The systemic inflammatory response syndrome and sequential organ failure assessment scores are effective triage markers following paracetamol (acetaminophen) overdose
The systemic inflammatory response syndrome and sequential organ failure assessment scores are effective triage markers following paracetamol (acetaminophen) overdose
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DOI：
10.1111/j.1365-2036.2011.04687.x
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发表时间：
2011-07-15
影响因子：
7.6
通讯作者：
Simpson, K. J.
中科院分区：
文献类型：
--
作者：
Craig, D. G. N.;Reid, T. W. D. J.;Simpson, K. J.
背景全身炎症反应综合征(SIRS)和序贯器官衰竭评估(SOFA)评分在重症监护环境中被广泛用作预后标志物，可以改善对乙酰氨基酚(对乙酰氨基酚)过量高危患者的分诊。目的评估单一时间点对乙酰氨基酚过量患者SIRS和SOFA评分的预后准确性。结果74例(74%)患者发生SIRS，死亡患者(n=21)较自然存活患者(n=53，P=0.05)更早发生SIRS。70例(70%)患者在服药后96h发生SIRS，死亡率为30%，而30例非SIRS患者的死亡率为0(P=0.001)。在48小时(P=0.009)、72小时(P<；0.001)和96小时(P<；0.001)，死亡患者SOFA评分的中位数显著较高。服药后96h内SOFA评分和GT；7预测死亡/移植的敏感性为95.0(95%CI为78.5~99.1)，特异性为70.5(95%CI为66.3~71.6)。38个单时间点过量扑热息痛的验证队列证实了SIRS和SOFA阈值极高的阴性预测值。结论在服用过量扑热息痛后的头96小时内，既没有SOFA评分，也没有SIRS反应，可以改善分诊，减少将低风险患者转移到三级肝脏中心。
BackgroundThe systemic inflammatory response syndrome (SIRS) and sequential organ failure assessment (SOFA) scores are widely used as prognostic markers in critical care settings and could improve triage of high-risk paracetamol (acetaminophen) overdose patients.AimTo evaluate the prognostic accuracy of the SIRS and SOFA scores following single time point paracetamol overdose.MethodsAnalysis of 100 single time point paracetamol overdoses admitted to a tertiary liver centre, with subsequent prospective validation of identified thresholds. Individual laboratory samples were correlated with the corresponding clinical parameters in relation to time post-overdose, and the daily SOFA and SIRS scores calculated.ResultsA total of 74 (74%) patients developed the SIRS, which occurred significantly earlier in patients who died (n = 21) compared with spontaneous survivors (n = 53, P = 0.05). The SIRS occurred in 70 (70%) patients by 96 h post-overdose, with a 30% mortality rate; compared with 0% mortality in the 30 non-SIRS patients (P = 0.001). Median SOFA scores were significantly higher in nonsurvivors at 48 (P = 0.009), 72 (P < 0.001), and 96 h (P < 0.001). A SOFA score >7 during the first 96 h post-overdose predicted death/transplantation with a sensitivity of 95.0 (95% CI 78.5-99.1) and specificity of 70.5 (95% CI 66.3-71.6). A validation cohort of 38 single time point paracetamol overdoses confirmed the extremely high negative predictive value of both the SIRS and SOFA thresholds.ConclusionsThe absence of either a SOFA score >7 or a SIRS response during the first 96 h following paracetamol overdose could improve triage and reduce transfers of lower risk patients to tertiary liver centres.