背景:自2016年引入以来,脓毒症-3指南,重点是快速序贯器官衰竭评估(qSOFA)评分,引发了很多争论和争议。人们认识到,新定义需要在特定的临床环境中进行验证,尚未被普遍采用。我们旨在验证急性肝胆感染的新Sepsis-3指南。
方法:对2016年7月至2017年6月急诊科收治的急性肝胆感染患者进行前瞻性队列研究。全身炎症反应综合征(SIRS)标准,计算SOFA和qSOFA评分,并通过接收器工作特征(AUROC)曲线下的面积评估预测性能,以评估这些指标对重症监护病房入院和发病率的预测能力。
结果:124例患者,中位年龄64.5岁,大多数男性(n=75,60.5%)在研究期间因急性肝胆感染入院。急性胆囊炎是最常见的入院诊断(n=83,66.9%),大多数患者在普通病房接受治疗(n=91,73.3%),中位住院时间为6天(范围1-40)。在多变量分析中,糖尿病(p=0.003)预测高依赖性单位(HDU)入院,而年龄(p=0.001),血培养阳性(p=0.012),阳性液体培养(p=0.015)和SOFA评分(p=0.002)可预测住院时间.SIRS预测HDU入院的敏感性(60%vs.4%),重症监护病房(ICU)入院(62.5%vs.0%)和发病率(66.7%vs.0%)高于qSOFA评分。qSOFA预测HDU入院的特异性(100%vs.49.5%),入住ICU(99.1%vs.53.3%)和发病率(99.2%vs.47.9%)高于SIRS标准。
结论:SIRS标准在预测急性肝胆感染患者预后方面具有较高的敏感性,qSOFA评分具有较高的特异性。
BACKGROUND: Since its introduction in 2016, the Sepsis-3
guidelines, with emphasis on the quick Sequential Organ Failure Assessment (qSOFA) score, have generated much debate and controversy. It is recognised that the new definitions require validation in specific clinical settings and have yet to be universally adopted. We aim to validate new Sepsis-3
guidelines in acute hepatobiliary infection.
METHODS: A prospective cohort of patients admitted with acute hepatobiliary infection from the emergency department from July 2016 to June 2017 was studied. The Systemic Inflammatory Response Syndrome (SIRS) criteria, SOFA and qSOFA scores were calculated and predictive performance evaluated with area under the receiver operating characteristic (AUROC) curves for predictive ability of these indices for critical care unit admission and morbidity.
RESULTS: 124 patients with a median age of 64.5 years and majority males (n = 75, 60.5%) were admitted with acute hepatobiliary infection during the study period. Acute cholecystitis was the most common admission diagnosis (n = 83, 66.9%) and most patients were managed in general ward (n = 91, 73.3%) with median length of stay of 6 days (range 1-40). On multivariate analysis, diabetes mellitus (p = 0.003) predicted high dependency unit (HDU) admission, while age (p = 0.001), positive blood culture (p = 0.012), positive fluid culture (p = 0.015) and SOFA score (p = 0.002) predicted length of hospital stay. The sensitivity of SIRS in predicting HDU admission (60% vs. 4%), intensive care unit (ICU) admission (62.5% vs. 0%) and morbidity (66.7% vs. 0%) was higher than qSOFA score. The specificity of qSOFA in predicting HDU admission (100% vs. 49.5%), ICU admission (99.1% vs. 53.3%) and morbidity (99.2% vs. 47.9%) was higher than SIRS criteria.
CONCLUSIONS: The SIRS criteria has high sensitivity and the qSOFA score has high specificity in predicting outcomes of patients with acute hepatobiliary infection.