摘要
BackgroundThe use of the quick sequential organ failure assessment score (qSOFA) score and systemic inflammatory response syndrome (SIRS) criteria to identify patients at high risk for adverse outcomes in the emergency department (ED) remains controversial due to their low predictive performance and lack of supporting evidence. This study aimed to determine the predictive performance of qSOFA, SIRS, and the qSOFA + SIRS combinations for adverse outcomes.MethodsAll adult patients admitted to the ED with suspected infection were prospectively included. qSOFA scores ≥ 2, SIRS score ≥ 2 were defined as risk-positive for adverse outcome. Furthermore, combination‑1, which was defined as either qSOFA or SIRS positivity, and combination‑2, which was defined as both qSOFA and SIRS positivity, were also considered as risk-positive for adverse outcome. The predictive performance of qSOFA, SIRS, combination‑1, and combination‑2 for a composite adverse outcome within 30 days, including mortality, intensive care unit (ICU) admission, and non-ICU hospitalization, were determined.ResultsA total of 350 patients were included in the analysis. The composite outcome occurred in 211 (60.3%) patients within 30 days: mortality in 84 (24%), ICU admission in 78 (22.3%), and non-ICU hospitalization in 154 (44%). The sensitivity and specificity, respectively, were determined in predicting composite outcome as 0.34 and 0.93 for qSOFA, 0.81 and 0.31 for SIRS, 0.84 and 0.28 for combination‑1, and 0.31 and 0.96 for combination‑2.ConclusionThe study results suggest that qSOFA and combination‑2 could be a useful tool for confirming patients at high risk for adverse outcomes. Although SIRS and combination‑1 could be helpful for excluding high-risk patients, the requirement of white blood cell counts limits their utilization for screening.
摘要译文
背景使用快速顺序器官失效评估评分评估评分（QSOFA）评分和全身性炎症综合征（SIRS）标准来识别急诊科（ED）不良后果风险的患者，由于其预测性能低和缺乏支持证据。这项研究旨在确定QSOFA，SIRS和QSOFA+SIRS组合的预测性能。QSOFA得分≥2，SIRS得分≥2定义为不良结果的风险阳性。此外，被定义为QSOFA或SIRS阳性的组合1，定义为QSOFA和SIRS阳性的组合−2也被认为是不良结果的风险阳性。确定了350名患者总共确定了30天的QSOFA，SIRS，COMBINATION −1和组合对复合不良结局的预测性能，包括死亡率，重症监护病房（ICU）入院和非ICU住院。被包括在分析中。综合结果发生在30天内的211例（60.3％）患者中：84例死亡率（24％），ICU入院78（22.3％）和154（44％）的非ICU住院。在预测QSOFA的综合结果为0.34和0.93时，确定了敏感性和特异性，SIRS为0.81和0.31，组合为0.84和0.28，组合为0.28，组合为0.31和0.96，组合生率为0.96。组合−2可能是确认患者高风险不良后果的有用工具。尽管SIRS和COMBINATION −1可能有助于排除高危患者，但白细胞计数的要求限制了其用于筛查的利用。
Yeşil; Olcay[1];Pekdemir; Murat[1];Özturan; İbrahim Ulaş[1];Doğan; Nurettin Özgür[1];Yaka; Elif[1];Yılmaz; Serkan[1];Karadaş Adnan[1];Pınar; Seda Güney[1]. Performance of qSOFA, SIRS, and the qSOFA + SIRS combinations for predicting 30-day adverse outcomes in patients with suspected infection[J]. Medizinische Klinik - Intensivmedizin und Notfallmedizin, 2022,117(8): 623-629