Clinical Study on the Value of Quick Sequential Organ Failure Assessment for Evaluating the Prognosis of Patients with Septic Shock_West China Medical Journal

Authors：

 XiaYiqin , HuHai ,  CaoYu

Emergency Department, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

CaoYu, Email: yuyuer@126.com

Keywords：

Quick sequential organ failure; Septic shock; Prognosis

DOI：

10.7507/1002-0179.201600453

Video：

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Objective To investigate the clinical value of quick sequential organ failure assessment (qSOFA) score in predicting the outcome of patients with septic shock. Methods We collected the clinical data of 170 patients with septic shock treated in the Emergency Intensive Care Unit between January 2013 and January 2014. According to the 28-day outcomes of the patients, they were recorded as survival group and non-survival group. We calculated the qSOFA score, acute physiology and chronic health evaluation (APACHE)Ⅱ score on patients' admission. Using receiver operating characteristic (ROC) curve, we analyzed the qSOFA score, the effect of APACHE Ⅱ score in predicting the 28-day prognosis for patients with septic shock. The correlation between qSOFA score and APACHEⅡ score was also assessed. Results The qSOFA and APACHEⅡ scores in non-survivors were higher than those in the survivors. According to ROC curve analysis, the area under the curve for qSOFA score and APACHE Ⅱ score was 0.666 and 0.791, respectively. For qSOFA score with 2 cut-off points to evaluate the prognosis of septic shock, the sensitivity was 62.7%, specificity was 61.1%, positive predictive value was 56.0%, negative predictive value was 67.4%, positive likelihood ratio was 1.61, and negative likelihood ratio was 0.61. For the APACHEⅡ score with 24 cut-off points to evaluate the prognosis of septic shock, the sensitivity was 70.7%, specificity was 80%, positive predictive value was 73.6%, negative predictive value was 67.3%, positive likelihood ratio was 3.54, and negative likelihood ratio was 0.37. The correlation coefficient of qSOFA score and APACHE Ⅱ score was 0.499. Conclusion The qSOFA score is useful to evaluate the prognosis of the patients with septic shock early in Emergency Department.

Citation： XiaYiqin, HuHai, CaoYu. Clinical Study on the Value of Quick Sequential Organ Failure Assessment for Evaluating the Prognosis of Patients with Septic Shock. West China Medical Journal, 2016, 31(10): 1645-1648. doi: 10.7507/1002-0179.201600453 Copy

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2.	Balk RA. Severe sepsis and septic shock. Definitions, epidemiology, and clinical manifestations[J]. Crit Care Clin, 2000, 16(2): 179-192.
3.	Shankar-Hari S, Manu, Phillips, et al. Developing a new definition and assessing new clinical criteria for septic shock, for the third international consensus definitions for sepsis and septic shock (sepsis-3)[J]. JAMA, 2016, 315(8): 775-787.
4.	董磊, 张辉.脓毒性休克的临床流行病学调查: 1087例全国多中心临床研究[J].中国临床医学, 2010, 17(3): 436-438.
5.	黄顺伟.四种评分系统对重症脓毒症病人动态评分的比较[J].中国急救医学, 2005, 25(11): 802-803.
6.	朱学云, 魏桃英. C反应蛋白和急性生理学与慢性健康状况评分系统Ⅱ在感染性休克中的临床意义[J].中国危重病急救医学, 2006, 18(9): 564.
7.	Beck DH, Taylor BL, Millar B, et al. Prediction of outcome from intensive care: a prospective cohort study comparing Acute Physiology and Chronic Health Evaluation Ⅱ and Ⅲ prognostic systems in a United Kingdom intensive care unit[J]. Crit Care Med, 1997, 25(1): 9-15.
8.	刘旭, 吕隽, 李文强, 等.急诊脓毒症病死率评分在急诊脓毒症休克患者中的应用研究[J].医学临床研究, 2016, 33(2): 216-220.
9.	VincentJL, MorenoR, TakalaJ, et al. The SOFA (sepsis-related organ failure assessment) score to describle organ dysfunction/failure[J]. Intensive Care Med, 1996, 22(7): 707-710.
10.	Vincent JL, De M. Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study[J]. Crit Care Med, 1998, 26(11): 1793-1800.
11.	Mereno R, Vincent JL. The use of maximum SOFA score to quantify organ dysfunction/failure in intensive care. Results of a prospective, multicentre study[J]. Intensive Care Med, 1999, 25(7): 686-696.
12.	Seymour CW, Liu VX, Iwashyna TJ, et al. Assessment of clinical criteria for sepsis: for the third international consensus definitions for sepsis and septic shock (sepsis-3)[J]. JAMA, 2016, 315(8): 762-774.
13.	Levy MM, Fink MP, Marshall JC, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS International sepsis difinitions conference[J]. Crit Care Med, 2003, 31(4): 1250-1256.
14.	顾永辉, 卞叶萍, 林兆奋. APACHE Ⅱ, SOFA评分及降钙素原水平对脓毒症严重程度及预后的评估价值[J].医学与哲学, 2015, 36(12B): 35-37.
15.	Knaus WA, Draper EA, Wagner DP, et al. APACHE Ⅱ: a severity of disease classification system[J]. Crit Care Med, 1985, 13(10):818-829.
16.	Opal SM, Girard TD, Ely EW. The immunopathogenesis of sepsis in elderly patients[J]. Clin Infect Dis, 2005, 41(Suppl 7): S504-S512.
17.	Martin GS, Mannino DM, Moss M. The effect of age on the development and outcome of adult sepsis[J]. Crit Care Med, 2006, 34(1): 15-21.
18.	廖谷清.探讨老年脓毒症患者晚期免疫失衡的特点[J].南华大学学报:医学版, 2010, 38(1): 109-111.
19.	张振辉, 熊旭明. ICU老年脓毒症患者危险因素分析[J].广东医学, 2009, 30(5): 769-771.
20.	Baffert F, Le T, Thurston G, et al. Angiopoietin-1 decreases plasma leakage by reducing number and size of endothelial gaps in venules[J]. Am J Physiol Heart Circ Physiol, 2006, 290(1): H107-H118.
21.	Bernard GR, Artigas A, Brigham KL, et al. The American-European consensus conference on ARDS. definitions, mechanisms, relevant outcomes, and clinical trial coordination[J]. Am J Respir Crit Care Med, 1994, 149(3 Pt 1): 818-824.
22.	蔡国龙, 童洪杰, 郝雪景, 等.早期目标导向治疗对严重脓毒症/脓毒性休克患者病死率的影响:系统文献回顾与Meta分析[J].中华危重病急救医学, 2015(6): 439-442.

