The early change of SOFA score as a prognostic marker of 28-day sepsis mortality: analysis through a derivation and a validation cohort
The early change of SOFA score as a prognostic marker of 28-day sepsis mortality: analysis through a derivation and a validation cohort
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DOI：
10.1186/s13054-019-2665-5
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发表时间：
2019-11-29
期刊：
影响因子：
15.1
通讯作者：
Giamarellos-Bourboulis, Evangelos J.
中科院分区：
文献类型：
--
作者：
Karakike, Eleni;Kyriazopoulou, Evdoxia;Giamarellos-Bourboulis, Evangelos J.
背景 自脓毒症 3 标准出台以来，序贯器官衰竭评估 (SOFA) 评分的变化已成为脓毒症识别的关键组成部分。因此，可以认为这种变化的逆转（Delta（SOFA））可能反映了脓毒症反应，并且可以用作干预试验中疗效的衡量标准。我们的目的是评估 Delta(SOFA) 对 28 天死亡率的预测性能。方法 研究了之前发表的两项随机对照试验的数据：第一项报告将严重革兰氏阴性感染患者作为派生队列，第二项报告将呼吸机相关肺炎患者作为验证队列。本分析仅纳入符合 Sepsis-3 定义的脓毒症患者。 SOFA 评分在第 1、2、3、5、7、14 和 28 天进行计算。 结果 我们在推导队列中纳入了 448 名患者，在验证队列中纳入了 199 名患者。第 1 天的平均 SOFA 评分分别为 6.06 +/- 4.07 和 7.84 +/- 3.39，28 天死亡率分别为 22.8% 和 29.6%。在推导队列中，Delta(SOFA) 评分预测死亡率的最早时间点是第 7 天 (AUROC (95% CI) 0.84 (0.80-0.89)；p < 0.001）。预测的最佳权衡是 25% 的变化（78% 的敏感性，80% 的特异性）；入院 SOFA 减少不到 25% 与死亡率增加相关（死亡比值比 14.87）。这一发现在验证队列中得到了证实。结论 第 7 天的 Delta(SOFA) 是 28 天死亡率的一个有用的早期预后标志物，并且可以作为未来脓毒症试验中与死亡率一起的终点。
Background Since the Sepsis-3 criteria, change in Sequential Organ Failure Assessment (SOFA) score has become a key component of sepsis identification. Thus, it could be argued that reversal of this change (Delta(SOFA)) may reflect sepsis response and could be used as measure of efficacy in interventional trials. We aimed to assess the predictive performance of Delta(SOFA) for 28-day mortality. Methods Data from two previously published randomized controlled trials were studied: the first reporting on patients with severe Gram-negative infections as a derivation cohort and the second reporting on patients with ventilator-associated pneumonia as a validation cohort. Only patients with sepsis according to the Sepsis-3 definition were included in this analysis. SOFA scores were calculated on days 1, 2, 3, 5, 7, 14, and 28. Results We included 448 patients within the derivation cohort and 199 within the validation cohort. Mean SOFA scores on day 1 were 6.06 +/- 4.07 and 7.84 +/- 3.39, and 28 day mortality 22.8% and 29.6%, respectively. In the derivation cohort, the earliest time point where Delta(SOFA) score predicted mortality was day 7 (AUROC (95% CI) 0.84 (0.80-0.89); p < 0.001). The best tradeoff for prediction was found with 25% changes (78% sensitivity, 80% specificity); less than 25% decrease of admission SOFA was associated with increased mortality (odds ratio for death 14.87). This finding was confirmed in the validation cohort. Conclusions Delta(SOFA) on day 7 is a useful early prognostic marker of 28-day mortality and could serve as an endpoint in future sepsis trials alongside mortality.