排序方式： 共有49条查询结果，搜索用时 15 毫秒
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Adam R. Aluisio Stephanie Garbern Tess Wiskel Zeta A. Mutabazi Olivier Umuhire Chin Chin Ch&#x;ng Kristina E. Rudd Jeanne D&#x;Arc Nyinawankusi Jean Claude Byiringiro Adam C. Levine 《The American journal of emergency medicine》2018,36(11):2010-2019
Objective
To evaluate the utility of the quick Sepsis-related Organ Failure Assessment (qSOFA) score to predict risks for emergency department (ED) and hospital mortality among patients in a sub-Saharan Africa (SSA) setting.Methods
This retrospective cohort study was carried out at a tertiary-care hospital, in Kigali, Rwanda and included patients ≥15 years, presenting for ED care during 2013 with an infectious disease (ID). ED and overall hospital mortality were evaluated using multivariable regression, with qSOFA scores as the primary predictor (reference: qSOFA = 0), to yield adjusted relative risks (aRR) with 95% confidence intervals (CI). Analyses were performed for the overall population and stratified by HIV status.Results
Among 15,748 cases, 760 met inclusion (HIV infected 197). The most common diagnoses were malaria and intra-abdominal infections. Prevalence of ED and hospital mortality were 12.5% and 25.4% respectively. In the overall population, ED mortality aRR was 4.8 (95% CI 1.9–12.0) for qSOFA scores equal to 1 and 7.8 (95% CI 3.1–19.7) for qSOFA scores ≥2. The aRR for hospital mortality in the overall cohort was 2.6 (95% 1.6–4.1) for qSOFA scores equal to 1 and 3.8 (95% 2.4–6.0) for qSOFA scores ≥2. For HIV infected cases, although proportional mortality increased with greater qSOFA score, statistically significant risk differences were not identified.Conclusion
The qSOFA score provided risk stratification for both ED and hospital mortality outcomes in the setting studied, indicating utility in sepsis care in SSA, however, further prospective study in high-burden HIV populations is needed. 相似文献2.
3.
Hiroshi Fukushima Masaki Kobayashi Keizo Kawano Shinji Morimoto 《The Journal of urology》2018,199(6):1526-1533
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【摘要】 目的 比较qSOFA评分和CURB 65评分在成人社区获得性肺炎（community acquired pneumonia,CAP）所致脓毒症患者的病情严重程度和预后评价中的临床价值。方法 回顾性分析2015年7月~2016年6月于四川大学华西医院急诊科就诊,诊断为成人CAP致脓毒症患者428例, 其中男284例,女144例,平均年龄（60±1743）岁。计算入院时的qSOFA及CURB 65评分,采用受试者工作特征曲线分析两种评分系统评估CAP致脓毒症的28天病死率的曲线下面积,并根据最佳临床分界点分组,比较两种评分方法评估CAP所致脓毒症的ICU平均住院天数、28天机械通气率和28天病死率的效能。结果 qSOFA评分及CURB 65评分评估CAP所致脓毒症28天病死率的曲线下面积分别为0670（95%CI=0611～0729）和0639(95%CI=0578～0700),两者均以2分为最佳临床分界点。qSOFA≥2分组和CURB 65≥2分组的ICU平均住院天数、28天机械通气率和28天病死率均分别高于qSOFA<2分组和CURB 65<2分组（P<005）;qSOFA≥2分组的28天机械通气率和28天病死率均高于CURB 65≥2分组（P<005）,但ICU平均住院天数的差异无统计学意义（P＞005）;qSOFA<2分组和CURB 65<2分组的ICU平均住院天数、28天机械通气率和28天病死率的差异均无统计学意义（P＞005）。结论 qSOFA评分和CURB 65评分均有一定评估CAP致脓毒症的病情及预后的临床价值。但qSOFA评分较CURB 65评分能更好识别危重患者和预测不良预后。 相似文献
5.
