一种新的脓毒症快速筛查评分系统：调整的简化序贯器官功能衰竭评分

背景　脓毒症是临床常见的危重症之一，早期发现、积极治疗有利于改善患者预后，但目前用于脓毒症筛查的快速序贯器官功能衰竭评分（qSOFA）灵敏度低，因此需要建立一种灵敏度和特异度均较高的脓毒症筛查评分。目的　在简化序贯器官功能衰竭评分（sSOFA）基础上建立一种新的脓毒症快速筛查评分--调整的简化序贯器官功能衰竭评分（M-sSOFA），为早期发现脓毒症提供参考。方法　收集2015年3月-2018年2月黄山首康医院和黄山市人民医院重症医学科（ICU）住院患者的临床资料进行回顾性分析，其中2016年3月-2018年2月符合入选标准的脓毒症患者105例，并选取同期101例符合入选标准的非脓毒症患者，该组病例用于M-sSOFA的建立（即为建模组）；2015年3月-2016年2月符合入选标准的脓毒症患者55例，并选取同期51例符合入选标准的非脓毒症患者，该组病例用于M-sSOFA有效性的验证（即为验证组）。利用受试者工作特征（ROC）曲线确定M-sSOFA新变量的取值和筛查脓毒症高危人群的诊断截点。并将新建立的M-sSOFA与qSOFA筛查脓毒症的ROC曲线进行比较。结果　建模组：脓毒症患者中男62例、女43例，平均年龄（71.1±15.2）岁，ICU病死率33.33%（35/105），非脓毒症患者中男80例、女21例，平均年龄（62.2±15.1）岁，ICU病死率11.88%（12/101）。M-sSOFA≥3分时〔即白细胞计数取<4×109/L或>10×109/L、氧合指数取<450 mm Hg（1 mm Hg=0.133 kPa）〕预测脓毒症的ROC曲线下面积（AUC）最大（P<0.05）。M-sSOFA≥3分时预测脓毒症的AUC为0.806〔95%CI（0.743，0.868）〕，灵敏度为81.90%，特异度为79.21%。白细胞计数<4×109/L或>10×109/L为1分和氧合指数<450 mm Hg为1分被纳入最终的M-sSOFA标准。验证组：脓毒症患者中男33例、女22例，平均年龄（70.9±14.4）岁，M-sSOFA 4（3，5）分，qSOFA 1（1，2）分，ICU病死率38.18%；非脓毒症患者中男38例、女13例，平均年龄（60.5±16.5）岁，M-sSOFA 1（0，2）分，qSOFA 0（0，1）分，ICU病死率11.76%。M-sSOFA和qSOFA筛查脓毒症的AUC、灵敏度、特异度和Kappa值分别为0.78与0.63、80.00%与40.00%、76.47%与86.28%、0.56与0.26。M-sSOFA和qSOFA筛查脓毒症的AUC比较，差异有统计学意义（Z=2.751，P=0.006）。结论　新的脓毒症快速筛查评分系统--M-sSOFA筛查脓毒症的效果优于qSOFA，AUC为0.78，灵敏度为80.00%，特异度为76.47%。

Modified Simple Sequential Organ Failure Assessment Score:a New Scoring System for Sepsis Screening

Background Sepsis is one of the most common critical diseases encountered clinically.Early detection and active treatment are beneficial to improving patient prognosis.Due to the low sensitivity of the quick Sequential Organ Failure Assessment(q SOFA)score in sepsis screening,it is necessary to establish a sepsis screening score with high sensitivity and specificity.Objective To develop a new scoring system for sepsis screening by modifying the simple Sequential Organ Failure Assessment(s SOFA)score,namely,Modified simple Sequential Organ Failure Assessment(M-s SOFA)score,providing a reference for early detection of sepsis.Methods The inpatients from the ICU,Huangshan Shoukang Hospital and Huangshan City People’s Hospital during March 2015 to February 2018 were recruited for retrospective analysis,including 206(105 with sepsis and 101 without)enrolled during March 2016 to February 2018(M-s SOFA model group),and 106(55 with sepsis and 51 without)enrolled during March 2015 to February 2016(M-s SOFA validation group).ROC curve analysis was performed to determine the new variables(white blood cell count and oxygenation index)and diagnostic cut-off point of M-s SOFA score,and was applied to measure the accuracy of M-s SOFA score and q SOFA score in screening sepsis.Results M-s SOFA model group:the sepsis patients(62 males and 43 females)had an average age of(71.1±15.2)years,with an ICU mortality rate of 33.33%(35/105),and the non-sepsis patients(80 males and 21 females)had an average age of(62.2±15.1)years,with an ICU mortality rate of 11.88%(12/101).The area under the ROC curve(AUC)of M-s SOFA score was biggest[AUC=0.806,95%CI(0.743,0.868),P<0.05],the sensitivity and specificity were 81.90%,and 79.21%,respectively,when diagnostic cut-off point of M-s SOFA score≥3(WBC<4×10^9/L or>10×10^9/L and oxygen index<450 mm Hg,1 mm Hg=0.133 k Pa).White blood cell count<4×10^9/L or>10×10^9/L scored as 1 point and oxygenation index<450 mm Hg scored as 1 point were included in the final M-s SOFA scoring standard.M-s SOFA validation group:the sepsis patients(33 males and 22 females)had an average age of(70.9±14.4)years,with an average M-s SOFA score of 4(range:3,5),an average q SOFA score of 1(range:1,2),and an ICU mortality rate of 38.18%,and the non-sepsis patients(38 males and 13 females)had an average age of(60.5±16.5)years,with an average M-s SOFA score of 1(range:0,2),an average q SOFA score of 0(range:0,1),and an ICU mortality rate of 11.76%.The AUC,sensitivity,specificity and Kappa coefficient of M-s SOFA score in screening sepsis were 0.78,80.00%,76.47%,and 0.56,respectively,and these aforementioned 4 indicators for M-s SOFA score were 0.63,40.00%,86.28%,and 0.26,respectively.The difference in AUC between M-s SOFA score and q SOFA score in screening sepsis was significant(Z=2.751,P=0.006).Conclusion M-s SOFA score,a new scoring system for rapid sepsis screening,demonstrated better predictive value for sepsis screening compared to q SOFA score,with an AUC of 0.78,80.00%sensitivity and 76.47%specificity.