Predictive Accuracy of the Quick Sepsis-related Organ Failure Assessment Score in Brazil A Prospective Multicenter Study
Predictive Accuracy of the Quick Sepsis-related Organ Failure Assessment Score in Brazil A Prospective Multicenter Study
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DOI：
10.1164/rccm.201905-0917oc
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发表时间：
2020-04-01
影响因子：
24.7
通讯作者：
Azevedo, Luciano C. P.
中科院分区：
文献类型：
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作者：
Machado, Flavia R.;Cavalcanti, Alexandre B.;Azevedo, Luciano C. P.
基本原理：虽然提出了作为一个临床提示败血症的基础上预测有效性的死亡率，快速脓毒症相关的器官衰竭评估（qSOFA）评分通常被用作筛选工具，这需要高sensitivity.Objectives：评估预测准确性qSOFA在巴西的死亡率，侧重于sensitivity.Methods：我们前瞻性地收集了两个队列的急诊科和病房患者的数据。队列1包括疑似感染但无器官功能障碍或败血症的患者（22家医院：3家公立医院和19家私立医院）。队列2包括脓毒症患者（54家医院：24家公立医院和28家私立医院）。主要结局为住院死亡率。qSOFA的预测准确性仅考虑在怀疑感染或脓毒症之前的最差值。测量和主要结果：队列1包含5，460名患者（死亡率，14.0%; 95%置信区间[CI]，13.1-15.0），其中78.3%的患者qSOFA评分≤ 1（死亡率，8.3%; 95% CI，7.5-9.1）。qSOFA评分大于或等于2预测死亡率的灵敏度为53.9%，95%CI为50.3 - 57.5。当qSOFA大于或等于1时，灵敏度较高（84.9%; 95% CI，82.1-87.3），qSOFA评分大于或等于1或乳酸大于2 mmol/L（91.3%; 95% CI，89.0-93.2），全身炎症反应综合征+器官功能障碍（68.7%; 95% CI，65.2-71.9）。队列2包含4，711例患者，其中623%的患者qSOFA评分≤ 1（死亡率，17.3%; 95%CI，15.9-18.7），而公立医院的死亡率为39.3%结论：在发展中国家，qSOFA评分大于或等于2对预测疑似感染患者死亡的敏感性较低。使用qSOFA评分大于或等于2作为败血症的筛选工具可能会错过最终死亡的患者。使用大于或等于1的qSOFA评分或将乳酸盐添加到大于或等于1的qSOFA评分可以改善灵敏度。
Rationale: Although proposed as a clinical prompt to sepsis based on predictive validity for mortality, the Quick Sepsis-related Organ Failure Assessment (qSOFA) score is often used as a screening tool, which requires high sensitivity.Objectives: To assess the predictive accuracy of qSOFA for mortality in Brazil, focusing on sensitivity.Methods: We prospectively collected data from two cohorts of emergency department and ward patients. Cohort 1 included patients with suspected infection but without organ dysfunction or sepsis (22 hospitals: 3 public and 19 private). Cohort 2 included patients with sepsis (54 hospitals: 24 public and 28 private). The primary outcome was in-hospital mortality. The predictive accuracy of qSOFA was examined considering only the worst values before the suspicion of infection or sepsis.Measurements and Main Results: Cohort 1 contained 5,460 patients (mortality rate, 14.0%; 95% confidence interval [CI], 13.1-15.0), among whom 78.3% had a qSOFA score less than or equal to 1 (mortality rate, 8.3%; 95% CI, 7.5-9.1). The sensitivity of a qSOFA score greater than or equal to 2 for predicting mortality was 53.9% and the 95% CI was 50.3 to 57.5. The sensitivity was higher for a qSOFA greater than or equal to 1 (84.9%; 95% CI, 82.1-87.3), a qSOFA score greater than or equal to 1 or lactate greater than 2 mmol/L (91.3%; 95% CI, 89.0-93.2), and systemic inflammatory response syndrome plus organ dysfunction (68.7%; 95% CI, 65.2-71.9). Cohort 2 contained 4,711 patients, among whom 623% had a qSOFA score less than or equal to 1 (mortality rate, 17.3%; 95% CI, 15.9-18.7), whereas in public hospitals the mortality rate was 39.3% (95% CI, 35.5-43.3).Conclusions: A qSOFA score greater than or equal to 2 has low sensitivity for predicting death in patients with suspected infection in a developing country. Using a qSOFA score greater than or equal to 2 as a screening tool for sepsis may miss patients who ultimately die. Using a qSOFA score greater than or equal to 1 or adding lactate to a qSOFA score greater than or equal to 1 may improve sensitivity.