当前位置: X-MOL 学术Ann. Intern. Med. › 论文详情
Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)
Prognostic Accuracy of the Quick Sequential Organ Failure Assessment for Mortality in Patients With Suspected Infection: A Systematic Review and Meta-analysis
Annals of Internal Medicine ( IF 19.6 ) Pub Date : 2018-02-06 , DOI: 10.7326/m17-2820
Shannon M. Fernando 1 , Alexandre Tran 1 , Monica Taljaard 2 , Wei Cheng 3 , Bram Rochwerg 4 , Andrew J.E. Seely 2 , Jeffrey J. Perry 2
Affiliation  

Background:

The quick Sequential Organ Failure Assessment (qSOFA) has been proposed for prediction of mortality in patients with suspected infection.

Purpose:

To summarize and compare the prognostic accuracy of qSOFA and the systemic inflammatory response syndrome (SIRS) criteria for prediction of mortality in adult patients with suspected infection.

Data Sources:

Four databases from inception through November 2017.

Study Selection:

English-language studies using qSOFA for prediction of mortality (in-hospital, 28-day, or 30-day) in adult patients with suspected infection in the intensive care unit (ICU), emergency department (ED), or hospital wards.

Data Extraction:

Two investigators independently extracted data and assessed study quality using standard criteria.

Data Synthesis:

Thirty-eight studies were included (n = 385 333). qSOFA was associated with a pooled sensitivity of 60.8% (95% CI, 51.4% to 69.4%) and a pooled specificity of 72.0% (CI, 63.4% to 79.2%) for mortality. The SIRS criteria were associated with a pooled sensitivity of 88.1% (CI, 82.3% to 92.1%) and a pooled specificity of 25.8% (CI, 17.1% to 36.9%). The pooled sensitivity of qSOFA was higher in the ICU population (87.2% [CI, 75.8% to 93.7%]) than the non-ICU population (51.2% [CI, 43.6% to 58.7%]). The pooled specificity of qSOFA was higher in the non-ICU population (79.6% [CI, 73.3% to 84.7%]) than the ICU population (33.3% [CI, 23.8% to 44.4%]).

Limitation:

Potential risk of bias in included studies due to qSOFA interpretation and patient selection.

Conclusion:

qSOFA had poor sensitivity and moderate specificity for short-term mortality. The SIRS criteria had sensitivity superior to that of qSOFA, supporting their use for screening of patients and as a prompt for treatment initiation.

Primary Funding Source:

Canadian Association of Emergency Physicians. (PROSPERO: CRD42017075964)



中文翻译:

疑似感染患者死亡率的快速顺序器官衰竭评估的预后准确性:系统评价和荟萃分析

背景:

已经提出了快速顺序器官衰竭评估(qSOFA)来预测可疑感染患者的死亡率。

目的:

总结和比较qSOFA和系统性炎症反应综合征(SIRS)的标准对预测可疑感染成人患者的死亡率的预后准确性。

数据源:

从成立到2017年11月的四个数据库。

研究选择:

使用qSOFA进行英语研究,以预测重症监护病房(ICU),急诊科(ED)或医院病房中疑似感染的成年患者的死亡率(住院,28天或30天)。

数据提取:

两名研究者独立提取数据并使用标准标准评估研究质量。

数据综合:

包括38项研究(n  = 385 333)。qSOFA与死亡率的合并敏感性为60.8%(95%CI,51.4%至69.4%)和合并特异性为72.0%(CI,63.4%至79.2%)。SIRS标准的综合敏感性为88.1%(CI,82.3%至92.1%)和特异性为25.8%(CI,17.1%至36.9%)。ICU人群(87.2%[CI,75.8%至93.7%])的qSOFA合并敏感性高于非ICU人群(51.2%[CI,43.6%至58.7%])。非ICU人群(79.6%[CI,73.3%至84.7%])中qSOFA的合并特异性高于ICU人群(33.3%[CI,23.8%至44.4%])。

局限性:

由于qSOFA的解释和患者选择,所纳入研究存在潜在的偏倚风险。

结论:

qSOFA对短期死亡率的敏感性较低,特异性中等。SIRS标准的敏感性优于qSOFA,支持将其用于筛查患者并提示开始治疗。

主要资金来源:

加拿大急诊医师协会。(PROSPERO:CRD42017075964)

更新日期:2018-02-06
down
wechat
bug