qSOFA评分联合休克指数评估脓毒症患者预后的价值

陈卫; 石齐芳; 陈嵩; 章冰玉; 杨光耀; 盛鹰; 徐英

doi:10.13201/j.issn.1009-5918.2023.03.004

qSOFA评分联合休克指数评估脓毒症患者预后的价值

- 1.
  上海市浦东医院急危重症医学科(上海，201399)
- 2.
  上海市浦东新区人民医院急诊与重症医学科
- 3.
  海军军医大学附属公利医院急诊医学科
基金项目:
上海市浦东新区卫生系统优秀青年医学人才培养计划(No：PWRq2021-25);复旦大学附属浦东医院重点专科专病诊治中心项目资助(No：Tszb2021-04)

详细信息

通讯作者: 徐英，E-mail：xuyingjz52@sina.com

中图分类号: R631.2

收稿日期: 2023-01-05

刊出日期: 2023-03-10

Evaluation of the prognostic value of qSOFA score combined with shock index in patients with sepsis

- 1.
  Department of Emergency and Intensive Care Unit, Shanghai Pudong Hospitai, Shanghai, 201399, China
- 2.
  Department of Emergency and Intensive Care Unit, Shanghai Pudong New Area People's Hospital
- 3.
  Department of Emergency, Gongli Hospital Affiliated to Naval Medical University

More Information

Corresponding author: XU Ying, E-mail: xuyingjz52@sina.com

Received Date: 05 January 2023

Publish Date: 10 March 2023

摘要

摘要: 目的探讨快速序贯器官衰竭(qSOFA)评分联合休克指数(SI)在预测脓毒症患者预后的价值。方法回顾性队列研究，收集3家区域医疗中心收治的306例脓毒症患者的临床资料，根据患者住院期间生存状态分存活组和死亡组，使用受试者工作曲线下面积(AUC)和决策曲线分析(DCA)评价qSOFA评分联合SI评估患者预后的价值。结果 SI与乳酸呈正相关(r=0.465，P < 0.001)。SI的最佳截断值为1.0，SI≥1.0为1分，联合qSOFA评分形成SqSOFA评分，其预测患者的预后AUC是0.694(95%CI：0.639~0.745)，优于qSOFA评分0.631(95%CI：0.574~0.685)，差异有统计学意义(Z=3.867，P < 0.001)，决策曲线分析显示SqSOFA评分具有较好的临床应用效能。结论 qSOFA评分联合SI评估脓毒症患者住院病死率有一定价值。
- 脓毒症 /
- 评分 /
- 休克指数 /
- 快速序贯器官衰竭评分
Abstract: Objective To explore the value of qSOFA score combined with shock index(SI) in predicting the prognosis of sepsis patients.Methods A retrospective cohort study from three regional medical centers collected clinical data of 306 sepsis patients, followed up the patients' survival status during hospitalization and divided them into a survival group and a death group. Assessing the efficacy of the combined qSOFA score and SI in predicting patient prognosis using the area under the receiver operating curve(AUC) and decision curve analysis(DCA).Results SI was positively correlated with lactate(r=0.465, P < 0.001). The optimal cut-off value for SI was 1.0, and a SI ≥1.0 was 1 point combined with the qSOFA score to form the SqSOFA score. AUC of SqSOFA score was 0.694(95%CI: 0.639-0.745), which was better than qSOFA score of 0.631(95%CI: 0.574-0.685), and the difference was statistically significant(Z=3.867, P < 0.001). Decision curve analysis showed that SqSOFA had high clinical benefit in the test group.Conclusion qSOFA score combined with SI has a certain value in predicting in-hospital mortality in sepsis patients.
- sepsis /
- score /
- shock index /
- quick sequential organ failure assessment

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图 1 脓毒症患者SI与Lac相关性散点图

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图 2 3种评分预测脓毒症患者住院病死率的AUC比较

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图 3 SqSOFA评分的DCA

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表 1 脓毒症患者存活组和死亡组基线资料的比较例(%)，X±S

