Predictive accuracy of Sepsis-3 definitions for mortality among adult critically ill patients with suspected infection
Predictive accuracy of Sepsis-3 definitions for mortality among adult critically ill patients with suspected infection
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Sepsis-3 定义对疑似感染的成年危重患者死亡率的预测准确性
DOI：
10.1097/cm9.0000000000000166
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发表时间：
2019-05-20
影响因子：
6.1
通讯作者：
Zheng, Rui-Qiang
中科院分区：
文献类型：
--
作者：
Chen, Qi-Hong;Shao, Jun;Zheng, Rui-Qiang
背景：最近发布了脓毒症-3的定义；然而，其诊断价值仍有争议。本研究通过对疑似感染的成人危重患者的死亡率进行分层，以评估脓毒症-3定义与脓毒症-1定义的准确性。方法：于2017年11月10日至2018年10月10日在4所教学医院的5个重症监护病房（icu）进行多中心前瞻性队列研究。比较脓毒症3型定义和1型定义的30天死亡率，通过logistic回归分析进行评估，然后测量受试者工作特征曲线下面积（AUROC）来预测30天死亡率。结果：749例入组患者中，644例（85.9%）根据败血症-1定义诊断为败血症。其中362例诊断为感染性休克（362/749,48.3%）。然而，根据脓毒症-3的定义，诊断为脓毒症的患者有483例（483/749,64.5%），其中诊断为感染性休克的患者有299例（299/749,39.9%）。根据脓毒症-3定义，脓毒症（脓毒症和脓毒症休克）患者的30天死亡率（41.8%）高于脓毒症-1定义的脓毒症患者（31.8%,&khgr;2 = 5.552, P = 0.020）。与30天死亡率相关的全身炎症反应综合征（SIRS）和快速序贯器官衰竭评估（qSOFA）评分AUROC分别为0.609（0.566-0.652）和0.694（0.654-0.733）。然而，SOFA评分的AUROC（0.828[0.795-0.862]）显著高于SIRS或qSOFA评分（P < 0.001）。结论：在疑似感染的成人危重患者中，脓毒症-3定义在死亡率分层上相对准确，优于脓毒症-1定义。试验注册：www.chictr.org.cn （ChiCTR-OOC-17013223）。
Background: Sepsis-3 definitions have been published recently; however, their diagnostic value remains controversial. This study was to assess the accuracy of Sepsis-3 definitions compared to Sepsis-1 definitions by stratifying mortality among adult critically ill patients with suspected infection. Methods: A multicenter, prospective cohort study was conducted from November 10, 2017 to October 10, 2018, in five Intensive Care Units (ICUs) at four teaching hospitals. Thirty-day mortality was compared across categories for both Sepsis-3 definitions and Sepsis-1 definitions, which were evaluated by logistic regression analysis followed by measurement of the area under the receiver operating characteristic curve (AUROC) for predicting 30-day mortality rates. Results: Of the 749 enrolled patients, 644 (85.9%) were diagnosed with sepsis according to the Sepsis-1 definitions. Among those patients, 362 were diagnosed with septic shock (362/749, 48.3%). However, according to the Sepsis-3 definitions, there were 483 patients with a diagnosis of sepsis (483/749, 64.5%), among whom 299 patients were diagnosed with septic shock (299/749, 39.9%). According to the Sepsis-3 definitions, sepsis (sepsis and septic shock) patients had higher 30-day mortality (41.8%) than sepsis patients according to the Sepsis-1 definitions (31.8%, &khgr;2 = 5.552, P = 0.020). The AUROC of systemic inflammatory response syndrome (SIRS) and quick sequential organ failure assessment (qSOFA) scores with regard to 30-day mortality rates were 0.609 (0.566–0.652) and 0.694 (0.654–0.733), respectively. However, the AUROC of SOFA scores (0.828 [0.795–0.862]) were significantly higher than that of SIRS or qSOFA scores (P < 0.001). Conclusion: In adult critically ill patients with suspected infection, the Sepsis-3 definitions were relatively accurate in stratifying mortality and were superior to the Sepsis-1 definitions. Trial Registration: www.chictr.org.cn (ChiCTR-OOC-17013223).