SOFA、qSOFA评分及SIRS标准对急诊疑似感染患者预测价值研究  

The values of SOFA score, qSOFA score and SIRS criteria in predicting the prognosis of adult patients with suspect infection

作　　者：张肖难 张泓[1] 

机构地区：[1]安徽医科大学第一附属医院急诊科,合肥230022

出　　处：《中华急诊医学杂志》2018年第3期259-264,共6页Chinese Journal of Emergency Medicine

基　　金：国家临床重点专科建设项目（2012）

摘　　要：目的 探讨SOFA评分、qSOFA评分及SIRS标准对收入急诊科的疑似感染患者预后预测的临床价值。方法 选择2015年1月至2017年4月就诊于安徽医科大学第一附属医院急诊门诊，疑似感染并收住院的患者（大于18周岁）。进行SOFA、qSOFA和SIRS标准。以死亡或需要ICU治疗作为预后指标，测试各评分的效度，通过受试者工作特征曲线下面积（AUROC）评估各评分系统对预后的预测价值。结果 487例患者，住院病死率为4.9%，需要ICU治疗比例为17%；SOFA评分预测住院病死率或需要ICU治疗（AUROC为0.905）优于其他评分（qSOFAWBC：AUROC为0.778、qSOFA ：AUROC为0.769、SIRS：AUROC为0.64）。与SIRS标准相比，评分〉1分的患者，qSOFA评分特异度较高（94.47%），但灵敏度较低（44.86%）；SIRS标准虽然有较高的灵敏度（77.57%），但特异度较差（42.63%）。当qSOFA加上白细胞异常（〈4×109/L或〉10×109/L）这一条件之后，改善了对预后的预测，灵敏度和特异度分别为73.83%和71.84%（qSOFA-WBC评分〉1）。在qSOFA-WBC评分为0分的患者，最后结果为死亡或需要ICU治疗的只有6例（阴性预测值94.2%）。结论 SOFA评分对于急诊感染患者预后预测能力优于qSOFA、SIRS；qSOFA-WBC对低风险的预测优于qSOFA、SIRS标准。Objective To investigate the clinical values of SOFA score, qSOFA score and SIRS criteria in predicting the prognosis of patients with suspected infection in the emergency department. Methods From January 2015 to April 2017, 487 patients aged over 18 years were suspected to be infected and admitted to hospital. SOFA, qSOFA, and SIRS scores were calculated. The mortality and the requirement of ICU treatment were used as prognostic factors for evaluating the validity of each score. The prognostic value of each scoring system was evaluated by the area under the receiver operating characteristic curve （AUROC）. Results In 487 patients, the hospital mortality rate was 4.9%, and requirement of ICU treatment rate was 17%. SOFA score predicting hospital mortality and requirement of ICU treatment （AUROC 0.905） were superior to other scores （qSOFA-WBC： AUROC 0.778, qSOFA： AUROC 0.769, SIRS： AUROC 0.64）. Compared with the SIRS criteria, patients with a score of 〉1 had higher qSOFA scores （94.47%）, but lower sensitivity （44.86%）; although SIRS criteria had a higher sensitivity （77.57%）, they were less specific （42.63%）.When qSOFA was added to the condition of leukocyte abnormalities （〈4×10^9/L or 〉10×10^9/L）, the prognosis was improved and the sensitivity and specificity for prognosis were 73.83% and 71.84% （qSOFA-WBC score, 〉1）, respectively. In patients with qSOFA-WBC score, only 6 patients （negative predictive value of 94.2%） died or required ICU treatment. Conclusion The SOFA score is superior to qSOFA and SIRS in predicting the prognosis of patients with suspect infection, and qSOFA-WBC is superior to qSOFA and SIRS in predicting low risk.

关 键 词：急性感染 SOFA评分 qSOFA评分 SIRS标准 

分 类 号：R459.7[医药卫生—急诊医学]