目的探讨术前/术后2 h血白细胞比联合快速序贯器官衰竭评分(qSOFA)对输尿管软镜术后发生尿脓毒血症的预测价值。方法回顾性分析2015年9月至2018年7月于上海交通大学附属第一人民医院因上尿路结石行输尿管软镜碎石取石术患者的病例资料。共2364例患者,男1613例,女751例。年龄(54.9±14.0)岁。体质指数(23.9±2.8)kg/m^2。结石最大径(10.9±6.2)mm。结石位于左侧1305例,右侧1018例,双侧41例。术前体温(36.8±0.4)℃。血糖(5.7±1.5)mmol/L。血WBC(7.4±4.6)×10^9/L,中性粒细胞0.62±0.11。C反应蛋白(20.1±59.3)mg/L,降钙素原(1.6±11.8)μg/L,白细胞介素-6(11.3±32.9)pg/ml。术前清洁中段尿细菌培养阳性465例。qSOFA诊断尿脓毒血症的标准为:①呼吸频率≥22次/分;②收缩压≤100 mmHg(1 mmHg=0.133 kPa);③精神状态改变。满足1项记1分,qSOFA≥2分为阳性,诊断为尿脓毒血症。结果本研究2364例的手术时间(39.3±23.0)min。术后2 h血WBC(6.7±2.9)×10^9/L,中性粒细胞0.70±0.12。qSOFA评分阳性69例,阴性2295例。15例术后发生尿脓毒血症,发生率为0.6%。尿脓毒血症组和非尿脓毒血症组qSOFA阳性患者例数分别为15例和54例,术前/术后2 h血WBC比分别为2.5±1.6和0.7±0.2。单因素分析结果显示:女性(χ^2=16.20,P<0.001)、结石体积大(t=2.14,P=0.050)、术前血WBC(t=2.51,P=0.025)、中性粒细胞(t=2.90,P=0.012)、C反应蛋白(t=2.58,0.028)、降钙素原(t=16.09,P<0.001)、白细胞介素-6(t=7.88,P=0.032)升高、术前清洁中段尿细菌培养阳性(χ^2=21.10,P<0.001)、术前/术后2 h血WBC比>1(t=4.51,P=0.001)、qSOFA阳性(χ^2=502.10,P<0.001)与术后尿脓毒血症发生有关。将qSOFA阳性且术前/术后2 h血WBC比>1的患者定义为尿脓毒血症高危患者。单独使用qSOFA的受试者工作特征曲线下面积(AUC)为0.98,阳性预测值为21.7%;单独使用术前/术后2 h血WBC比的AUC为0.98,特异性为60.0%,阳性预测值为38.5%;qSOFA联合术前/术后2 h血WBC比的AUC为1.00,特异性为98.3%,阳性预测值为93.8%,与前两者相比其预测效力明显提高。结论qSOFA阳性联合术前/术后2 h血WBC比>1可以在术后2 h早期、快速、准确地预测输尿管软镜碎石取石术后尿脓毒血症的发生。 相似文献
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Samir Haydar Matthew Spanier Patricia Weems Samantha Wood Tania Strout 《The American journal of emergency medicine》2017,35(11):1730-1733
Objectives
The Quick Sequential [Sepsis-related] Organ Failure Assessment (qSOFA) score has been shown to accurately predict mortality in septic patients and is part of recently proposed diagnostic criteria for sepsis. We sought to ascertain the sensitive of the score in diagnosing sepsis, as well as the diagnostic timeliness of the score when compared to traditional systemic inflammatory response syndrome (SIRS) criteria in a population of emergency department (ED) patients treated in the ED, admitted, and subsequently discharged with a diagnosis of sepsis.Methods
Electronic health records of 200 patients who were treated for suspected sepsis in our ED and ultimately discharged from our hospital with a diagnosis of sepsis were randomly selected for review from a population of adult ED patients (N = 1880). Data extracted included the presence of SIRS criteria and the qSOFA score as well as time required to meet said criteria.Results
In this cohort, 94.5% met SIRS criteria while in the ED whereas only 58.3% met qSOFA. The mean time from arrival to SIRS documentation was 47.1 min (95% CI: 36.5–57.8) compared to 84.0 min (95% CI: 62.2–105.8) for qSOFA. The median ED “door” to positive SIRS criteria was 12 min and 29 min for qSOFA.Conclusions
Although qSOFA may be valuable in predicting sepsis-related mortality, it performed poorly as a screening tool for identifying sepsis in the ED. As the time to meet qSOFA criteria was significantly longer than for SIRS, relying on qSOFA alone may delay initiation of evidence-based interventions known to improve sepsis-related outcomes. 相似文献7.
