SIRS标准、qSOFA评分、qPitt评分对细菌性血流感染患者死亡风险的预测价值分析

Analysis of the predictive value of SIRS standard,qSOFA score and qPitt score on the risk of death in patients with bacterial bloodstream infection

目的:比较全身炎症反应综合征(SIRS)标准、快速序贯器官衰竭(qSOFA)评分及快速皮塔菌血症(qPitt)评分对细菌性血流感染患者死亡风险的预测价值。方法:回顾性分析2018年1月—2020年9月天津医科大学总医院急诊医学科110例发生细菌性血流感染患者的病例资料,以血培养阳性作为血流感染的诊断依据,计算血流感染发生24 h内SIR标准、qPitt评分、qSOFA评分,以28 d内患者预后作为依据分为存活组(81例)及死亡组(29例),应用受试者工作特征(ROC)曲线下面积(AUC)评估不同评分系统对患者预后的预测价值,Logistic回归分析不同评分系统与血流感染患者死亡风险的关系,Pearson相关分析不同评价系统之间的相关性。结果:死亡组SIRS标准、qSOFA评分、qPitt评分分别为(2.76±1.12)、(1.59±0.87)、(1.52±0.87),与存活组的差异具有统计学意义(均P<0.05);ROC曲线显示qSOFA评分对血流感染患者预后的预测价值最大(AUC=0.866),SIRS标准、qSOFA评分、qPitt评分的最佳截断值分别为3分、1分、1分;通过Logistic回归分析发现SIRS标准≥3(OR=3.673,95%CI:1.213~11.126)、qSOFA评分≥1(OR=5.864,95%CI:1.205~28.549)、qPitt评分≥1(OR=4.456,95%CI:1.035~19.190)与细菌性血流感染患者的死亡风险显著相关;Pearson相关分析显示qPitt评分与qSOFA评分相关性最好(r=0.835,P<0.01)。结论:SIRS标准、qPitt评分和qSOFA评分均能有效地预测细菌性血流感染患者的死亡风险,其中qSOFA评分对患者预后的预测价值最大。

Objective:To compare the predictive value,systemic inflammatory response syndrome(SIRS)criteria,rapid sequential organ failure(qSOFA)score and rapid Pitataemia(qPitt)score on the risk of death in patients with bacterial bloodstream infection.Methods:Retrospective analysis was performed on the data of 110 patients with bacterial bloodstream infection in the Department of Emergency Medicine,General Hospital,Tianjin Medical University from January 2018 to September 2020.Diagnostic criteria were based on the blood culture positive for bloodstream infections,and bloodstream infections occurred within 24 h of SIR standard,qPitt score,and qSOFA score were calculated.The patients were divided into the survival group(81 cases)and the death group(29 cases)according to the prognosis within 28 days.The area under the receiver operating characteristic(ROC)curve(AUC)was used to evaluate the predictive value of different scoring systems for the prognosis of patients,Logistic regression was used to analyze the relationship between different scoring systems and the death risk of patients with bloodstream infection,and Pearson correlation was used to analyze the correlation between different evaluation systems.Results:SIRS standard,qSOFA score and qPitt score in the death group were(2.76±1.12),(1.59±0.87)and(1.52±0.87),respectively,the differences were statistically significant(all P<0.05)compared with the survival group.The ROC curve showed that qSOFA score had the greatest predictive value for the prognosis of patients with bloodstream infection(AUC=0.866).The optimal cut-off values of SIRS standard,qSOFA score and qPitt score were 3 scores,1 score and 1 score,respectively.Logistic regression found that SIRS standard≥3(OR=3.673,95%CI:1.213-11.126),qSOFA score≥1(OR=5.864,95%CI:1.205-28.549)and qPitt score≥1(OR=4.456,95%CI:1.035-19.190)were significantly correlated with the risk of death in patients with bacterial bloodstream infection.Pearson correlation analysis showed that qPitt score had the best correlation with qSOFA score(r=0.835,P<0.01).Conclusion:SIRS standard,qPitt score and qSOFA score can effectively predict the risk of death in patients with bacterial bloodstream infection,among which qSOFA score has the greatest predictive value for the prognosis of patients.