperfusion at the time of emergency department presentation.
The Sequential Organ Failure Assessment score for predicting outcome in patients with severe sepsis and evidence of hypoperfusion at the time of emergency department presentation.
复制标题
DOI：
10.1097/ccm.0b013e31819def97
复制
发表时间：
2009-05
影响因子：
8.8
通讯作者：
Kline JA
中科院分区：
文献类型：
--
作者：
Jones AE;Trzeciak S;Kline JA
器官衰竭是脓毒症的结局。序贯器官衰竭评估（SOFA）评分在数字上量化了衰竭器官的数量和严重程度。我们研究了SOFA评分在评估急诊科（艾德）就诊时有灌注不足证据的严重脓毒症患者预后中的作用。前瞻性观察性研究。城市，第三级艾德，年度人口普查> 110 000人。艾德患者严重脓毒症，有灌注不足的证据。入选标准：疑似感染，两项或两项以上全身炎症标准，收缩压<<90 mm Hg after a fluid bolus or lactate >4 mmol/L。排除标准年龄<18岁或需要立即手术。在艾德识别时（T0）和入住重症监护室后72小时（T72）计算SOFA评分。主要结局为住院死亡率。采用受试者工作特征曲线下面积评价各时间点SOFA评分的预测能力。检查了Δ SOFA（从T0至T72的SOFA变化）之间的线性关系。2年内共入组了248例受试者，年龄为57 ± 16岁，48%为男性。所有患者均接受标准化定量复苏方案治疗，院内死亡率为21%。T0时的平均SOFA评分为7.1 ± 3.6分，T72时为7.4 ± 4.9分。预测T0时住院死亡率的SOFA受试者工作特征曲线下面积为0.75（95%置信区间0.68 - 0.83），T72时为0.84（95%置信区间0.77-0.90）。发现Δ SOFA与住院死亡率呈正相关。SOFA评分可为艾德出现低灌注的严重脓毒症患者的住院生存提供潜在的有价值的预后信息。
Organ failure worsens outcome in sepsis. The Sequential Organ Failure Assessment (SOFA) score numerically quantifies the number and severity of failed organs. We examined the utility of the SOFA score for assessing outcome of patients with severe sepsis with evidence of hypoperfusion at the time of emergency department (ED) presentation. Prospective observational study. Urban, tertiary ED with an annual census of >110,000. ED patients with severe sepsis with evidence of hypoperfusion. Inclusion criteria: suspected infection, two or more criteria of systemic inflammation, and either systolic blood pressure <90 mm Hg after a fluid bolus or lactate >4 mmol/L. Exclusion criteria age <18 years or need for immediate surgery. SOFA scores were calculated at ED recognition (T0) and 72 hours after intensive care unit admission (T72). The primary outcome was in-hospital mortality. The area under the receiver operating characteristic curve was used to evaluate the predictive ability of SOFA scores at each time point. The relationship between Δ SOFA (change in SOFA from T0 to T72) was examined for linearity. A total of 248 subjects aged 57 ± 16 years, 48% men, were enrolled over 2 years. All patients were treated with a standardized quantitative resuscitation protocol; the in-hospital mortality rate was 21%. The mean SOFA score at T0 was 7.1 ± 3.6 points and at T72 was 7.4 ± 4.9 points. The area under the receiver operating characteristic curve of SOFA for predicting in-hospital mortality at T0 was 0.75 (95% confidence interval 0.68 - 0.83) and at T72 was 0.84 (95% confidence interval 0.77-0.90). The Δ SOFA was found to have a positive relationship with in-hospital mortality. The SOFA score provides potentially valuable prognostic information on in-hospital survival when applied to patients with severe sepsis with evidence of hypoperfusion at the time of ED presentation.