BACKGROUND:The quick sequential organ failure assessment(qSOFA)is recommended to identify sepsis and predict sepsis mortality.However,some studies have recently shown its poor performance in sepsis mortality predictio...BACKGROUND:The quick sequential organ failure assessment(qSOFA)is recommended to identify sepsis and predict sepsis mortality.However,some studies have recently shown its poor performance in sepsis mortality prediction.To enhance its effectiveness,researchers have developed various revised versions of the qSOFA by adding other parameters,such as the lactate-enhanced qSOFA(LqSOFA),the procalcitonin-enhanced qSOFA(PqSOFA),and the modified qSOFA(MqSOFA).This study aimed to compare the performance of these versions of the qSOFA in predicting sepsis mortality in the emergency department(ED).METHODS:This retrospective study analyzed data obtained from an electronic register system of adult patients with sepsis between January 1 and December 31,2019.Receiver operating characteristic(ROC)curve analyses were performed to determine the area under the curve(AUC),with sensitivity,specificity,and positive and negative predictive values calculated for the various scores.RESULTS:Among the 936 enrolled cases,there were 835 survivors and 101 deaths.The AUCs of the LqSOFA,MqSOFA,PqSOFA,and qSOFA were 0.740,0.731,0.712,and 0.705,respectively.The sensitivity of the LqSOFA,MqSOFA,PqSOFA,and qSOFA were 64.36%,51.40%,71.29%,and 39.60%,respectively.The specificity of the four scores were 70.78%,80.96%,61.68%,and 91.62%,respectively.The LqSOFA and MqSOFA were superior to the qSOFA in predicting in-hospital mortality.CONCLUSIONS:Among patients with sepsis in the ED,the performance of the PqSOFA was similar to that of the qSOFA and the values of the LqSOFA and MqSOFA in predicting in-hospital mortality were greater compared to qSOFA.As the added parameter of the MqSOFA was more convenient compared to the LqSOFA,the MqSOFA could be used as a candidate for the revised qSOFA to increase the performance of the early prediction of sepsis mortality.展开更多
BACKGROUND Acute pancreatitis(AP)is a common surgical condition,with severe AP(SAP)potentially lethal.Many prognostic indices,including;acute physiology and chronic health evaluation II score(APACHE II),bedside index ...BACKGROUND Acute pancreatitis(AP)is a common surgical condition,with severe AP(SAP)potentially lethal.Many prognostic indices,including;acute physiology and chronic health evaluation II score(APACHE II),bedside index of severity in acute pancreatitis(BISAP),Glasgow score,harmless acute pancreatitis score(HAPS),Ranson’s score,and sequential organ failure assessment(SOFA)evaluate AP severity and predict mortality.AIM To evaluate these indices'utility in predicting severity,intensive care unit(ICU)admission,and mortality.METHODS A retrospective analysis of 653 patients with AP from July 2009 to September 2016 was performed.The demographic,clinical profile,and patient outcomes were collected.SAP was defined as per the revised Atlanta classification.Values for APACHE II score,BISAP,HAPS,and SOFA within 24 h of admission were retrospectively obtained based on laboratory results and patient evaluation recorded on a secure hospital-based online electronic platform.Data with<10%missing data was imputed via mean substitution.Other patient information such as demographics,disease etiology,and patient outcomes were also derived from electronic medical records.RESULTS The mean age was 58.7±17.5 years,with 58.7%males.Gallstones(n=404,61.9%),alcohol(n=38,5.8%),and hypertriglyceridemia(n=19,2.9%)were more common aetiologies.81(12.4%)patients developed SAP,20(3.1%)required ICU admission,and 12(1.8%)deaths were attributed to SAP.Ranson’s score and APACHE-II demonstrated the highest sensitivity in predicting SAP(92.6%,80.2%respectively),ICU admission(100%),and mortality(100%).While SOFA and BISAP demonstrated lowest sensitivity in predicting SAP(13.6%,24.7%respectively),ICU admission(40.0%,25.0%respectively)and mortality(50.0%,25.5%respectively).However,SOFA demonstrated the highest specificity in predicting SAP(99.7%),ICU admission(99.2%),and mortality(98.9%).SOFA demonstrated the highest positive predictive value,positive likelihood ratio,diagnostic odds ratio,and overall accuracy in predicting SAP,ICU admission,and mortality.SOFA and Ranson’s score demonstrated the highest area under receiver-operator curves at 48 h in predicting SAP(0.966,0.857 respectively),ICU admission(0.943,0.946 respectively),and mortality(0.968,0.917 respectively).CONCLUSION The SOFA and 48-h Ranson’s scores accurately predict severity,ICU admission,and mortality in AP,with more favorable statistics for the SOFA score.展开更多
