Assessment of Sepsis-3 criteria and quick SOFA in patients with cirrhosis and bacterial infections
Assessment of Sepsis-3 criteria and quick SOFA in patients with cirrhosis and bacterial infections
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DOI：
10.1136/gutjnl-2017-314324
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发表时间：
2018-10-01
期刊：
影响因子：
24.5
通讯作者：
Angeli, Paolo
中科院分区：
文献类型：
--
作者：
Piano, Salvatore;Bartoletti, Michele;Angeli, Paolo
前言：肝硬变患者感染脓毒症的风险高，预后差。全身性炎症反应综合征(SIRS)标准在肝硬变中有几个局限性。最近，在普通人群中提出了新的脓毒症标准(Sepsis-3)(序贯器官衰竭评估(SOFA)比基线增加2分)。在重症监护病房(ICU)外，建议使用快速沙发(QSOFA)(在精神状态改变、收缩压100 mm Hg或呼吸频率22次/min中至少两项)筛查脓毒症。这些标准从未在肝硬变患者中被评估过。本研究的目的是评估Sepsis-3标准在预测肝硬变和细菌/真菌感染患者住院死亡率方面的能力。在诊断感染时收集人口学、实验室和微生物学数据。基线SOFA使用入院前数据进行评估。对患者进行随访，直至死亡、肝移植或出院。结果与SIRS(AUROC=0.606)相比，脓毒症-3和QSOFA对住院死亡率的区分性(AUROC分别为0.784和0.732)有显著差异(P
Introduction Patients with cirrhosis have a high risk of sepsis, which confers a poor prognosis. The systemic inflammatory response syndrome (SIRS) criteria have several limitations in cirrhosis. Recently, new criteria for sepsis (Sepsis-3) have been suggested in the general population (increase of Sequential Organ Failure Assessment (SOFA) 2 points from baseline). Outside the intensive care unit (ICU), the quick SOFA (qSOFA (at least two among alteration in mental status, systolic blood pressure 100mm Hg or respiratory rate 22/min)) was suggested to screen for sepsis. These criteria have never been evaluated in patients with cirrhosis. The aim of the study was to assess the ability of Sepsis-3 criteria in predicting in-hospital mortality in patients with cirrhosis and bacterial/fungal infections.Methods 259 consecutive patients with cirrhosis and bacterial/fungal infections were prospectively included. Demographic, laboratory and microbiological data were collected at diagnosis of infection. Baseline SOFA was assessed using preadmission data. Patients were followed up until death, liver transplantation or discharge. Findings were externally validated (197 patients).Results Sepsis-3 and qSOFA had significantly greater discrimination for in-hospital mortality (area under the receiver operating characteristic (AUROC)=0.784and 0.732, respectively) than SIRS (AUROC=0.606) (p