Sepsis3．0对ICU脓毒症患者诊断及预后评估的验证

Test of Sepsis 3.0 for diagnosis and prognosis of the septic patients in the intensive care unit

目的验证Sepsis3．0诊断标准下序贯器官衰竭评分（SOFA）、快速SOFA（qSOFA）对脓毒症患者的诊断及预后评估价值。方法回顾性分析2014年7月至2016年6月首都医科大学附属北京中医医院重症加强治疗病房（ICU）收治的脓毒症患者的临床资料，根据人院转归分为存活组与死亡组，收集患者性别、年龄、感染部位，以及患者人院时的呼吸频率（RR）、氧合指数（PaO2/FiO2）、格拉斯哥昏迷评分（GCS）、总胆红素（TBil）、血小板计数（PLT）、血肌酐（SCr）、血乳酸水平等一般资料，进行SOFA评分、qSOFA评分，筛选符合Sepsis3．0诊断标准的脓毒症患者作为SOFA组和qSOFA组。结果纳入的545例脓毒症患者中符合Sepsis3．0诊断标准者189例，其中SOFA组脓毒症发生率为34．68％，qSOFA组脓毒症发生率为15．96％，两组比较差异有统计学意义（P〈0．01）；SOFA组病死率明显低于qSOFA组[28．04％（53／189）比42．53％（38／87），P〈0．05]，qSOFA组病死率约为SOFA组的1．52倍。评分方面，死亡组患者SOFA评分明显高于存活组（分：8．74±0．42比7．10±0．23，P〈0．01）；死亡组和存活组qSOFA评分比较差异无统计学意义（分：2．32±0．48比2．16±0．37，P〉0．05）。实验室指标方面，死亡组GCS评分明显低于存活组（分：8．15±0．67比12．48±0．36）、血乳酸水平高于存活组（mmol／L：8．55±4．66比2．31±0．16，P〈0．01）；两组PaO2/FiO2、TBil、PLT、SCr比较差异均无统计学意义（均P〉0．05）。结论Sepsis5．0可用于ICU脓毒症患者的诊断，SOFA评分比qSOFA评分更适用于ICU脓毒症患者的诊断及预后评估；SOFA评分、GCS评分、血乳酸水平可用于评估脓毒症患者的预后。

Objective To investigate the estimated values of sequential organ failure assessment （SOFA） and quick SOFA （qSOFA） for diagnosis and prognosis in patients with sepsis according to the new diagnostic criteria in Sepsis 3.0. Methods A retrospective study was conducted. All the clinical data were collected from patients with definite diagnosis of infection and they were admitted into the Intensive Care Unit （ICU） of Beijing Traditional Chinese Medicine Hospital Affiliated to Capital Medical University from July 2014 to June 2016. The patients＇ gender, age, infectious location, respiratory rate （RR）, oxygenation index （PaO2/FiO2）, Glasgow coma scale （GCS）, total bilirubin （TBil）, platelet count （PLT）, serum creatinine （SCr）, serum lactate level, etc. general data on admission were collected to carry out SOFA and qSOFA scorings. And then the septic patients in accord with the diagnostic criteria of Sepsis 3.0 were screened out. According to outcome after admission, the septic patients were divided into survival group and death group, and the differences in diagnosis and in estimation value of prognosis between SOFA scoring and qSOFA scoring were assessed as SOFA group and qSOFA group. Results From 545 septic patients enrolled, 189 septic patients consistent with the diagnostic criteria of Sepsis 3.0 were selected. In SOFA scoring group, the morbidity of septic patients was 34,68%, while in qSOFA scoring group, it was 15.96%, the difference between the two groups being statistically significant （P 〈 0.01）. The mortality was significantly lower in SOFA scoring group than that in qSOFA scoring group [28.04% （53/189） vs. 42.53% （38/87）, P 〈 0.05]. The mortality of qSOFA scoring group was about 1.52 times that of SOFA scoring group. On the aspect of scoring, in patients with SOFA scoring the score of death group was significantly higher than that in survival group （8.74 ±0.417 vs. 7.10 ± 0.235, P 〈 0.01）; in the patients with qSOFA scoring, the score in death group compared with that in survival group showed no statistical significant difference （2.32 ± 0.48 vs. 2.16 ± 0.37, P 〉 0.05）. On the aspect of laboratory indexes, the levels of GCS score in death group was significantly lower than that in the survival group （8.15 ± 0.67 vs. 12.48 ± 0.36）, blood lactate level in death group was significantly higher than that in the survival group （mmol/L： 8.55 ± 4.66 vs. 2.31 ± 0.16, P 〈 0.01）; the PaO2/FiO2 TBil, PLT and SCr showed no significant differences between the two groups （all P 〉 0.05）. Conclusions The new diagnostic criteria （Sepsis 3.0） can be used for diagnosis of sepsis in ICU. Compared with qSOFA scoring, the SOFA scoring is more suitable to be used for diagnosis and predicting prognosis of septic patients in ICU; SOFA scoring, GCS scoring and serum lactate level can be applied to estimate outcome of septic patients.