Background The prognostic power of n-terminal pro-brain natriuretic peptide （NT-proBNP） in sepsis is disputable and unstable among different models. We attempt to evaluate the prognostic potential of NT-proBNP in co...Background The prognostic power of n-terminal pro-brain natriuretic peptide （NT-proBNP） in sepsis is disputable and unstable among different models. We attempt to evaluate the prognostic potential of NT-proBNP in combination with the sequential organ failure assessment （SOFA） score in sepsis. Methods In this retrospective study, 100 consecutive sepsis patients were enrolled. Clinical data such as admission SOFA, the Acute Physiologic and Chronic Health Evaluation score, shock prevalence, use of lung protective ventilation, vasopressors, and glucocorticoids were recorded. Additionally, serum creatinine （Scrl and Scr3） and NT-proBNP （NT-proBNP1 and NT-proBNP3） were assayed and evaluated at admission and on day 3 respectively. Results ANT-proBNP （NT-proBNP3 minus NT-proBNP1） （P 〈0.001, Hazard ratio （HR）=1.245, 95% confidence interval （CI）, 1.137-1.362） and admission SOFA （P 〈0.001, HR=1.197, 95% CI, 1.106-1.295） were independently related to in-hospital mortality. Their combination was a more robust predictor for in-hospital mortality than either of them individually. Patients with high ANT-proBNP and SOFA had the poorest prognosis. Conclusions In our study, both ANT-proBNP and SOFA were independent predictors of septic patients＇ prognosis. Moreover, the combination of ,~NT-proBNP and admission SOFA provided a novel strategy that contained information regarding both the response to treatment and sepsis severity.展开更多
Background： The quick Sequential Organ Failure Assessment （qSOFA） score emerged recently. We investigated its contribution to risk stratification in acute pulmonary embolism （PE） by combining with electrocardiogr...Background： The quick Sequential Organ Failure Assessment （qSOFA） score emerged recently. We investigated its contribution to risk stratification in acute pulmonary embolism （PE） by combining with electrocardiography （ECG）. Methods： Acute PE patients diagnosed in Beijing Chao-Yang Hospital, Capital Medical University, from 2008 to 2018 were retrospectively studied and divided into high- and low-risk groups by imaging and biomarkers. The ECG scores consisted oftachycardia, McGinn-White sign （S1Q3T3）, right bundle branch block, and T-wave inversion of leads V1-V3. A new combination of qSOFA scores and ECG scores by logistic regression for predicting high-risk stratification patients with acute PE was evaluated by a receiver operating characteristic curve. Results： Totally 1318 patients were enrolled, including 271 in the high-risk group and 1047 in the low-risk group. A combination predictive scoring system named qSOFA-ECG = qSOFA score ＋ ECG score was created. The optimal cutoffvalue for qSOFA-ECG was 2, and the sensitivity, specificity, positive predictive value, and negative predictive value were 81.5%, 72.3%, 43.2%, and 93.8%, respectively. For predicting high-risk stratification and reperfusion therapy, the qSOFA-ECG is superior to PE Severity Index （PESI） and simplified PESI. Conclusions： The qSOFA score contributes to identify acute PE patients with potentially hemodynamic decompensation that need monitoring and possible reperfusion therapy at the emergency department arrival when used in combination with ECG score.展开更多
目的探讨快速序贯器官衰竭评分(quick sequential organ failure assessment,qSOFA)联合红细胞分布宽度与血钙比值(red blood cell distribution width-to-serum calcium ratio,RDC)对重症急性胰腺炎(severe acute pancreatitis,SAP)的...目的探讨快速序贯器官衰竭评分(quick sequential organ failure assessment,qSOFA)联合红细胞分布宽度与血钙比值(red blood cell distribution width-to-serum calcium ratio,RDC)对重症急性胰腺炎(severe acute pancreatitis,SAP)的预测价值。方法回顾性分析2018年6月~2022年10月徐州医科大学附属医院收治的319例急性胰腺炎患者的临床资料,根据病情严重程度分为非SAP组(n=260)和SAP组(n=59)。所有患者均于入院24h内进行血样采集并检测相应血液学指标,并于24h内进行qSOFA与急性胰腺严重床旁指数(bedside index for severity in acute pancreatitis,BISAP)评分。比较两组间的临床资料并进行Logistic回归分析危险因素。采用受试者工作特征(receiver operating characteristic,ROC)曲线评估qSOFA评分、RDC及两者联合评分对SAP的预测效能,并与BISAP评分进行比较。结果多因素Logistic回归分析发现,RDC(OR=4.111,95%CI:2.053~8.231,P<0.05)和qSOFA(OR=9.732,95%CI:3.974~23.832,P<0.05)高评分是SAP的独立危险因素。联合评分及BISAP评分预测SAP的曲线下面积(area under the curve,AUC)分别为0.915(95%CI:0.872~0.959,P<0.001)、0.839(95%CI:0.782~0.896,P<0.001),敏感度分别为93.2%、66.1%,特异性分别为85.0%、86.2%。结论qSOFA评分、RDC均可预测SAP的发生,两者联合评分对SAP发生的预测效能更高,可用于早期识别SAP的发生并指导早期干预。展开更多
