Evaluation of the prognostic value of qSOFA score combined with shock index in patients with sepsis
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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。
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关键词:
- 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.-
Key words:
- sepsis /
- score /
- shock index /
- quick sequential organ failure assessment
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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 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 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 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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