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Accuracy of qSOFA for the diagnosis of sepsis-3: a secondary analysis of a population-based cohort study

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机构: [1]Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 100730, China [2]Department of Critical Care Medicine, China Rehabilitation Research Center, Capital Medical University, Beijing 100068, China [3]Department of Critical Care Medicine, Beijing Tian Tan Hospital, Capital Medical University, Beijing 100050, China [4]Department of General Internal Medicine, Fuxing Hospital, Capital Medical University, Beijing 100038, China [5]Department of Critical Care Medicine, Fuxing Hospital, Capital Medical University, Beijing 100038, China [6]Department of Critical Care Medicine, Peking University People’s Hospital, Beijing 100044, China [7]Department of Critical Care Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
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关键词: Sequential (sepsis-related) Organ Failure Assessment (SOFA) quick Sequential Organ Failure Assessment (qSOFA) score sepsis-3 mortality the area under the receiver operating characteristic curves (AUROCs)

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Background: We aimed to evaluate the accuracy of quick Sequential (sepsis-related) Organ Failure Assessment (qSOFA) for the diagnosis of sepsis-3, and to analyze the prognosis of infected patients in wards over-diagnosed with qSOFA but missed by sepsis-3, and those missed by qSOFA but in accordance with sepsis-3 criteria. We also intended to validate the performance of qSOFA as one predictor of outcome in patients with suspicion of infection. Methods: We reviewed the medical records of 1,716 adult patients with infection who were hospitalized from July 1st, 2012 to June 30th , 2014 in the Yuetan subdistrict of Beijing, China. Based on the sepsis-3 criteria and qSOFA score proposed by the Third International Consensus Definitions for Sepsis and Septic Shock, these patients were categorized into four groups: qSOFA(-)sepsis(-), qSOFA(+)sepsis(-), qSOFA(-) sepsis(+), and qSOFA(+)sepsis(+). Multivariate logistic regression analysis was used to determine the independent risk factors for in-hospital mortality. The area under the receiver operating characteristic curves (AUROCs) of the qSOFA(+) group were compared with the sepsis(+) group for in-hospital mortality, ICU admission, and invasive ventilation. Results: Among the 1,716 patients with infection, there were 935 patients (54.5%) with sepsis, and 640 patients (37.3%) with qSOFA >= 2. There were 610 patients in the qS0FA(-)sepsis(-) group, 171 in the qSOFA(+)sepsis(-) group, 466 in the qSOFA(-)sepsis(+) group, and 469 in the qSOFA(+)sepsis(+) group. In the logistic regression analysis, increasing age, bedridden status, and malignancy were all independent risk factors of hospital mortality. Sepsis and qSOFA >= 2 were also independent risk factors of hospital mortality, with an adjusted OR of 3.85 (95% CI: 2.70-5.50) and 13.92 (95% CI: 9.87-16.93) respectively. qSOFA had a sensitivity of 50.2% and a specificity of 78.1% for sepsis-3. The false-positive [qSOFA(+)sepsis(-)] group had 38 patients (22.2%) die during hospitalization, and an adjusted OR of 9.20 (95% CI: 4.86-17.38). In addition, the false-negative [qSOFA(-)sepsis(+)] group had a hospital mortality rate of 7.3% (34/466) and an adjusted OR of 2.59 (95% CI: 1.39-4.83). In comparison, patients meeting neither qSOFA nor sepsis criteria had the lowest hospital mortality [2.6% (16/610)], whereas patients with both qSOFA >= 2 and sepsis had the highest hospital mortality [56.5% (265/469)], with an adjusted OR of 42.02 (95% CI: 24.31-72.64). The discrimination of in-hospital mortality using qSOFA (AUROC, 0.846; 95% CI, 0.824-0.868) was greater compared with sepsis-3 criteria (AUROC, 0.834; 95% CI, 0.805-0.863; P<0.001). Conclusions: In our analysis, the sensitivity(Se) of qSOFA for the diagnosis of sepsis was lower, and qSOFA score >= 2 might identify a group of patients at a higher risk of mortality, regardless of being septic or not.

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出版当年[2018]版:
大类 | 4 区 医学
小类 | 4 区 呼吸系统
最新[2023]版:
大类 | 3 区 医学
小类 | 4 区 呼吸系统
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出版当年[2017]版:
Q4 RESPIRATORY SYSTEM
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Q3 RESPIRATORY SYSTEM

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第一作者机构: [1]Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 100730, China [2]Department of Critical Care Medicine, China Rehabilitation Research Center, Capital Medical University, Beijing 100068, China
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通讯机构: [1]Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing 100730, China [*1]Medical ICU, Peking Union Medical College Hospital, 1 Shuai Fu Yuan, Beijing 100730, China.
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