基线资料	存活组(n=234)	死亡组(n=72)	χ²/t	P
年龄/岁	66.56±13.71	72.19±10.29	3.220	0.001
性别(男/女)	147/87	42/30	0.469	0.493
基础疾病
高血压	74(31.62)	22(30.56)	0.029	0.864
冠状动脉粥样硬化性心脏病	48(20.51)	26(36.11)	7.306	0.007
慢性阻塞性肺疾病	53(22.65)	23(31.94)	2.548	0.110
脑血管疾病	35(14.96)	17(23.61)	2.923	0.087
2型糖尿病	54(23.08)	15(20.83)	0.159	0.690
慢性肾脏疾病	21(8.97)	8(11.11)	0.293	0.588
感染部位
肺部	116(49.57)	33(45.83)	0.308	0.579
腹腔	48(20.51)	23(31.94)	4.038	0.044
泌尿系统	55(23.50)	8(11.11)	5.172	0.023
血源性	4(1.71)	3(4.17)	0.591	0.442
皮肤软组织	10(4.27)	2(2.78)	0.050	0.822
其他	1(0.43)	3(4.17)	3.421	0.064
急诊首诊生命体征
T/℃	36.87±0.61	36.64±0.85	2.444	0.015
HR/(次·min^-1)	105.04±26.34	112.57±30.83	2.034	0.043
RR/(次·min^-1)	21.59±5.46	23.54±5.58	2.643	0.009
SBP/mmHg	109.35±24.30	120.64±24.10	3.470	0.001
DBP/mmHg	63.56±15.79	68.43±15.91	2.278	0.023
实验室检查
WBC/(×10⁹·L^-1)	14.12±6.44	16.28±10.78	2.088	0.038
Hb/(g·L^-1)	115.95±26.30	108.92±24.76	2.011	0.045
PLT/(×10⁹·L^-1)	183.86±84.02	181.01±113.51	0.230	0.818
BUN/(mmol·L^-1)	10.64±6.84	14.36±8.11	3.845	< 0.001
Cr/(mmol·L^-1)	115.24±86.15	155.65±108.78	3.262	0.001
TBIL/(μmol·L^-1)	13.02±5.82	21.55±11.25	8.491	< 0.001
ALB/(g·L^-1)	31.21±6.12	28.47±5.46	3.387	0.001
Lac/(mmol·L^-1)	2.86±1.80	4.72±3.22	6.217	< 0.001
qSOFA评分/分	1.91±0.76	2.28±0.70	3.707	< 0.001
SOFA评分/分	6.75±3.54	10.76±4.62	7.797	< 0.001
SI	0.91±0.31	1.08±0.39	3.805	< 0.001

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表 2 脓毒症患者不同SI截断值的Youden指数

Cutoff值	灵敏度/%	特异度/%	阳性似然比	阴性似然比	Youden指数
0.7	79.17	27.78	1.10	0.75	0.0695
0.8	70.83	39.32	1.17	0.74	0.1015
0.9	63.89	53.85	1.38	0.67	0.1774
1.0	54.17	69.66	1.79	0.66	0.2383
1.1	43.06	77.35	1.90	0.74	0.2041
1.2	33.33	82.48	1.90	0.81	0.1581
1.3	26.39	89.32	2.47	0.82	0.1571

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表 3 SI及Lac对脓毒症患者住院病死率的预测价值

参数	AUC	95%CI	Cutoff值	灵敏度/%	特异度/%	阳性似然比	阴性似然比	约登指数
SI	0.626	0.570~0.681	>1.0	54.17	69.66	1.79	0.66	0.2383
Lac	0.679	0.623~0.731	>4.7	40.28	90.17	4.10	0.66	0.3045

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表 4 3种评分对脓毒症患者住院病死率预测能力的比较

参数	AUC	95%CI	最佳诊断阈值	灵敏度/%	特异度/%	阳性似然比	阴性似然比	约登指数
SqSOFA评分	0.694	0.639~0.745	>2	75.00	58.97	1.83	0.42	0.3397
qSOFA评分	0.631	0.574~0.685	>2	41.67	77.78	1.88	0.75	0.1944
SOFA评分	0.758	0.706~0.804	>9	63.89	79.49	3.11	0.45	0.4338

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