全身炎症反应综合征评分、序贯器官衰竭评分、快速脓毒症相关器官功能障碍评分对急诊感染性疾病预后的评估价值  

The value of SIRS,SOFA and qSOFA in evaluating the prognosis of infectious diseases in emergency department

作　　者：朱梦莉[1] 王智超[1] 张婧 袁琪 张衡[1] 孙茹雪 ZHU Mengli;WANG Zhichao;ZHANG Jing;YUAN Qi;ZHANG Heng;SUN Ruxue(Department of Emergency Medicine,Wuhan NO.1 Hospital,Wuhan,Hubei 430022,China)

机构地区：[1]武汉市第一医院急诊医学科,湖北武汉430022

出　　处：《安徽医药》2021年第2期261-264,共4页Anhui Medical and Pharmaceutical Journal

基　　金：湖北省卫计委科研基金资助项目(JX6B11);武汉市第一医院院内课题(2019Y29)。

摘　　要：目的分析全身炎症反应综合征(SIRS)评分、序贯器官衰竭(SOFA)评分、快速脓毒症相关器官功能障碍(qSOFA)评分对急诊感染性疾病预后评估的价值。方法选取2017年10月至2018年10月就诊于武汉市第一医院感染性疾病病人392例作为研究对象,根据入院后28 d病人的预后情况分为存活组和死亡组。根据入院24 h内病人的临床资料评估SIRS评分、SOFA评分、qSOFA评分,并通过受试者工作特征(ROC)曲线分析评分对病人预后情况的预测价值。结果存活组SIRS评分[1(0,2)分比2(0,4)分]、SOFA评分[3(0,11)分比6(3,16)分]、qSOFA评分[1(0,2)分比2(0,3)分]均低于死亡组(P<0.05)。qSOFA评分预测感染性疾病死亡的灵敏度为71.97%,特异度为80.43%,ROC曲线下面积为0.778(95%CI:0.713~0.843);SIRS评分预测感染性疾病死亡的灵敏度为69.08%,特异度为71.74%,ROC曲线下面积为0.757(95%CI:0.694~0.820);SOFA评分预测感染性疾病死亡的灵敏度为73.12%,特异度为78.26%,ROC曲线下面积为0.794(95%CI:0.733~0.855);三者联合应用预测感染性疾病死亡的灵敏度为68.21%,特异度为91.30%,ROC曲线下面积为0.856(95%CI:0.809~0.903),三者联合应用的曲线下面积最高(P<0.05)。结论SIRS评分、SOFA评分、qSOFA评分均对急诊感染性疾病预后死亡情况具有预测价值,三者联合应用具有更高的预测价值。Objective To analyze the value of systemic inflammatory response syndrome(SIRS),sequential organ failure assessment(SOFA)and quick sepsis-related organ failure assessment(qSOFA)in evaluating the prognosis of infectious diseases in emergency department.Methods A total of 392 patients with infectious diseases treated in emergency department of Wuhan NO.1 Hospital from October 2017 to October 2018 were selected as research subjects.The patients were assigned into survival group and death group according to their prognosis 28 days after admission.SIRS score,SOFA score and qSOFA score were assessed according to the clinical data of the patients within 24 hours of admission.The predictive value of SIRS score,SOFA score and qSOFA score for the prognosis of patients was evaluated by receiver operating characteristic(ROC)curve.Results The SIRS score[1(0,2)vs.2(0,4)],SOFA score[3(0,11)vs.6(3,16)]and qSOFA score[1(0,2)vs.2(0,3)]of survival group were significantly lower than those of death group(P<0.05).The sensitivity,specificity and area under ROC.curve of qSOFA were 71.97%,80.43%and 0.778 respectively(95%CI:0.713-0.843).The sensitivity and specificity of SIRS score in predicting death from infectious diseases were 69.08%,71.74%,respectively and the area under ROC.curve was 0.757(95%CI 0.694-0.820).The sensitivity and specificity of SOFA score for predicting death from infectious diseases were 73.12%,78.26%,and the area under ROC curve was 0.794(95%CI:0.733-0.855).The sensitivity,specificity and area under ROC curve were 68.21%,91.30%and 0.856(95%CI:0.809-0.903),respectively for predicting death from infectious diseases by combined use of the three methods.The area under ROC curve was the largest with combined use of the three methods(P<0.05).Conclusion SIRS score,SOFA score and qSOFA score all have predictive value for the prognosis and mortality of infectious diseases in emergency department.The combined application of the three methods has higher predictive value.

关 键 词：传染病 病人病情 危险性评估 全身炎症反应综合征评分 序贯器官衰竭评分 快速脓毒症相关器官功能障碍评分 

分 类 号：R459.7[医药卫生—急诊医学]