PDF(Pubmed)
Abstract：
Severe complicated intra-abdominal sepsis (SCIAS) is a worldwide challenge with increasing incidence. Open abdomen management with enhanced clearance of fluid and biomediators from the peritoneum is a potential therapy requiring prospective evaluation. Given the complexity of powering multi-center trials, it is essential to recruit an inception cohort sick enough to benefit from the intervention; otherwise, no effect of a potentially beneficial therapy may be apparent. An evaluation of abilities of recognized predictive systems to recognize SCIAS patients was conducted using an existing intra-abdominal sepsis (IAS) database.
All consecutive adult patients with a diffuse secondary peritonitis between 2012 and 2013 were collected from a quaternary care hospital in Finland, excluding appendicitis/cholecystitis. From this retrospectively collected database, a target population (93) of those with either ICU admission or mortality were selected. The performance metrics of the Third Consensus Definitions for Sepsis and Septic Shock based on both SOFA and quick SOFA, the World Society of Emergency Surgery Sepsis Severity Score (WSESSSS), the APACHE II score, Manheim Peritonitis Index (MPI), and the Calgary Predisposition, Infection, Response, and Organ dysfunction (CPIRO) score were all tested for their discriminant ability to identify this subgroup with SCIAS and to predict mortality.
Predictive systems with an area under-the-receiving-operating characteristic (AUC) curve > 0.8 included SOFA, Sepsis-3 definitions, APACHE II, WSESSSS, and CPIRO scores with the overall best for CPIRO. The highest identification rates were SOFA score ≥ 2 (78.4%), followed by the WSESSSS score ≥ 8 (73.1%), SOFA ≥ 3 (75.2%), and APACHE II ≥ 14 (68.8%) identification. Combining the Sepsis-3 septic-shock definition and WSESSS ≥ 8 increased detection to 80%. Including CPIRO score ≥ 3 increased this to 82.8% (Sensitivity-SN; 83% Specificity-SP; 74%. Comparatively, SOFA ≥ 4 and WSESSSS ≥ 8 with or without septic-shock had 83.9% detection (SN; 84%, SP; 75%, 25% mortality).
No one scoring system behaves perfectly, and all are largely dominated by organ dysfunction. Utilizing combinations of SOFA, CPIRO, and WSESSSS scores in addition to the Sepsis-3 septic shock definition appears to offer the widest \"inclusion-criteria\" to recognize patients with a high chance of mortality and ICU admission.
https://clinicaltrials.gov/ct2/show/NCT03163095; Registered on May 22, 2017.
All consecutive adult patients with a diffuse secondary peritonitis between 2012 and 2013 were collected from a quaternary care hospital in Finland, excluding appendicitis/cholecystitis. From this retrospectively collected database, a target population (93) of those with either ICU admission or mortality were selected. The performance metrics of the Third Consensus Definitions for Sepsis and Septic Shock based on both SOFA and quick SOFA, the World Society of Emergency Surgery Sepsis Severity Score (WSESSSS), the APACHE II score, Manheim Peritonitis Index (MPI), and the Calgary Predisposition, Infection, Response, and Organ dysfunction (CPIRO) score were all tested for their discriminant ability to identify this subgroup with SCIAS and to predict mortality.
Predictive systems with an area under-the-receiving-operating characteristic (AUC) curve > 0.8 included SOFA, Sepsis-3 definitions, APACHE II, WSESSSS, and CPIRO scores with the overall best for CPIRO. The highest identification rates were SOFA score ≥ 2 (78.4%), followed by the WSESSSS score ≥ 8 (73.1%), SOFA ≥ 3 (75.2%), and APACHE II ≥ 14 (68.8%) identification. Combining the Sepsis-3 septic-shock definition and WSESSS ≥ 8 increased detection to 80%. Including CPIRO score ≥ 3 increased this to 82.8% (Sensitivity-SN; 83% Specificity-SP; 74%. Comparatively, SOFA ≥ 4 and WSESSSS ≥ 8 with or without septic-shock had 83.9% detection (SN; 84%, SP; 75%, 25% mortality).
No one scoring system behaves perfectly, and all are largely dominated by organ dysfunction. Utilizing combinations of SOFA, CPIRO, and WSESSSS scores in addition to the Sepsis-3 septic shock definition appears to offer the widest \"inclusion-criteria\" to recognize patients with a high chance of mortality and ICU admission.
https://clinicaltrials.gov/ct2/show/NCT03163095; Registered on May 22, 2017.
