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J. Moreira A. Paixão J. Oliveira W. Jaló O. Manuel R. Rodrigues A. Oliveira L. Tinoco J. Lima B. Grinsztejn V.G. Veloso A.M. Japiassú C.C. Lamas 《Clinical microbiology and infection》2019,25(1):113.e1-113.e3
Objectives
: To compare the discriminatory capacity of the quick sequential organ failure assessment (qSOFA) vs. the systemic inflammatory response syndrome (SIRS) score for predicting 30-day mortality and intensive care unit (ICU) admission in patients with suspicion of infection at an HIV reference centre.Methods
We performed a prospective cohort study including consecutive adult patients who had suspected infection and who were subsequently admitted to the medical ward. Variables related to qSOFA and SIRS were measured at admission. The performance (area under the receiver operating curve, AUROC) of qSOFA (score ≥2) and SIRS (≥2 criteria) as a predictor of 30-day mortality and ICU admission was evaluated.Results
One hundred seventy-three patients (mean ± standard deviation age, 42.6 ± 12.4 years) were included in the analysis; 107 (61.8%) were male, and 111 (64.2%) were HIV positive. Respiratory and gastrointestinal infections occurred in 49 (28.3%) and 23 (13.3%), respectively. The 30-day mortality rate was 9 (5.2%) of 173. The prognostic performance of qSOFA was similar compared to SIRS, with an AUROC of 0.68 (95% confidence interval, 0.55–0.81) and 0.69 (95% confidence interval, 0.53–0.86) (p 0.96). Twenty patients (11%) were admitted to the ICU; qSOFA and SIRS had a similar discriminatory capacity for ICU admission (AUROC 0.63 (95% confidence interval, 0.51–0.75) and 0.63 (95% confidence interval, 0.50–0.76)), respectively).Conclusions
We found a poor prognostic accuracy of the qSOFA to predict 30-day mortality in hospitalized patients suspected of infection in a setting with a high burden of HIV infection. 相似文献22.
Soo Kang Areum Durey Young Ju Suh Ah Jin Kim 《The American journal of emergency medicine》2018,36(6):935-941
Objectives
Clinical studies have indicated that transient hypotension can occur after propacetamol administration. This study aimed to analyze the hemodynamic changes after propacetamol administration in patients visiting the ED due to febrile UTI. We also examined the incidence of propacetamol-induced hypotension and compared the clinical characteristics of patients with persistent hypotension, defined as requiring additional fluids or vasopressors, to those with transient hypotension.Methods
A retrospective analysis of the electronic medical records of patients who visited the ED between June 2015 and May 2016, were diagnosed with febrile UTI, and treated with propacetamol, was conducted.Results
We included 195 patients in this study; of these, 87 (44.6%) showed hypotension. In all patients, significant decreases in systolic blood pressure (SBP; 135.06 ± 20.45 mm Hg vs 117.70 ± 16.41 mm Hg), diastolic blood pressure (DBP; 79.74 ± 12.17 mm Hg vs 69.69 ± 10.96 mm Hg), and heart rate (97.46 ± 17.14 mm Hg vs 90.72 ± 14.90 mm Hg) were observed after propacetamol administration. The basal SBP and DBP were higher in the hypotension than in the non-hypotension group (basal SBP: 144.4 ± 22.3 mm Hg vs 127.6 ± 15.3 mm Hg; basal DBP: 83.3 ± 12.6 mm Hg vs 76.9 ± 11.0 mm Hg). Patients with persistent hypotension had a lower baseline BP, which was not elevated despite fever, and a higher rate of bacteremia than those with transient hypotension.Conclusions
Although febrile UTI patients treated with propacetamol in the ED showed hemodynamic changes, these changes did not have a large effect on their prognosis. However, in patients who showed bacteremia or a normal initial BP despite fever, the possibility of developing persistent hypotension should be considered. 相似文献23.
