快速序贯器官衰竭评分诊断成人软组织感染致脓毒症的准确性评估

Diagnosis accuracy of quick sequential organ failure assessment score for adult sepsis patient with soft tissue infection

目的评估快速序贯器官衰竭评分(qSOFA)用于诊断成人软组织感染所致脓毒症的准确性,及对患者发生脓毒性休克的预测价值。方法回顾性分析2012年1月至2018年12月北京医院普外科和解放军总医院第四医学中心烧伤整形科收治的软组织感染患者的临床资料。根据诊断感染48 h内是否发生脓毒症将患者分为脓毒症组和非脓毒症组。比较两组患者的基线数据、预后以及qSOFA、序贯器官衰竭评分变化值(ΔSOFA)、全身炎症反应综合征评分(SIRS评分);绘制受试者工作特征曲线(ROC),分析qSOFA、SIRS评分对软组织感染致脓毒症的诊断价值,以及qSOFA、ΔSOFA、SIRS评分对患者发生脓毒性休克的预测价值。结果共192例患者纳入研究,诊断感染48 h内发生脓毒症79例(41.1%),28 d住院期间进展为脓毒性休克28例(14.6%),共死亡6例(3.1%)。与非脓毒症组比较,脓毒症组坏死性筋膜炎、脓毒性休克和接受机械通气治疗的比例更高(21.5%比4.4%,31.6%比2.7%,16.5%比4.4%,均P<0.01),并具有更高的病死率(7.6%比0%,P=0.003)。ROC曲线分析显示,以qSOFA≥2分为截断值,诊断软组织感染致脓毒症的敏感度为48.1%,特异度为92.0%,阳性预测值为80.8%,阴性预测值为71.7%,ROC曲线下面积(AUC)为0.824〔95%可信区间(95%CI)=0.764~0.884,P<0.01〕;以SIRS评分≥3分为截断值,诊断软组织感染致脓毒症的敏感度为89.8%,特异度为48.6%,阳性预测值为55.0%,阴性预测值为87.3%,AUC为0.721(95%CI=0.677~0.765,P<0.01)。qSOFA≥2分、ΔSOFA≥2分、SIRS评分≥3分均可预测成人软组织感染患者发生脓毒性休克(均P<0.01),AUC分别为0.767(95%CI=0.665~0.869)、0.840(95%CI=0.757~0.923)、0.716(95%CI=0.596~0.835)。结论可以将qSOFA≥2分作为诊断成人软组织感染所致脓毒症的快速筛查工具。对于普通病房患者,建议可以使用qSOFA或SIRS评分来初步预测软组织感染患者发生脓毒性休克。

Objective To assess the diagnosis accuracy of the quick sequential organ failure assessment(qSOFA)score for adult sepsis patient with soft tissue infection,and to assess the prognostic accuracy of the qSOFA score for septic shock.Methods A retrospective study was conducted.The patients with soft tissue infection admitted to the general surgery department of Beijing Hospital and the burns and plastic surgery department of Fourth Medical Center of PLA General Hospital from January 2012 to December 2018 were enrolled.Patients were divided into the sepsis group and the non-sepsis group according to whether sepsis occurred within 48 hours after diagnosis of infection.The baseline data,prognosis,and qSOFA,the change of sequential organ failure assessment(ΔSOFA),systemic inflammatory response syndrome(SIRS)scores were compared between the two groups,and the receiver operating characteristic(ROC)curves were also drawn to assess the diagnosis accuracy of the qSOFA and SIRS scores for adult sepsis patients with soft tissue infection and to assess the prognostic accuracy of the qSOFA,ΔSOFA and SIRS scores for septic shock of these patients.Results 192 patients were included in the study.Sepsis occurred in 79 patients(41.1%)within 48 hours after diagnosis of infection.Septic shock occurred in 28 patients(14.6%)during 28-day hospitalization and 6 patients(3.1%)died.Compared with non-sepsis group,more proportion of necrotizing fasciitis,septic shock and patients received mechanical ventilation(21.5%vs.4.4%,31.6%vs.2.7%,16.5%vs.4.4%,all P<0.01),with higher mortality(7.6%vs.0%,P=0.003)in sepsis group.ROC curve analysis showed that when the cut-off value of qSOFA≥2,the sensitivity,specificity,positive predictive value,negative predictive value and area under ROC curve(AUC)were 48.1%,92.0%,80.8%,71.7%and 0.824[95%confidence interval(95%CI)=0.764-0.884,P<0.01]respectively for diagnosis of sepsis caused by soft tissue infection.When the cut-off value of SIRS score≥3,the sensitivity,specificity,positive predictive value,negative predictive value and AUC were 89.8%,48.6%,55.0%,87.3%and 0.721(95%CI=0.677-0.765,P<0.01)respectively for diagnosis of sepsis caused by soft tissue infection.All scores of qSOFA≥2,ΔSOFA≥2 and SIRS score≥3 could be used to predict septic shock(all P<0.01).The AUC ofΔSOFA,qSOFA and SIRS scores were 0.767(95%CI=0.665-0.869),0.840(95%CI=0.757-0.923)and 0.716(95%CI=0.596-0.835)respectively.Conclusions qSOFA≥2 can be used as a rapid sepsis screening tool for adult patients with soft tissue infection.It is suggested that qSOFA or SIRS scores can be used to predict septic shock of adult patients with soft tissue infection initially.