Abstract：
OBJECTIVE: Sepsis has a high incidence and a poor prognosis. Early recognition is important to facilitate timely initiation of adequate care. Sepsis screening tools, such as the (quick) Sequential Organ Failure Assessment ((q)SOFA) and National Early Warning Score (NEWS), could help recognize sepsis. These tools have been validated in a general immunocompetent population, while their performance in immunocompromised patients, who are particularly at risk of sepsis development, remains unknown.
METHODS: This study is a post hoc analysis of a prospective observational study performed at the emergency department. Inclusion criteria were age ≥ 18 years with a suspected infection, while ≥ two qSOFA and/or SOFA criteria were used to classify patients as having suspected sepsis. The primary outcome was in-hospital mortality.
RESULTS: 1516 patients, of which 40.5% used one or more immunosuppressives, were included. NEWS had a higher prognostic accuracy as compared to qSOFA for predicting poor outcome among immunocompromised sepsis patients. Of all tested immunosuppressives, high-dose glucocorticoid therapy was associated with a threefold increased risk of both in-hospital and 28-day mortality.
CONCLUSIONS: In contrast to NEWS, qSOFA underestimates the risk of adverse outcome in patients using high-dose glucocorticoids. As a clinical consequence, to adequately assess the severity of illness among immunocompromised patients, health care professionals should best use the NEWS.
METHODS: This study is a post hoc analysis of a prospective observational study performed at the emergency department. Inclusion criteria were age ≥ 18 years with a suspected infection, while ≥ two qSOFA and/or SOFA criteria were used to classify patients as having suspected sepsis. The primary outcome was in-hospital mortality.
RESULTS: 1516 patients, of which 40.5% used one or more immunosuppressives, were included. NEWS had a higher prognostic accuracy as compared to qSOFA for predicting poor outcome among immunocompromised sepsis patients. Of all tested immunosuppressives, high-dose glucocorticoid therapy was associated with a threefold increased risk of both in-hospital and 28-day mortality.
CONCLUSIONS: In contrast to NEWS, qSOFA underestimates the risk of adverse outcome in patients using high-dose glucocorticoids. As a clinical consequence, to adequately assess the severity of illness among immunocompromised patients, health care professionals should best use the NEWS.
摘要：
目的：脓毒症发病率高，预后差。早期识别对于促进及时开始适当护理很重要。脓毒症筛查工具,例如（快速）顺序器官衰竭评估（（q）SOFA）和国家早期预警评分（NEWS），可以帮助识别败血症.这些工具已在一般免疫功能正常的人群中得到验证，虽然它们在免疫受损患者中的表现，特别是有败血症发展风险的人，仍然未知。
方法：本研究是对急诊科进行的一项前瞻性观察性研究的事后分析。纳入标准为年龄≥18岁，疑似感染，而≥两个qSOFA和/或SOFA标准被用于将患者分类为疑似脓毒症。主要结果是院内死亡率。
结果：1516例患者，其中40.5%使用了一种或多种免疫抑制剂，包括在内。与qSOFA相比，NEWS在预测免疫功能低下的脓毒症患者预后不良方面具有更高的预后准确性。在所有测试的免疫抑制剂中，大剂量糖皮质激素治疗与院内死亡和28日死亡风险增加3倍相关.
结论：与新闻相反，qSOFA低估了使用大剂量糖皮质激素患者出现不良结局的风险.作为临床结果，为了充分评估免疫功能低下患者的疾病严重程度，医疗保健专业人员应该最好地使用新闻。
方法：本研究是对急诊科进行的一项前瞻性观察性研究的事后分析。纳入标准为年龄≥18岁，疑似感染，而≥两个qSOFA和/或SOFA标准被用于将患者分类为疑似脓毒症。主要结果是院内死亡率。
结果：1516例患者，其中40.5%使用了一种或多种免疫抑制剂，包括在内。与qSOFA相比，NEWS在预测免疫功能低下的脓毒症患者预后不良方面具有更高的预后准确性。在所有测试的免疫抑制剂中，大剂量糖皮质激素治疗与院内死亡和28日死亡风险增加3倍相关.
结论：与新闻相反，qSOFA低估了使用大剂量糖皮质激素患者出现不良结局的风险.作为临床结果，为了充分评估免疫功能低下患者的疾病严重程度，医疗保健专业人员应该最好地使用新闻。