文摘BACKGROUND:The quick sequential organ failure assessment(qSOFA)is recommended to identify sepsis and predict sepsis mortality.However,some studies have recently shown its poor performance in sepsis mortality prediction.To enhance its effectiveness,researchers have developed various revised versions of the qSOFA by adding other parameters,such as the lactate-enhanced qSOFA(LqSOFA),the procalcitonin-enhanced qSOFA(PqSOFA),and the modified qSOFA(MqSOFA).This study aimed to compare the performance of these versions of the qSOFA in predicting sepsis mortality in the emergency department(ED).METHODS:This retrospective study analyzed data obtained from an electronic register system of adult patients with sepsis between January 1 and December 31,2019.Receiver operating characteristic(ROC)curve analyses were performed to determine the area under the curve(AUC),with sensitivity,specificity,and positive and negative predictive values calculated for the various scores.RESULTS:Among the 936 enrolled cases,there were 835 survivors and 101 deaths.The AUCs of the LqSOFA,MqSOFA,PqSOFA,and qSOFA were 0.740,0.731,0.712,and 0.705,respectively.The sensitivity of the LqSOFA,MqSOFA,PqSOFA,and qSOFA were 64.36%,51.40%,71.29%,and 39.60%,respectively.The specificity of the four scores were 70.78%,80.96%,61.68%,and 91.62%,respectively.The LqSOFA and MqSOFA were superior to the qSOFA in predicting in-hospital mortality.CONCLUSIONS:Among patients with sepsis in the ED,the performance of the PqSOFA was similar to that of the qSOFA and the values of the LqSOFA and MqSOFA in predicting in-hospital mortality were greater compared to qSOFA.As the added parameter of the MqSOFA was more convenient compared to the LqSOFA,the MqSOFA could be used as a candidate for the revised qSOFA to increase the performance of the early prediction of sepsis mortality.
文摘BACKGROUND Acute pancreatitis(AP)is a common surgical condition,with severe AP(SAP)potentially lethal.Many prognostic indices,including;acute physiology and chronic health evaluation II score(APACHE II),bedside index of severity in acute pancreatitis(BISAP),Glasgow score,harmless acute pancreatitis score(HAPS),Ranson’s score,and sequential organ failure assessment(SOFA)evaluate AP severity and predict mortality.AIM To evaluate these indices'utility in predicting severity,intensive care unit(ICU)admission,and mortality.METHODS A retrospective analysis of 653 patients with AP from July 2009 to September 2016 was performed.The demographic,clinical profile,and patient outcomes were collected.SAP was defined as per the revised Atlanta classification.Values for APACHE II score,BISAP,HAPS,and SOFA within 24 h of admission were retrospectively obtained based on laboratory results and patient evaluation recorded on a secure hospital-based online electronic platform.Data with<10%missing data was imputed via mean substitution.Other patient information such as demographics,disease etiology,and patient outcomes were also derived from electronic medical records.RESULTS The mean age was 58.7±17.5 years,with 58.7%males.Gallstones(n=404,61.9%),alcohol(n=38,5.8%),and hypertriglyceridemia(n=19,2.9%)were more common aetiologies.81(12.4%)patients developed SAP,20(3.1%)required ICU admission,and 12(1.8%)deaths were attributed to SAP.Ranson’s score and APACHE-II demonstrated the highest sensitivity in predicting SAP(92.6%,80.2%respectively),ICU admission(100%),and mortality(100%).While SOFA and BISAP demonstrated lowest sensitivity in predicting SAP(13.6%,24.7%respectively),ICU admission(40.0%,25.0%respectively)and mortality(50.0%,25.5%respectively).However,SOFA demonstrated the highest specificity in predicting SAP(99.7%),ICU admission(99.2%),and mortality(98.9%).SOFA demonstrated the highest positive predictive value,positive likelihood ratio,diagnostic odds ratio,and overall accuracy in predicting SAP,ICU admission,and mortality.SOFA and Ranson’s score demonstrated the highest area under receiver-operator curves at 48 h in predicting SAP(0.966,0.857 respectively),ICU admission(0.943,0.946 respectively),and mortality(0.968,0.917 respectively).CONCLUSION The SOFA and 48-h Ranson’s scores accurately predict severity,ICU admission,and mortality in AP,with more favorable statistics for the SOFA score.
