PDF(Pubmed)
Abstract：
BACKGROUND: Sepsis is a leading cause of death and serious illness that requires early recognition and therapeutic management to improve survival. The quick-SOFA score helps in its recognition, but its diagnostic performance is insufficient. To develop a score that can rapidly identify a community acquired septic situation at risk of clinical complications in patients consulting the emergency department (ED).
METHODS: We conducted a monocentric, prospective cohort study in the emergency department of a university hospital between March 2016 and August 2018 (NCT03280992). All patients admitted to the emergency department for a suspicion of a community-acquired infection were included. Predictor variables of progression to septic shock or death within the first 90 days were selected using backward stepwise multivariable logistic regression to develop a clinical score. Receiver operating characteristic (ROC) curves were constructed to determine the discriminating power of the area under the curve (AUC). We also determined the threshold of our score that optimized the performance required for a sepsis-worsening score. We have compared our score with the NEWS-2 and qSOFA scores.
RESULTS: Among the 21,826 patients admitted to the ED, 796 patients were suspected of having community-acquired infection and 461 met the sepsis criteria; therefore, these patients were included in the analysis. The median [interquartile range] age was 72 [54-84] years, 248 (54%) were males, and 244 (53%) had respiratory symptoms. The clinical score ranged from 0 to 90 and included 8 variables with an area under the ROC curve of 0.85 (confidence interval [CI] 95% 0.81-0.89). A cut-off of 26 yields a sensitivity of 88% (CI 95% 0.79-0.93), a specificity of 62% (CI 95% 57-67), and a negative predictive value of 95% (CI 95% 91-97). The area under the ROC curve for our score was 0.85 (95% CI, 0.81-0.89) versus 0.73 (95% CI, 0.68-0.78) for qSOFA and 0.66 (95% CI, 0.60-0.72) for NEWS-2.
CONCLUSIONS: Our study provides an accurate clinical score for identifying septic patients consulting the ED early at risk of worsening disease. This score could be implemented at admission.
METHODS: We conducted a monocentric, prospective cohort study in the emergency department of a university hospital between March 2016 and August 2018 (NCT03280992). All patients admitted to the emergency department for a suspicion of a community-acquired infection were included. Predictor variables of progression to septic shock or death within the first 90 days were selected using backward stepwise multivariable logistic regression to develop a clinical score. Receiver operating characteristic (ROC) curves were constructed to determine the discriminating power of the area under the curve (AUC). We also determined the threshold of our score that optimized the performance required for a sepsis-worsening score. We have compared our score with the NEWS-2 and qSOFA scores.
RESULTS: Among the 21,826 patients admitted to the ED, 796 patients were suspected of having community-acquired infection and 461 met the sepsis criteria; therefore, these patients were included in the analysis. The median [interquartile range] age was 72 [54-84] years, 248 (54%) were males, and 244 (53%) had respiratory symptoms. The clinical score ranged from 0 to 90 and included 8 variables with an area under the ROC curve of 0.85 (confidence interval [CI] 95% 0.81-0.89). A cut-off of 26 yields a sensitivity of 88% (CI 95% 0.79-0.93), a specificity of 62% (CI 95% 57-67), and a negative predictive value of 95% (CI 95% 91-97). The area under the ROC curve for our score was 0.85 (95% CI, 0.81-0.89) versus 0.73 (95% CI, 0.68-0.78) for qSOFA and 0.66 (95% CI, 0.60-0.72) for NEWS-2.
CONCLUSIONS: Our study provides an accurate clinical score for identifying septic patients consulting the ED early at risk of worsening disease. This score could be implemented at admission.
摘要：
背景：脓毒症是导致死亡和严重疾病的主要原因，需要早期识别和治疗管理以提高生存率。快速SOFA分数有助于其识别，但其诊断性能不足。制定一个分数，可以快速识别社区获得性败血症情况，有临床并发症风险的患者咨询急诊科（ED）。
方法：我们进行了单中心，2016年3月至2018年8月在大学医院急诊科进行的前瞻性队列研究（NCT03280992）。包括所有因怀疑社区获得性感染而进入急诊科的患者。使用后向逐步多变量逻辑回归选择前90天内感染性休克或死亡进展的预测变量，以制定临床评分。构建受试者工作特征(ROC)曲线以确定曲线下面积(AUC)的辨别能力。我们还确定了我们的评分阈值，该阈值优化了败血症恶化评分所需的性能。我们已经将我们的分数与NEWS-2和qSOFA分数进行了比较。
结果：在收治的21,826名患者中，796名患者被怀疑患有社区获得性感染，461名患者符合脓毒症标准；因此，这些患者被纳入分析.年龄中位数为72[54-84]岁，248（54%）是男性，244人(53%)有呼吸道症状。临床评分范围从0到90，包括8个变量，ROC曲线下面积为0.85（置信区间[CI]95％0.81-0.89）。截止值26的灵敏度为88%(CI95%0.79-0.93)，特异性为62%（CI95%57-67），阴性预测值为95%（CI95%91-97）。我们评分的ROC曲线下面积为0.85（95％CI，0.81-0.89），qSOFA为0.73（95％CI，0.68-0.78），NEWS-2为0.66（95％CI，0.60-0.72）。
结论：我们的研究提供了一个准确的临床评分，用于识别早期有恶化风险的脓毒症患者。这个分数可以在入学时实施。
方法：我们进行了单中心，2016年3月至2018年8月在大学医院急诊科进行的前瞻性队列研究（NCT03280992）。包括所有因怀疑社区获得性感染而进入急诊科的患者。使用后向逐步多变量逻辑回归选择前90天内感染性休克或死亡进展的预测变量，以制定临床评分。构建受试者工作特征(ROC)曲线以确定曲线下面积(AUC)的辨别能力。我们还确定了我们的评分阈值，该阈值优化了败血症恶化评分所需的性能。我们已经将我们的分数与NEWS-2和qSOFA分数进行了比较。
结果：在收治的21,826名患者中，796名患者被怀疑患有社区获得性感染，461名患者符合脓毒症标准；因此，这些患者被纳入分析.年龄中位数为72[54-84]岁，248（54%）是男性，244人(53%)有呼吸道症状。临床评分范围从0到90，包括8个变量，ROC曲线下面积为0.85（置信区间[CI]95％0.81-0.89）。截止值26的灵敏度为88%(CI95%0.79-0.93)，特异性为62%（CI95%57-67），阴性预测值为95%（CI95%91-97）。我们评分的ROC曲线下面积为0.85（95％CI，0.81-0.89），qSOFA为0.73（95％CI，0.68-0.78），NEWS-2为0.66（95％CI，0.60-0.72）。
结论：我们的研究提供了一个准确的临床评分，用于识别早期有恶化风险的脓毒症患者。这个分数可以在入学时实施。
