Investigating the Impact of Different Suspicion of Infection Criteria on the Accuracy of Quick Sepsis-Related Organ Failure Assessment, Systemic Inflammatory Response Syndrome, and Early Warning Scores
Investigating the Impact of Different Suspicion of Infection Criteria on the Accuracy of Quick Sepsis-Related Organ Failure Assessment, Systemic Inflammatory Response Syndrome, and Early Warning Scores
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DOI：
10.1097/ccm.0000000000002648
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发表时间：
2017-11-01
影响因子：
8.8
通讯作者：
Edelson, Dana P.
中科院分区：
文献类型：
--
作者：
Churpek, Matthew M.;Snyder, Ashley;Edelson, Dana P.
目的：脓毒症的研究受到异质性的限制，关于什么构成怀疑感染。我们试图在患者特征和结果方面比较使用抗生素和培养顺序组合的潜在怀疑标准。我们进一步试图确定不同标准对脓毒症筛查工具和早期预警评分准确性的影响。设计：观察性队列研究。地点：学术中心，2008年11月至2016年1月。患者：ICU外住院患者。干预措施:没有。测量和主要结果：研究了6项标准：1)任何培养，2)血液培养，3)任何培养加静脉抗生素，4)血液培养加静脉抗生素，5)任何培养加静脉抗生素至少7天中的4天，6)血液培养加静脉抗生素至少7天中的4天。计算脓毒症相关器官衰竭快速评估评分、脓毒症相关器官衰竭评估评分、全身炎症反应综合征标准、国家和修订预警评分、心脏骤停风险电子分诊评分的准确性，以预测符合怀疑标准的48小时内ICU转移或死亡。共有53849例患者符合至少一项感染标准。死亡率从第1组的3%增加到第6组的9%，符合Angus败血症标准的百分比从20%增加到40%。在所有标准中，系统性炎症反应综合征（受者工作特征曲线下的中位数面积，0.60）和败血症相关器官衰竭评估评分（受者工作特征曲线下的中位数面积，0.62）的评分歧视最低，快速败血症相关器官衰竭评估评分（受者工作特征曲线下的中位数面积，0.62）的评分歧视最低。修正预警评分（受试者工作特征曲线下面积中值0.67），国家预警评分（受试者工作特征曲线下面积中值0.71）和心脏骤停风险电子分诊（受试者工作特征曲线下面积中值0.73）得分最高。结论：定义潜在感染人群的标准的选择显著影响死亡率的流行，但对准确性影响不大。无论如何定义感染，全身性炎症反应综合征的预测性最低，而电子心脏骤停风险分类的预测性最高。
Objective: Studies in sepsis are limited by heterogeneity regarding what constitutes suspicion of infection. We sought to compare potential suspicion criteria using antibiotic and culture order combinations in terms of patient characteristics and outcomes. We further sought to determine the impact of differing criteria on the accuracy of sepsis screening tools and early warning scores.Design: Observational cohort study.Setting: Academic center from November 2008 to January 2016.Patients: Hospitalized patients outside the ICU.Interventions: None.Measurements and Main Results: Six criteria were investigated: 1) any culture, 2) blood culture, 3) any culture plus IV antibiotics, 4) blood culture plus IV antibiotics, 5) any culture plus IV antibiotics for at least 4 of 7 days, and 6) blood culture plus IV antibiotics for at least 4 of 7 days. Accuracy of the quick Sepsis-related Organ Failure Assessment score, Sepsis-related Organ Failure Assessment score, systemic inflammatory response syndrome criteria, the National and Modified Early Warning Score, and the electronic Cardiac Arrest Risk Triage score were calculated for predicting ICU transfer or death within 48 hours of meeting suspicion criteria. A total of 53,849 patients met at least one infection criteria. Mortality increased from 3% for group 1 to 9% for group 6 and percentage meeting Angus sepsis criteria increased from 20% to 40%. Across all criteria, score discrimination was lowest for systemic inflammatory response syndrome (median area under the receiver operating characteristic curve, 0.60) and Sepsis-related Organ Failure Assessment score (median area under the receiver operating characteristic curve, 0.62), intermediate for quick Sepsis-related Organ Failure Assessment (median area under the receiver operating characteristic curve, 0.65) and Modified Early Warning Score (median area under the receiver operating characteristic curve 0.67), and highest for National Early Warning Score (median area under the receiver operating characteristic curve 0.71) and electronic Cardiac Arrest Risk Triage (median area under the receiver operating characteristic curve 0.73).Conclusions: The choice of criteria to define a potentially infected population significantly impacts prevalence of mortality but has little impact on accuracy. Systemic inflammatory response syndrome was the least predictive and electronic Cardiac Arrest Risk Triage the most predictive regardless of how infection was defined.