1. 中华医学会重症医学分会.中国严重脓毒症/脓毒性休克治疗指南(2014)[J].中华危重病急救医学, 2015, 27(6): 401-426.
2. Balk RA. Severe sepsis and septic shock. Definitions, epidemiology, and clinical manifestations[J]. Crit Care Clin, 2000, 16(2): 179-192.
3. Shankar-Hari S, Manu, Phillips, et al. Developing a new definition and assessing new clinical criteria for septic shock, for the third international consensus definitions for sepsis and septic shock (sepsis-3)[J]. JAMA, 2016, 315(8): 775-787.
4. 董磊, 张辉.脓毒性休克的临床流行病学调查: 1087例全国多中心临床研究[J].中国临床医学, 2010, 17(3): 436-438.
5. 黄顺伟.四种评分系统对重症脓毒症病人动态评分的比较[J].中国急救医学, 2005, 25(11): 802-803.
6. 朱学云, 魏桃英. C反应蛋白和急性生理学与慢性健康状况评分系统Ⅱ在感染性休克中的临床意义[J].中国危重病急救医学, 2006, 18(9): 564.
7. Beck DH, Taylor BL, Millar B, et al. Prediction of outcome from intensive care: a prospective cohort study comparing Acute Physiology and Chronic Health Evaluation Ⅱ and Ⅲ prognostic systems in a United Kingdom intensive care unit[J]. Crit Care Med, 1997, 25(1): 9-15.
8. 刘旭, 吕隽, 李文强, 等.急诊脓毒症病死率评分在急诊脓毒症休克患者中的应用研究[J].医学临床研究, 2016, 33(2): 216-220.
9. VincentJL, MorenoR, TakalaJ, et al. The SOFA (sepsis-related organ failure assessment) score to describle organ dysfunction/failure[J]. Intensive Care Med, 1996, 22(7): 707-710.
10. Vincent JL, De M. Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study[J]. Crit Care Med, 1998, 26(11): 1793-1800.
11. Mereno R, Vincent JL. The use of maximum SOFA score to quantify organ dysfunction/failure in intensive care. Results of a prospective, multicentre study[J]. Intensive Care Med, 1999, 25(7): 686-696.
12. Seymour CW, Liu VX, Iwashyna TJ, et al. Assessment of clinical criteria for sepsis: for the third international consensus definitions for sepsis and septic shock (sepsis-3)[J]. JAMA, 2016, 315(8): 762-774.
13. Levy MM, Fink MP, Marshall JC, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS International sepsis difinitions conference[J]. Crit Care Med, 2003, 31(4): 1250-1256.
14. 顾永辉, 卞叶萍, 林兆奋. APACHE Ⅱ, SOFA评分及降钙素原水平对脓毒症严重程度及预后的评估价值[J].医学与哲学, 2015, 36(12B): 35-37.
15. Knaus WA, Draper EA, Wagner DP, et al. APACHE Ⅱ: a severity of disease classification system[J]. Crit Care Med, 1985, 13(10):818-829.
16. Opal SM, Girard TD, Ely EW. The immunopathogenesis of sepsis in elderly patients[J]. Clin Infect Dis, 2005, 41(Suppl 7): S504-S512.
17. Martin GS, Mannino DM, Moss M. The effect of age on the development and outcome of adult sepsis[J]. Crit Care Med, 2006, 34(1): 15-21.
18. 廖谷清.探讨老年脓毒症患者晚期免疫失衡的特点[J].南华大学学报:医学版, 2010, 38(1): 109-111.
19. 张振辉, 熊旭明. ICU老年脓毒症患者危险因素分析[J].广东医学, 2009, 30(5): 769-771.
20. Baffert F, Le T, Thurston G, et al. Angiopoietin-1 decreases plasma leakage by reducing number and size of endothelial gaps in venules[J]. Am J Physiol Heart Circ Physiol, 2006, 290(1): H107-H118.
21. Bernard GR, Artigas A, Brigham KL, et al. The American-European consensus conference on ARDS. definitions, mechanisms, relevant outcomes, and clinical trial coordination[J]. Am J Respir Crit Care Med, 1994, 149(3 Pt 1): 818-824.
22. 蔡国龙, 童洪杰, 郝雪景, 等.早期目标导向治疗对严重脓毒症/脓毒性休克患者病死率的影响:系统文献回顾与Meta分析[J].中华危重病急救医学, 2015(6): 439-442.

West China Medical Journal

Clinical Study on the Value of Quick Sequential Organ Failure Assessment for Evaluating the Prognosis of Patients with Septic Shock

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