The diagnostic value of blood lactate combined with qSOFA score for the early screening of sepsis patients
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摘要: 目的:探讨血乳酸联合快速序贯器官衰竭评分(qSOFA)评分对急诊脓毒症早期筛选诊断的价值。方法:选择在急诊抢救室就诊的506例疑似感染患者纳入研究。根据Sepsis 3.0诊断标准分为脓毒症组295例及非脓毒症组211例,统计所有患者qSOFA评分,乳酸联合qSOFA的Lac-qSOFA评分及SOFA评分,通过ROC曲线比较3种方法对脓毒症诊断的价值,分别计算敏感度和特异度等指标。结果:Lac-qSOFA评分与SOFA评分对脓毒症诊断的价值差异无统计学意义,与qSOFA评分对脓毒症诊断的价值差异有统计学意义。ROC曲线分析显示,qSOFA评分及Lac-qSOFA评分诊断脓毒症的截断值为1.5,qSOFA≥2分及Lac-qSOFA≥3分时,诊断脓毒症的敏感度分别为32%、26%,特异度分别为96%、98%。Lac-qSOFA≥2分时,诊断脓毒症的敏感度为67%,特异度为75%。结论:Lac-qSOFA评分诊断脓毒症比qSOFA评分诊断脓毒症更为准确,当Lac-qSOFA≥2分时,需高度怀疑脓毒症,对早期筛选诊断脓毒症更有价值。Abstract: Objective: To explore the value of blood lactate combined with qSOFA in the early screening and diagnosis of emergency sepsis.Methods: Five hundred and six patients patients with suspected infection in the emergency department were selected in the study. According to the Sepsis 3.0 diagnostic criteria, they were divided into the sepsis group(n=295) and the non-sepsis group(n=211). All patients were assessed for qSOFA,Lac-qSOFA and SOFA. The diagnostic value of three methods for sepsis was compared by ROC curve, and the sensitivity and specificity were calculated respectively.Results: There was no significant difference between Lac-qSOFA and SOFA for the diagnosis of sepsis, but there was statistical difference between qSOFA and Lac-qSOFA. ROC curve analysis showed that the cut-off value of qsolfa score and lac qsolfa score in the diagnosis of sepsis was 1.5. When qsolfa score ≥ 2 and lac qsolfa score ≥ 3, the sensitivity of diagnosis of sepsis were 32%, 26%, 96% and 98%, respectively. When lac qsofea ≥ 2, the sensitivity and specificity were 67% and 75%, respectively.Conclusion: Lac-qSOFA score was more accurate in the diagnosing of sepsis than qSOFA score. When Lac-qSOFA ≥2, sepsis should be highly suspected, which was more valuable for the early screening of sepsis.
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[1] Oh HJ,Kim SJ,Kim YC,et al.An increased chloride level in hypoc-hloremia is associated with decreased mortality in patients with severe sepsis or septic shock[J].Sci Rep,2017,217(1):15883.
[2] Singer M,Deutschman CS,Seymour CW,et al.The Third International Consensus definitions for Sepsis and Septic Shock(Sepsis-3)[J].JAMA,2016,315(8):801-810.
[3] Tusgul S,Carron PN,Yersin B.Low sensitivity of qSOFA,SIRS criteria and sepsis definition to identify infected patients at risk of complication in the prehospital setting and at the emergency department triage[J].Scand J Trauma Resusc Emerg Med,2017,25(1):108.
[4] Siddiqui S,Chua M,Kumaresh V,et al.A comparison of pre ICU admission SIRS,EWS and q SOFA scores for predicting mortality and length of stay in ICU[J].J Crit Care,2017,41:191-193.
[5] Bennett V,Board J,McCracken P,et al.Potential Impact of the 2016 Consensus Definitions of Sepsis and Septic Shock on Future Sepsis Research[J].Ann Emerg Med,2017,70(4):553-561.
[6] Amland RC,Sutariya BB.Quick Sequential[Sepsis-Related]Organ Failure Assessment(qSOFA)and St.JohnSepsisSurveillanceAgent to DetectPatients at Risk of Sepsis:An Observational Cohort Study[J].Am J Med Qual,2018,33(1):50-57.
[7] 安莹波.早期动脉血乳酸水平和乳酸清除率对评估严重脓毒症患者预后的临床价值[J].微循环学杂志,2013,23(3):50-54.
[8] Seymour CW,Liu VX,Iwashyna TJ,et al.Assessment of clinical criteria for sepsis:for the third international consensus definitions for Sepsis and Septic Shock(Sepsis-3)[J].JAMA,2016,315(8):762-774.
[9] Raith EP,Ldy AA,Bailey M,et al.Prognostic accuracy of the SOFA score,SIRS criteria,and qSOFA score for in-hospital mortality among adults with suspected infection admitted to the intensive care unit[J].JAMA,2017,317(3):290-300.
[10] Jouffroy R,Saade A,Carpentier A,et al.Triage of septic patients using qSOFA criteria at the SAMU regulation:a retrospective anal-ysis[J].Prehosp Emerg Care,2018,22(1):84-90.
[11] 中国医疗保健国际交流促进会急诊医学分会,中华医学会急诊医学分会,中国医师协会急诊医师分会,等.中国脓毒症早期预防与阻断急诊专家共识[J].临床急诊杂志,2020,21(7):517-529.
[12] Khwannimit B,Bhurayanontachai R,Vattanavanit V.Comparison of the performance of SOFA,qSOFA and SIRS for predicting mortality and organ failure among sepsis patients admitted to the intensive care unit in a middle-income country[J].J Crit Care,2017,18(44):156-160.
[13] Williams JM,Greenslade JH,McKenzie JV,et al.Systemic Inflammatory Response Syndrome,Quick Sequential Organ Function Assessment,and Organ Dysfunction:Insights From a Prospective Database of ED Patients With Infection[J].Chest,2017,151(3):586-596.
[14] Levy MM,Fink MP,Marshall JC,et al.2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference[J].Crit Care Med,2003,31(4):1250-1256.
[15] Du XM,Hu H,Kurbah OM.Both qSOFA score and bedside plasma lactate are the predictors of mortality for patients with infections in ED[J].Am J Emerg Med,2017,5(9):1381-1382.
[16] 刘思佳,胡海,杜鑫淼.整合床旁血浆乳酸检测的qSOFA评分在急诊科快速评估严重脓毒症患者预后的价值[J].中国急救复苏与灾害医学杂志,2018,13(1):25-28.
[17] Shetty A,MacDonald SP,Williams JM.Lactate ≥ 2mmol/L plus qSOFA improves utility over qSOFA alone in emergency department patients presenting with suspected sepsis[J].Emerg Med Australas,2017,29(6):626-634.
[18] 庾胜,张碧波,顾晓蕾,等.qSOFA联合SIRS评分对急诊脓毒症的早期诊断效能分析[J].山东医药,2019,59(20):86-89.
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