Low Accuracy of Positive qSOFA Criteria for Predicting 28-Day Mortality in Critically Ill Septic Patients During the Early Period After Emergency Department Presentation
Low Accuracy of Positive qSOFA Criteria for Predicting 28-Day Mortality in Critically Ill Septic Patients During the Early Period After Emergency Department Presentation
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DOI：
10.1016/j.annemergmed.2017.05.022
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发表时间：
2018-01-01
影响因子：
6.2
通讯作者：
Shin, Tae Gun
中科院分区：
文献类型：
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作者：
Hwang, Sung Yeon;Jo, Ik Joon;Shin, Tae Gun
研究目的：我们确定的诊断性能的积极快速序贯器官衰竭评估（qSOFA）评分预测28天的死亡率重症脓毒症患者在早期急诊科（艾德）presentation.Methods：这是一项回顾性队列研究在三级医疗学术中心。我们回顾了2008年8月至2014年9月在艾德住院期间诊断为严重脓毒症或脓毒性休克的成人（≥ 18岁）患者的登记研究。我们确定了患者在最初24小时内同时满足3个qSOFA标准中的2个或更多标准（表明qSOFA评分阳性）的时间点。评估qSOFA评分阳性预测28天死亡率的诊断性能（在艾德到达时和艾德出现后3、6和24小时内）。对于qSOFA评分阳性的患者，到达艾德时的28天死亡率为23%（95%置信区间[CI] 19%至28%），3小时为20%（95% CI 17%至23%），6小时为20%（95% CI 17%至22%），24小时为17%（95% CI 15%至20%）。qSOFA评分阳性预测28天死亡率的敏感性、特异性和受试者工作曲线下面积分别为39%（95% CI 32%至46%），77%（95% CI 75%至80%），和0.58（95% CI 0.55 - 0.62）艾德到达时; 68%（95% CI 62%至75%），52%（95% CI 49%至55%），和0.60（95% CI 0.57 - 0.63）3小时内; 82%（95% CI 76%至87%），41%（95% CI 38%至44%），和0.61（95% CI 0.58 - 0.64）6小时内;和91%（95% CI 86%至94%），23%（95% CI 21%至25%），和0.57（95% CI 0.54 - 0.59）。结论：在重症脓毒症患者中，qSOFA评分阳性预测28天死亡率的诊断性能较低，尤其是在艾德出现后的早期。由于其回顾性设计和使用单中心数据的局限性，该研究需要进一步的前瞻性验证。
Study objective: We determine the diagnostic performance of positive Quick Sequential Organ Failure Assessment (qSOFA) scores for predicting 28-day mortality among critically ill septic patients during the early period after emergency department (ED) presentation.Methods: This was a retrospective cohort study at a tertiary care academic center. We reviewed a registry of adult (>= 18 years) patients who received a diagnosis of severe sepsis or septic shock during an ED stay from August 2008 through September 2014. We identified the point at which patients met 2 or more of the 3 qSOFA criteria (indicating a positive qSOFA score) simultaneously during the initial 24 hours. The diagnostic performance of positive qSOFA score for predicting 28-day mortality was assessed (on ED arrival and within 3, 6, and 24 hours after ED presentation).Results: A total of 1,395 patients were included, and the overall 28-day mortality was 15%. For patients with positive qSOFA score, 28-day mortality was 23% (95% confidence interval [CI] 19% to 28%) on ED arrival, 20% (95% CI 17% to 23%) at 3 hours, 20% (95% CI 17% to 22%) at 6 hours, and 17% (95% CI 15% to 20%) at 24 hours. Positive qSOFA score for predicting 28-day mortality had a sensitivity, specificity, and area under the receiver operating curve, respectively, of 39% (95% CI 32% to 46%), 77% (95% CI 75% to 80%), and 0.58 (95% CI 0.55 to 0.62) on ED arrival; 68% (95% CI 62% to 75%), 52% (95% CI 49% to 55%), and 0.60 (95% CI 0.57 to 0.63) within 3 hours; 82% (95% CI 76% to 87%), 41% (95% CI 38% to 44%), and 0.61(95% CI 0.58 to 0.64) within 6 hours; and 91% (95% CI 86% to 94%), 23% (95% CI 21% to 25%), and 0.57 (95% CI 0.54 to 0.59) within 24 hours.Conclusion: The diagnostic performance of positive qSOFA score for predicting 28-day mortality was low in critically ill septic patients, particularly during the early period after ED presentation. The study requires further prospective validation because of limitations with its retrospective design and use of single-center data.