文摘Background The prognostic power of n-terminal pro-brain natriuretic peptide （NT-proBNP） in sepsis is disputable and unstable among different models. We attempt to evaluate the prognostic potential of NT-proBNP in combination with the sequential organ failure assessment （SOFA） score in sepsis. Methods In this retrospective study, 100 consecutive sepsis patients were enrolled. Clinical data such as admission SOFA, the Acute Physiologic and Chronic Health Evaluation score, shock prevalence, use of lung protective ventilation, vasopressors, and glucocorticoids were recorded. Additionally, serum creatinine （Scrl and Scr3） and NT-proBNP （NT-proBNP1 and NT-proBNP3） were assayed and evaluated at admission and on day 3 respectively. Results ANT-proBNP （NT-proBNP3 minus NT-proBNP1） （P 〈0.001, Hazard ratio （HR）=1.245, 95% confidence interval （CI）, 1.137-1.362） and admission SOFA （P 〈0.001, HR=1.197, 95% CI, 1.106-1.295） were independently related to in-hospital mortality. Their combination was a more robust predictor for in-hospital mortality than either of them individually. Patients with high ANT-proBNP and SOFA had the poorest prognosis. Conclusions In our study, both ANT-proBNP and SOFA were independent predictors of septic patients＇ prognosis. Moreover, the combination of ,~NT-proBNP and admission SOFA provided a novel strategy that contained information regarding both the response to treatment and sepsis severity.
文摘Background： The quick Sequential Organ Failure Assessment （qSOFA） score emerged recently. We investigated its contribution to risk stratification in acute pulmonary embolism （PE） by combining with electrocardiography （ECG）. Methods： Acute PE patients diagnosed in Beijing Chao-Yang Hospital, Capital Medical University, from 2008 to 2018 were retrospectively studied and divided into high- and low-risk groups by imaging and biomarkers. The ECG scores consisted oftachycardia, McGinn-White sign （S1Q3T3）, right bundle branch block, and T-wave inversion of leads V1-V3. A new combination of qSOFA scores and ECG scores by logistic regression for predicting high-risk stratification patients with acute PE was evaluated by a receiver operating characteristic curve. Results： Totally 1318 patients were enrolled, including 271 in the high-risk group and 1047 in the low-risk group. A combination predictive scoring system named qSOFA-ECG = qSOFA score ＋ ECG score was created. The optimal cutoffvalue for qSOFA-ECG was 2, and the sensitivity, specificity, positive predictive value, and negative predictive value were 81.5%, 72.3%, 43.2%, and 93.8%, respectively. For predicting high-risk stratification and reperfusion therapy, the qSOFA-ECG is superior to PE Severity Index （PESI） and simplified PESI. Conclusions： The qSOFA score contributes to identify acute PE patients with potentially hemodynamic decompensation that need monitoring and possible reperfusion therapy at the emergency department arrival when used in combination with ECG score.
文摘目的探讨快速序贯器官衰竭评分(quick sequential organ failure assessment,qSOFA)联合红细胞分布宽度与血钙比值(red blood cell distribution width-to-serum calcium ratio,RDC)对重症急性胰腺炎(severe acute pancreatitis,SAP)的预测价值。方法回顾性分析2018年6月~2022年10月徐州医科大学附属医院收治的319例急性胰腺炎患者的临床资料,根据病情严重程度分为非SAP组(n=260)和SAP组(n=59)。所有患者均于入院24h内进行血样采集并检测相应血液学指标,并于24h内进行qSOFA与急性胰腺严重床旁指数(bedside index for severity in acute pancreatitis,BISAP)评分。比较两组间的临床资料并进行Logistic回归分析危险因素。采用受试者工作特征(receiver operating characteristic,ROC)曲线评估qSOFA评分、RDC及两者联合评分对SAP的预测效能,并与BISAP评分进行比较。结果多因素Logistic回归分析发现,RDC(OR=4.111,95%CI:2.053~8.231,P<0.05)和qSOFA(OR=9.732,95%CI:3.974~23.832,P<0.05)高评分是SAP的独立危险因素。联合评分及BISAP评分预测SAP的曲线下面积(area under the curve,AUC)分别为0.915(95%CI:0.872~0.959,P<0.001)、0.839(95%CI:0.782~0.896,P<0.001),敏感度分别为93.2%、66.1%,特异性分别为85.0%、86.2%。结论qSOFA评分、RDC均可预测SAP的发生,两者联合评分对SAP发生的预测效能更高,可用于早期识别SAP的发生并指导早期干预。