Salvatore Piano Virendra Singh Paolo Caraceni Rakhi Maiwall Carlo Alessandria Javier Fernandez Elza Cotrim Soares Dong Joon Kim Sung Eun Kim Monica Marino Julio Vorobioff Rita de Cassia Ribeiro Barea Manuela Merli Laure Elkrief Victor Vargas Aleksander Krag Shivaram Prasad Singh Laurentius Adrianto Lesmana Giacomo Zaccherini 《Gastroenterology》2019,156(5):1368-1380.e10
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Hyeongkyu Kwak Gil Joon Suh Taegyun Kim Woon Yong Kwon Kyung Su Kim Yoon Sun Jung Jung-In Ko So Mi Shin 《The American journal of emergency medicine》2018,36(10):1784-1788
Objective
We conducted this study to investigate whether ESI combined with qSOFA score (ESI + qSOFA) predicts hospital outcome better than ESI alone in the emergency department (ED).Methods
This was a retrospective study for patients aged over 15 years who visited an ED of a tertiary referral hospital from January 1st, 2015 to December 31st, 2015. We calculated and compared predictive performances of ESI alone and ESI + qSOFA for prespecified outcomes. The primary outcome was hospital mortality, and the secondary outcome was composite outcome of in-hospital mortality and ICU admission. We calculated in-hospital mortality rates by positive qSOFA in each subgroup divided according to ESI levels (1, 2, 3, 4 + 5).Results
43,748 patients were enrolled. The area under receiver-operating characteristics curves were higher in ESI + qSOFA than in ESI alone for both mortality and composite outcome (0.786 vs. 0.777, P < .001 for mortality; 0.778 vs. 0.774, P < .001 for composite outcome). In each subgroup divided by ESI levels, patients with positive qSOFA had significantly higher in-hospital mortality rate compared to those with negative qSOFA (20.4% vs. 14.7%, P = .117 in ESI level 1 subgroup; 11.3% vs. 2.7%, P = .001 in ESI level 2 subgroup; 2.3% vs. 0.4%, P < .001 in ESI level 3 subgroup; 0.0% vs. 0.0% in ESI level 4 or 5 subgroup).Conclusion
The prognostic performance of ESI + qSOFA for in-hospital mortality was significantly higher than that of ESI alone. Within each subgroup, patients with positive qSOFA had higher in-hospital mortality compared to those with negative qSOFA. 相似文献9.
Paul Barbara Christopher Graziano William Caputo Ilya Litvak Dominick Battinelli Barry Hahn 《The American journal of emergency medicine》2018,36(6):1022-1026
Background
Recently a multispecialty, multinational task force convened to redefine the criteria for organ dysfunction, sepsis, severe sepsis, and septic shock. The study recommended the quick sequential organ failure assessment (qSOFA) score to identify sepsis patients. The qSOFA is felt to be the initial screen to prompt a more in-depth sepsis workup. This may be particularly true in resource-limited environments such as the prehospital arena.Objectives
The goal of this study was to identify whether emergency medical services (EMS) patients who met all three qSOFA criteria correlated with an emergency department (ED) identification of sepsis.Methods
This was a retrospective chart review of adult patients ≥ 18 years of age, meeting qSOFA criteria and presenting to the emergency department between 1/01/2014 and 6/30/2016. Subjects were identified through an electronic query of the EMS record repository.Results
72 subjects were included in the final analysis. Subjects in the septic group tended to be older with a mean age of 72 years vs 64 years. There was no observed discrepancy relating to gender. 48 of the subjects (67%) were identified as septic and 24 (33%) were identified as non-septic after review of the ED chart. This yielded a positive predictive value of the prehospital qSOFA as 66.67% (95% CI 55.8–77.6).Conclusions
EMS patients with positive qSOFA screens were more likely to be septic upon disposition to the ED. 相似文献10.