目的:构建急性胃肠损伤（acute gastrointestinal injury,AGI）分级联合qSOFA评分诊断脓毒症的预测模型,并评价其价值。方法:为前瞻性观察性研究,纳入2018年9月至2019年9月入住常熟市第一人民医院普通病房的感染或疑似感染患者,排除年龄小于18岁、妊娠、中途放弃治疗、入院后3 d内死亡患者。记录感染前48 h内至发病后24 h的基本生命体征、实验室化验结果、AGI分级情况,根据患者是否诊断为脓毒症分为脓毒症组和非脓毒症组。将研究对象按7∶3比例随机分为建模组和验证组,在建模组中对单因素分析有统计学差异的因素进行多因素logistic回归分析。分别建立诊断模型A（qSOFA）、模型B（AGI分级联合qSOFA评分）以及模型C（多因素分析中有统计学差异的变量为参数）。在验证组进行验证,通过ROC曲线评价模型的诊断效果,绘制校准曲线评价一致性,使用决策曲线分析评价净效益,并绘制各预测模型诊断的列线图。结果:共2 553例患者纳入研究,建模组1 789例,验证组764例,两组患者基本情况差异无统计学意义,其中共326例患者发生了脓毒症。单因素分析显示年龄、性别、感染源、体温、心率、呼吸急促、意识改变、严重水肿、高血糖、白细胞数量、CRP、PCT、低血压、低氧、急性少尿、凝血功能异常、高乳酸血症、毛细血管充盈受损或皮肤花斑、AGI分级及qSOFA对脓毒症的发生有显著影响（均
P<0.01）。多因素Logistic回归分析,显示预测脓毒症的危险因素为年龄（
OR=1.027,
P<0.01）,感染源（
OR=2.809,
P=0.03）,低血压（
OR=35.449,
P<0.01）、低氧血症（
OR=57.018,
P<0.01）,AGI分级（
OR=19.313,
P<0.01）。ROC分析显示建模组中模型A、B、C的曲线下面积（AUC）分别为0.784,0.944,0.971,敏感度分别为63.9%,89.5%,97.5%,特异度分别为90.8%,90.3%,88.1%,验证组中,模型A、B、C的AUC为0.832,0.975,0.980,敏感度分别为72.7%,90.9%,96.6%,特异度分别为92.2%,94.5%,92.8%。模型B、模型C的AUC明显大于模型A（
P<0.01）,而在验证组之间B、C（
P=0.684）。模型A在验证组中的校准度较差,精确性低,有漏诊脓毒症的风险（
P=0.044）。决策曲线分析显示模型B及模型C的净效益优于模型A。
结论:AGI分级联合qSOFA评分在脓毒症诊断中的具有较高的预测价值和准确性。 相似文献
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目的研究游离钙(iCa)和氧合指数(PaO2/FiO2)联合快速脓毒症相关序贯器官衰竭评分(qSOFA)在识别成人脓毒症患者中的诊断效能。方法回顾性分析2019年10月至2021年3月就诊于东部战区总医院抢救室的147例脓毒症患者及158例主要诊断为非脓毒症的感染性疾病患者,收集患者临床资料(包括iCa、PaO2/FiO2、qSOFA等指标),通过倾向性评分匹配(PSM)校正患者年龄、性别、感染部位等混杂因素,得到脓毒症组(n=93)和非脓毒症组(n=93)患者,比较PSM前后两组间的临床资料,将匹配后数据集(n=186)作为训练集,采用Logistic回归分析感染性疾病患者发生脓毒症的独立危险因素,通过受试者工作特征曲线下面积(AUC)进行诊断效能分析,比较新发低钙血症、PaO2/FiO2、qSOFA及三者联合模型在识别成人脓毒症患者中的诊断效能,将原数据集(n=305)作为验证集代入联合模型进行验证,并比较联合模型与脓毒症相关序贯器官衰竭评分(SOFA)间的差异和一致性。结果PSM前后脓毒症患者iCa、PaO2/FiO2均低于非脓毒症组(PSM前:Z=-5.138,Z=-7.743;PSM后:Z=-3.505,Z=-4.817,P<0.001),qSOFA分值高于非脓毒症组(PSM前:Z=-7.089;PSM后:Z=-4.149,P<0.001),iCa与降钙素原(PCT)、C-反应蛋白(CRP)、白细胞介素-6(IL-6)、SOFA及急性生理与慢性健康状况评分系统Ⅱ(APACHEⅡ)呈负相关(r=-0.338、-0.243、-0.271、-0.281、-0.269,P<0.05),联合模型在训练集(n=186)中识别成人脓毒症患者的AUC为0.777,95%CI为0.711~0.835,敏感度为74.19%,特异度为73.12%,阳性似然比为2.76,阴性似然比为0.35,在验证集(n=305)中识别成人脓毒症患者的AUC为0.836,95%CI为0.790~0.876,敏感度为77.55%,特异度为77.85%,阳性似然比为3.50,阴性似然比为0.29,联合模型在训练集及验证集中的AUC大于新发低钙血症、PaO2/FiO2及qSOFA分值(P<0.001),与SOFA进行McNemar检验提示P=0.904、一致性检验Kappa值为0.554(P<0.001)。结论新发低钙血症、PaO2/FiO2、qSOFA分值与感染性疾病患者发生脓毒症有回归关系,其中新发低钙血症是独立危险因素,与iCa、PaO2/FiO2及qSOFA单独使用相比,三者联合模型在识别成人脓毒症中的诊断效能更高。 相似文献
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Colin A. Graham Ling Yan Leung Ronson Sze Long Lo Chun Yu Yeung Suet Yi Chan 《Annals of medicine》2020,52(7):403-412
Abstract