摘要：
严重的复杂性腹腔内脓毒症（SCIAS）是一个全球性的挑战，发病率不断增加。开放式腹部管理可增强腹膜中液体和生物标志物的清除是一种需要前瞻性评估的潜在治疗方法。考虑到为多中心试验提供动力的复杂性，必须招募一个患病到足以从干预中受益的初始队列；否则，潜在有益的治疗可能没有明显的效果。使用现有的腹腔内败血症（IAS）数据库对识别的预测系统识别SCIAS患者的能力进行了评估。
2012年至2013年期间，所有患有弥漫性继发性腹膜炎的连续成年患者均从芬兰一家四级护理医院收集。不包括阑尾炎/胆囊炎。从这个回顾性收集的数据库中，我们选择了入住ICU或死亡患者的目标人群(93).基于SOFA和快速SOFA的脓毒症和脓毒症休克第三共识定义的性能指标，世界急诊外科学会脓毒症严重程度评分（WSESSSS），APACHEII得分,曼海姆腹膜炎指数（MPI），和卡尔加里倾向,感染,回应,和器官功能障碍(CPIRO)评分均进行了鉴别诊断和预测死亡率的能力测试.
具有接收操作特性（AUC）曲线下面积>0.8的预测系统包括SOFA，脓毒症-3定义，APACHEII,WSESSSS,和CPIRO得分与CPIRO的整体最好。识别率最高的是SOFA评分≥2(78.4%)，其次是WSESSSS评分≥8(73.1%)，SOFA≥3（75.2%），APACHEII≥14（68.8%）鉴定。结合脓毒症-3脓毒性休克定义和WSESSS≥8将检出率提高到80％。包括CPIRO评分≥3将其增加到82.8%(灵敏度-SN；83%特异性-SP；74%。相对而言,SOFA≥4和WSESSSS≥8伴或不伴感染性休克的检出率为83.9%(SN;84%，SP;75%,25%死亡率)。
没有一个评分系统表现完美,所有这些都主要由器官功能障碍主导。利用SOFA的组合，CPIRO,除了脓毒症-3脓毒性休克定义外,WSESSSS评分似乎提供了最广泛的“纳入标准”,以识别死亡率和ICU入住几率高的患者.
https://clinicaltrials.gov/ct2/show/NCT03163095；于2017年5月22日注册。
2012年至2013年期间，所有患有弥漫性继发性腹膜炎的连续成年患者均从芬兰一家四级护理医院收集。不包括阑尾炎/胆囊炎。从这个回顾性收集的数据库中，我们选择了入住ICU或死亡患者的目标人群(93).基于SOFA和快速SOFA的脓毒症和脓毒症休克第三共识定义的性能指标，世界急诊外科学会脓毒症严重程度评分（WSESSSS），APACHEII得分,曼海姆腹膜炎指数（MPI），和卡尔加里倾向,感染,回应,和器官功能障碍(CPIRO)评分均进行了鉴别诊断和预测死亡率的能力测试.
具有接收操作特性（AUC）曲线下面积>0.8的预测系统包括SOFA，脓毒症-3定义，APACHEII,WSESSSS,和CPIRO得分与CPIRO的整体最好。识别率最高的是SOFA评分≥2(78.4%)，其次是WSESSSS评分≥8(73.1%)，SOFA≥3（75.2%），APACHEII≥14（68.8%）鉴定。结合脓毒症-3脓毒性休克定义和WSESSS≥8将检出率提高到80％。包括CPIRO评分≥3将其增加到82.8%(灵敏度-SN；83%特异性-SP；74%。相对而言,SOFA≥4和WSESSSS≥8伴或不伴感染性休克的检出率为83.9%(SN;84%，SP;75%,25%死亡率)。
没有一个评分系统表现完美,所有这些都主要由器官功能障碍主导。利用SOFA的组合，CPIRO,除了脓毒症-3脓毒性休克定义外,WSESSSS评分似乎提供了最广泛的“纳入标准”,以识别死亡率和ICU入住几率高的患者.
https://clinicaltrials.gov/ct2/show/NCT03163095；于2017年5月22日注册。
