SOFA、SIRS、qSOFA评分和乳酸对儿童脓毒症预后的判断价值

Prognostic value of SOFA,SIRS,qSOFA score and lactate level in pediatric sepsis

目的评价乳酸及序贯器官衰竭评分(SOFA)、全身炎症反应综合征评分(SIRS)、快速序贯器官衰竭评分(qSOFA)评分对儿童脓毒症患者预后的评估价值。方法回顾性分析2016年1月—2018年12月江苏省淮安市妇幼保健院儿科普通病房及重症病房且符合Sepsis-3诊断标准的259例患儿的临床资料,根据预后将其分为存活组(241例)和死亡组(18例)。受试者工作特征曲线(ROC)评估两组乳酸、24 h内SOFA、SIRS及qSOFA对患者预后的预测价值。结果死亡组乳酸水平、SOFA、SIRS、qSOFA评分高于存活组,差异均有高度统计学意义(均P<0.01)。SOFA评分诊断脓毒症患儿死亡的临界值为7.5分,敏感度为68.8%,特异性为80.0%;qSOFA评分诊断脓毒症患儿死亡的临界值为1.5分,敏感度为68.8%,特异性为80.0%;乳酸诊断脓毒症患儿死亡的临界值为1.75 mmol/L,敏感度为93.8%,特异性为40.0%。结论与SIRS评分比较,SOFA、qSOFA评分对于儿童脓毒症预后的判断更有价值,而传统指标乳酸有很好的敏感性,是判断脓毒症患儿预后的可靠指标,但特异性低。

Objective To investigate the prognostic value of sequential organ failure assessment(SOFA),systemic inflammatory response syndrome(SIRS)score,quick sequential organ failure assessment(qSOFA)score and lactate level in pediatric sepsis.Methods A total of 259 pediatric patients with Sepsis-3 diagnosis in general and intensive care units of Huai′an Maternal and Child Health Hospital of Jiangsu Province from January 2016 to December 2018 were retrospectively analyzed.They were divided into survival group(241 cases)and death group(18 cases)according to the prognosis.Receiver operating characteristic curve(ROC)was used to assessed the predictive value of lactate level,SOFA within 24 h and SIRS and qSOFA for prognosis of patients.Results Lactate level,SIRS,SOFA and qSOFA scores in death group were higher than those in survival group,and the differences were all highly statistically significant(all P<0.01).The cut-off value for the death of sepsis by SOFA score was 7.5 points,the sensitivity was 68.8%,and the specificity was 80.0%respectively.The cut-off value for the death of sepsis by qSOFA score was 1.5 points,the sensitivity was 68.8%,and the specificity was 80.0%.The cut-off value for the death of sepsis by lactate value was 1.75 mmol/L,the sensitivity was 93.8%,and the specificity was 40.0%.Conclusion Compared with SIRS score,SOFA and qSOFA scores have better prognostic accuracy in predicting the prognosis of children with sepsis.Although lactate level has good sensitivity and is a reliable indicator for the prognosis of children with sepsis,but its specificity is low.