PDF(Pubmed)
Abstract：
BACKGROUND: Sepsis remains a worldwide major cause of hospitalization, mortality, and morbidity. To enhance the identification of patients with suspected sepsis at high risk of mortality and adverse outcomes in the emergency department (ED), the use of mortality predictors is relevant. This study aims to establish whether quick sofa (qSOFA) and the severity criteria applied in patients with suspicion of sepsis in a monitored ED are in fact predictors of mortality.
METHODS: We performed a retrospective cohort study among adult patients with suspicion of sepsis at the ED of a tertiary care hospital in Brazil between January 1st, 2019 and December 31, 2020. All adult patients (ages 18 and over) with suspected sepsis that scored two or more points on qSOFA score or at least one point on the severity criteria score were included in the study.
RESULTS: The total of patients included in the study was 665 and the average age of the sample was 73 ± 19 years. The ratio of men to women was similar. Most patients exhibited qSOFA ≥ 2 (58.80%) and 356 patients (53.61%) scored one point in the severity criteria at admission. The overall mortality rate was 19.7% (131 patients) with 98 patients (14.74%) having positive blood cultures, mainly showing Escherichia coli as the most isolated bacteria. Neither scores of qSOFA nor the severity criteria were associated with mortality rates, but scoring any point on qSOFA was considered as an independent factor for intensive care unit (ICU) admission (qSOFA = 1 point, p = 0.02; qSOFA = 2 points, p = 0.03, and qSOFA = 3 points, p = 0.04). Positive blood cultures (RR, 1.63;95% CI, 1.10 to 2.41) and general administration of vasopressors at the ED (RR, 2.14;95% CI, 1.44 to 3.17) were associated with 30-day mortality. The administration of vasopressors at the ED (RR, 2.25; CI 95%, 1.58 to 3.21) was found to be a predictor of overall mortality.
CONCLUSIONS: Even though an association was found between qSOFA and ICU admission, there was no association of qSOFA or the severity criteria with mortality. Therefore, patients with a tendency toward greater severity could be identified and treated more quickly and effectively in the emergency department. Further studies are necessary to assess novel scores or biomarkers to predict mortality in sepsis patients admitted to the ED\'s initial care.
METHODS: We performed a retrospective cohort study among adult patients with suspicion of sepsis at the ED of a tertiary care hospital in Brazil between January 1st, 2019 and December 31, 2020. All adult patients (ages 18 and over) with suspected sepsis that scored two or more points on qSOFA score or at least one point on the severity criteria score were included in the study.
RESULTS: The total of patients included in the study was 665 and the average age of the sample was 73 ± 19 years. The ratio of men to women was similar. Most patients exhibited qSOFA ≥ 2 (58.80%) and 356 patients (53.61%) scored one point in the severity criteria at admission. The overall mortality rate was 19.7% (131 patients) with 98 patients (14.74%) having positive blood cultures, mainly showing Escherichia coli as the most isolated bacteria. Neither scores of qSOFA nor the severity criteria were associated with mortality rates, but scoring any point on qSOFA was considered as an independent factor for intensive care unit (ICU) admission (qSOFA = 1 point, p = 0.02; qSOFA = 2 points, p = 0.03, and qSOFA = 3 points, p = 0.04). Positive blood cultures (RR, 1.63;95% CI, 1.10 to 2.41) and general administration of vasopressors at the ED (RR, 2.14;95% CI, 1.44 to 3.17) were associated with 30-day mortality. The administration of vasopressors at the ED (RR, 2.25; CI 95%, 1.58 to 3.21) was found to be a predictor of overall mortality.
CONCLUSIONS: Even though an association was found between qSOFA and ICU admission, there was no association of qSOFA or the severity criteria with mortality. Therefore, patients with a tendency toward greater severity could be identified and treated more quickly and effectively in the emergency department. Further studies are necessary to assess novel scores or biomarkers to predict mortality in sepsis patients admitted to the ED\'s initial care.
摘要：
背景：脓毒症仍然是世界范围内住院的主要原因，死亡率,和发病率。加强对急诊科（ED）高危死亡和不良结局的疑似脓毒症患者的识别，死亡率预测因子的使用是相关的.这项研究旨在确定在监测的ED中怀疑败血症的患者中应用的快速沙发（qSOFA）和严重程度标准是否实际上是死亡率的预测因子。
方法：我们进行了一项回顾性队列研究，研究对象是1月1日在巴西一家三级护理医院的ED怀疑脓毒症的成年患者，2019年和2020年12月31日。所有疑似脓毒症患者（18岁及以上）在qSOFA评分上得分2分或以上，或在严重程度标准评分上得分至少1分，均纳入研究。
结果：纳入研究的患者总数为665例，样本的平均年龄为73±19岁。男女比例相似。大多数患者在入院时表现为qSOFA≥2（58.80％），356例患者（53.61％）在严重程度标准中得分1分。总死亡率为19.7%（131例），其中98例（14.74%）血培养阳性，主要显示大肠杆菌是最分离的细菌。qSOFA评分和严重程度标准均与死亡率无关，但是在qSOFA上得分任何一点被认为是重症监护病房（ICU）入院的独立因素（qSOFA=1分，p=0.02；qSOFA=2分，p=0.03，qSOFA=3分，p=0.04)。血培养阳性（RR，1.63；95%CI，1.10至2.41）和ED处血管升压药的一般管理（RR，2.14；95%CI，1.44至3.17）与30天死亡率相关。在ED（RR，2.25；CI95%，发现1.58至3.21）是总死亡率的预测因子。
结论：尽管发现qSOFA与ICU入院之间存在关联，qSOFA或严重程度标准与死亡率无相关性.因此,有严重程度倾向的患者可以在急诊科得到更快、更有效的识别和治疗.需要进一步的研究来评估新的评分或生物标志物，以预测接受ED初始护理的脓毒症患者的死亡率。
方法：我们进行了一项回顾性队列研究，研究对象是1月1日在巴西一家三级护理医院的ED怀疑脓毒症的成年患者，2019年和2020年12月31日。所有疑似脓毒症患者（18岁及以上）在qSOFA评分上得分2分或以上，或在严重程度标准评分上得分至少1分，均纳入研究。
结果：纳入研究的患者总数为665例，样本的平均年龄为73±19岁。男女比例相似。大多数患者在入院时表现为qSOFA≥2（58.80％），356例患者（53.61％）在严重程度标准中得分1分。总死亡率为19.7%（131例），其中98例（14.74%）血培养阳性，主要显示大肠杆菌是最分离的细菌。qSOFA评分和严重程度标准均与死亡率无关，但是在qSOFA上得分任何一点被认为是重症监护病房（ICU）入院的独立因素（qSOFA=1分，p=0.02；qSOFA=2分，p=0.03，qSOFA=3分，p=0.04)。血培养阳性（RR，1.63；95%CI，1.10至2.41）和ED处血管升压药的一般管理（RR，2.14；95%CI，1.44至3.17）与30天死亡率相关。在ED（RR，2.25；CI95%，发现1.58至3.21）是总死亡率的预测因子。
结论：尽管发现qSOFA与ICU入院之间存在关联，qSOFA或严重程度标准与死亡率无相关性.因此,有严重程度倾向的患者可以在急诊科得到更快、更有效的识别和治疗.需要进一步的研究来评估新的评分或生物标志物，以预测接受ED初始护理的脓毒症患者的死亡率。
