Quantitative capillary refill time predicts sepsis in patients with suspected infection in the emergency department: an observational study
Quantitative capillary refill time predicts sepsis in patients with suspected infection in the emergency department: an observational study
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DOI：
10.1186/s40560-019-0382-4
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发表时间：
2019-05-06
影响因子：
7.1
通讯作者：
Takeuchi, Ichiro
中科院分区：
文献类型：
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作者：
Yasufumi, Oi;Morimura, Naoto;Takeuchi, Ichiro
背景疑似感染的急诊患者的结果取决于临床医生评估患者和开始治疗的速度。本研究旨在比较定量毛细血管再充盈时间（Q-CRT）作为一种新的快速指标与快速序贯器官衰竭评估（qSOFA）评分和全身炎症反应综合征（SIRS）评分对急诊科脓毒症筛查的预测能力。方法这是一项针对疑似感染的成年患者的多中心、观察性、回顾性研究。采用受试者工作特征曲线分析的曲线下面积（AUC）和多变量分析来探讨 Q-CRT 与 qSOFA 评分、SIRS 评分和乳酸浓度的关联。 结果 75 例入组患者中，48 例患有脓毒症。 Q-CRT 的 AUC、敏感性和特异性分别为 0.74、58% 和 81%； qSOFA 评分分别为 0.83、66% 和 100%； SIRS 评分的分别为 0.61、81% 和 40%；乳酸浓度分别为0.76、72%和81%。我们发现分数之间的 AUC 没有统计学上的显着差异。然后，我们结合 Q-CRT 和 qSOFA 评分（Q-CRT/qSOFA 组合）进行脓毒症筛查。 Q-CRT/qSOFA组合的AUC、敏感性和特异性分别为0.82、83%和81%。结论在本研究中，Q-CRT/qSOFA组合比单独的qSOFA评分具有更好的敏感性，比单独的SIRS评分更好的特异性。 Q-CRT/qSOFA 组合与 qSOFA 评分或乳酸浓度之间的准确性没有显着差异。 Q-CRT 预测脓毒症的能力可能与 qSOFA 评分或血清乳酸浓度相似；因此，在评估疑似脓毒症患者时，Q-CRT 测量可能是血乳酸浓度侵入性测量的替代方法。
BackgroundOutcomes in emergent patients with suspected infection depend on how quickly clinicians evaluate the patients and start treatment. This study was performed to compare the predictive ability of the quantitative capillary refill time (Q-CRT) as a new rapid index versus the quick sequential organ failure assessment (qSOFA) score and the systemic inflammatory response syndrome (SIRS) score for sepsis screening in the emergency department.MethodsThis was a multicenter, observational, retrospective study of adult patients with suspected infection. The area under the curve (AUC) of receiver operating characteristic curve analyses and multivariate analyses were used to explore associations of the Q-CRT with the qSOFA score, SIRS score, and lactate concentration.ResultsOf the 75 enrolled patients, 48 had sepsis. The AUC, sensitivity, and specificity of Q-CRT were 0.74, 58%, and 81%, respectively; those for the qSOFA score were 0.83, 66%, and 100%, respectively; those for the SIRS score were 0.61, 81%, and 40%, respectively, for SIRS score; and those for the lactate concentration were 0.76, 72%, and 81%, respectively. We found no statistically significant differences in the AUC between the scores. We then combined the Q-CRT and qSOFA score (Q-CRT/qSOFA combination) for sepsis screening. The AUC, sensitivity, and specificity of Q-CRT/qSOFA combination were 0.82, 83%, and 81%, respectively.ConclusionsIn this study, Q-CRT/qSOFA combination had better sensitivity than the qSOFA score alone and better specificity than the SIRS score alone. There was no significant difference in accuracy between Q-CRT/qSOFA combination and the qSOFA score or lactate concentration. The ability of the Q-CRT to predict sepsis may be similar to that of the qSOFA score or serum lactate concentration; therefore, measurement of the Q-CRT may be an alternative for invasive measurement of the blood lactate concentration in evaluating patients with suspected sepsis.