感染相关危重症评分对感染或可疑感染患者死亡风险预测价值比较的网状Meta分析  

A comparison of the infection related critical illness scores for predicting mortality in patients with infection or suspected infection: a network Meta-analysis

作　　者：肖璐[1] 牛丽青 张学敏 孙崇翔 刘学政[1] 刘新桥[1] Xiao Lu;Niu Liqing;Zhang Xuemin;Sun Chongxiang;Liu Xuezheng;Liu Xinqiao(Department of Emergency,First Teaching Hospital of Tianjin University of Traditional Chinese Medicine,National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion,Tianjin 300381,China)

机构地区：[1]天津中医药大学第一附属医院急症部,国家中医针灸临床医学研究中心,天津300381

出　　处：《中华危重病急救医学》2021年第10期1187-1192,共6页Chinese Critical Care Medicine

基　　金：国家重点研发计划项目(2020YFC0841600);中医药防治新型冠状病毒感染的肺炎应急研究专项(2020ZYLCYJ03-9)。

摘　　要：目的使用网状Meta分析方法评估序贯器官衰竭评分(SOFA)、快速序贯器官衰竭评分(qSOFA)及全身炎症反应综合征(SIRS)评分对感染或可疑感染患者死亡风险的预测价值。方法应用计算机检索万方、中国知网(CNKI)、维普、美国国立医学图书馆PubMed、科学网(Web of Science)等中英文数据库,检索时间从2016年2月23日至2020年9月5日,同时追踪已检出文献的参考文献,收集关于比较SOFA、qSOFA与SIRS评分中2种或以上评分对感染或可疑感染患者死亡风险预测价值的队列研究。由2名研究者独立筛选文献、提取资料和评价纳入研究的偏倚风险。使用Stata 14.0软件检验3种评分中两两比较的研究间的异质性,采用环不一致性检验法判断直接比较与间接比较的一致性,然后进行网状Meta分析并对结果进行排序,通过累积概率曲线下面积(SUCRA)评估3种评分的预测能力。绘制"比较-校正"漏斗图,评估纳入研究是否存在发表偏倚。结果最终纳入38项研究,整体质量较高。网状Meta分析结果显示,在3种评分的两两比较中,SOFA评分对感染或可疑感染患者死亡风险的预测能力优于qSOFA评分〔均数差(MD)=0.07,95%可信区间(95%CI)为0.05~0.09〕和SIRS评分(MD=0.16,95%CI为0.14~0.18),且qSOFA评分优于SIRS评分(MD=0.09,95%CI为0.07~0.11)。在对感染或可疑感染患者死亡风险预测效能排序中,SOFA评分的预测价值更高,其次是qSOFA评分,SIRS评分最低,SUCRA值分别为1.0、0.5、0。漏斗图显示,所有研究分布于中线两侧,但分布不太对称,提示存在发表偏倚及小样本效应的可能性大。结论SOFA评分对感染或可疑感染患者死亡风险的预测效能较qSOFA评分和SIRS评分更佳,但由于漏斗图提示存在小样本效应和发表偏倚,故仍需开展多中心大样本前瞻性研究进行验证。Objective To evaluate the prognostic accuracy of the sequential organ failure assessment(SOFA),quick sequential organ failure assessment(qSOFA)and systemic inflammatory response syndrome(SIRS)criteria in predicting the mortality in patients with infection or suspected infection by using network Meta-analysis.Methods Five databases including Wanfang Data,China National Knowledge Infrastructure(CNKI),China Science and Technology Journal Database(VIP),PubMed,Web of Science were searched from February 23,2016 to September 5,2020 to identify the relevant literatures comparing the prognostic accuracy of two or more scores for mortality in patients with infection or suspected infection.The literatures screening,data extraction and the quality assessment of the included studies were all conducted independently by two reviewers.Stata 14.0 software was used to test the heterogeneity between the original studies of pairwise comparison of each of the three scoring systems.Ring inconsistency test was used to judge the consistency between direct comparison and indirect comparison.Then network Meta-analysis was performed and the results were ranked.The predictive ability of the three scoring systems was evaluated by surface under cumulative ranking curve(SUCRA).A"comparison-correction"funnel plot was drawn to assess whether there was publication bias in the included studies.Results A total of 38 studies were enrolled,the overall quality was high.Network meta-analysis showed that SOFA had a great prognostic performance in predicting mortality for patients with infection or suspected infection,which was followed by qSOFA[mean difference(MD)=0.07,95%confidence interval(95%CI)was 0.05-0.09]and SIRS scores(MD=0.16,95%CI was 0.14-0.18),and the qSOFA score was better than SIRS score(MD=0.09,95%CI was 0.07-0.11).In the order of predicting the death risk of patients with infection or suspected infection,SOFA score had higher predictive value,followed by qSOFA score,and SIRS score was the lowest,with SUCRA values of 1.0,0.5 and 0,respect

关 键 词：序贯器官衰竭评分 快速序贯器官衰竭评分 全身炎症反应综合征评分 感染 死亡风险预测 网状Meta分析 

分 类 号：R459.7[医药卫生—急诊医学]