Evaluation of the Neonatal Sequential Organ Failure Assessment and Mortality Risk in Preterm Infants With Late-Onset Infection.
Evaluation of the Neonatal Sequential Organ Failure Assessment and Mortality Risk in Preterm Infants With Late-Onset Infection.
复制标题
对早产儿的新生儿顺序器官衰竭评估和死亡感染的死亡风险的评估。
DOI：
10.1001/jamanetworkopen.2020.36518
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发表时间：
2021-02-01
影响因子：
13.8
通讯作者：
Wynn JL
中科院分区：
文献类型：
--
作者：
Fleiss N;Coggins SA;Lewis AN;Zeigler A;Cooksey KE;Walker LA;Husain AN;de Jong BS;Wallman-Stokes A;Alrifai MW;Visser DH;Good M;Sullivan B;Polin RA;Martin CR;Wynn JL
新生儿序贯性器官衰竭评估在鉴别晚发型感染相关死亡高危早产儿中的作用如何？在这项对653例迟发性感染早产儿的多中心队列研究中，新生儿序贯器官衰竭评估评分与感染所致死亡率相关。按性别或病原体种类的革兰氏染色分层或限制在小于25周的完整妊娠的分析没有降低新生儿序贯器官衰竭评估评分与感染相关死亡率的相关性。在一个大型多中心队列中，单中心验证的新生儿序贯器官衰竭评估评分与早产儿迟发性感染的死亡风险相关，这意味着普遍性。新生儿感染仍然是一个重大问题。由于缺乏对脓毒症的共识定义，这一人群的进展受到阻碍。在成人中，序贯器官衰竭评估（SOFA）可操作感染的死亡风险，并定义败血症。新生儿SOFA（nSOFA）用于新生儿迟发性感染相关死亡率的普遍性尚不清楚。确定nSOFA在多个研究中心新生儿迟发性感染相关死亡率中的普遍性。一项多中心回顾性队列研究于2010年1月1日至2019年12月31日在7个新生儿重症监护病房进行。参与者包括653名早产（<33周）极低出生体重儿。迟发性（> 72小时）感染，包括菌血症、真菌血症或手术腹膜炎。主要结局是迟发性感染事件死亡率。在事件发生前后的9个时间点（T），比较了确认迟发性感染的存活者和非存活者的nSOFA评分。在符合纳入标准的653名婴儿中，中位胎龄为25.5周（四分位距，24 - 27周），中位出生体重为780 g（四分位距，638 - 960 g）。共有366名婴儿（56%）为男性。97名婴儿（15%）发生迟发性感染事件死亡。总队列中死亡率的受试者工作特征曲线下面积在各研究中心的范围为0.71 - 0.95（T0小时）、0.77 - 0.96（T6小时）和0.78 - 0.96（T12小时），在所有研究中心和总体中均观察到效用。使用T0或T6时的最大nSOFA评分，死亡率的受试者工作特征曲线下面积为0.88（95% CI，0.84 - 0.91）。按性别或革兰氏染色鉴定病原体分类分层分析或仅限于小于25周的完整妊娠出生的婴儿，并没有降低nSOFA评分与感染相关死亡率的相关性。nSOFA评分与评估时早产儿迟发性感染死亡率相关，无论是总体还是每个中心。这些结果表明，nSOFA可以作为该人群脓毒症共识定义的基础。该队列研究评估了新生儿序贯器官衰竭评估指标在定义新生儿败血症和估计感染相关死亡风险方面的普遍性。
How useful is the neonatal Sequential Organ Failure Assessment for identification of preterm infants at high risk for late-onset, infection-associated mortality? In this multicenter cohort study of 653 preterm infants with late-onset infection, the neonatal Sequential Organ Failure Assessment score was associated with infection-attributable mortality. Analyses stratified by sex or Gram stain of pathogen class or restricted to less than 25 weeks’ completed gestation did not reduce the association of the neonatal Sequential Organ Failure Assessment score with infection-related mortality. In a large, multicenter cohort, the single-center–validated neonatal Sequential Organ Failure Assessment score was associated with mortality risk with late-onset infection in preterm infants, implying generalizability. Infection in neonates remains a substantial problem. Advances for this population are hindered by the absence of a consensus definition for sepsis. In adults, the Sequential Organ Failure Assessment (SOFA) operationalizes mortality risk with infection and defines sepsis. The generalizability of the neonatal SOFA (nSOFA) for neonatal late-onset infection-related mortality remains unknown. To determine the generalizability of the nSOFA for neonatal late-onset infection-related mortality across multiple sites. A multicenter retrospective cohort study was conducted at 7 academic neonatal intensive care units between January 1, 2010, and December 31, 2019. Participants included 653 preterm (<33 weeks) very low-birth-weight infants. Late-onset (>72 hours of life) infection including bacteremia, fungemia, or surgical peritonitis. The primary outcome was late-onset infection episode mortality. The nSOFA scores from survivors and nonsurvivors with confirmed late-onset infection were compared at 9 time points (T) preceding and following event onset. In the 653 infants who met inclusion criteria, median gestational age was 25.5 weeks (interquartile range, 24-27 weeks) and median birth weight was 780 g (interquartile range, 638-960 g). A total of 366 infants (56%) were male. Late-onset infection episode mortality occurred in 97 infants (15%). Area under the receiver operating characteristic curves for mortality in the total cohort ranged across study centers from 0.71 to 0.95 (T0 hours), 0.77 to 0.96 (T6 hours), and 0.78 to 0.96 (T12 hours), with utility noted at all centers and in aggregate. Using the maximum nSOFA score at T0 or T6, the area under the receiver operating characteristic curve for mortality was 0.88 (95% CI, 0.84-0.91). Analyses stratified by sex or Gram-stain identification of pathogen class or restricted to infants born at less than 25 weeks’ completed gestation did not reduce the association of the nSOFA score with infection-related mortality. The nSOFA score was associated with late-onset infection mortality in preterm infants at the time of evaluation both in aggregate and in each center. These findings suggest that the nSOFA may serve as the foundation for a consensus definition of sepsis in this population. This cohort study assesses the generalizability of the neonatal Sequential Organ Failure Assessment metric for defining sepsis in neonates and estimating risk of infection-related mortality.
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DOI：
10.1186/s13054-017-1609-1
发表时间：
2017-02-24
期刊：
Critical care (London, England)
影响因子：
--
作者：
de Grooth HJ;Geenen IL;Girbes AR;Vincent JL;Parienti JJ;Oudemans-van Straaten HM
通讯作者：
Oudemans-van Straaten HM
影响因子：
158.5
作者：
Dorling, Jon;Abbott, Jane;Townend, John
通讯作者：
Townend, John
影响因子：
168.9
作者：
Griffiths, James;Jenkins, Paula;Bradburn, Mike
通讯作者：
Bradburn, Mike
影响因子：
158.5
作者：
Brocklehurst, Peter;Farrell, Barbara;Tarnow-Mordi, William
通讯作者：
Tarnow-Mordi, William
影响因子：
3
作者：
Jhang, Won Kyoung;Kim, Young A.;Park, Seong Jong
通讯作者：
Park, Seong Jong