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Prognostic value of serial score measurements of the national early warning score, the quick sequential organ failure assessment and the systemic inflammatory response syndrome to predict clinical outcome in early sepsis
European Journal of Emergency Medicine ( IF 4.4 ) Pub Date : 2022-10-01 , DOI: 10.1097/mej.0000000000000924
Lara E E C Zonneveld 1 , Raymond J van Wijk 1 , Tycho J Olgers 1 , Hjalmar R Bouma 1, 2 , Jan C Ter Maaten 1
Affiliation  

Background and importance 

Sepsis is a common and potentially lethal syndrome, and early recognition is critical to prevent deterioration. Yet, currently available scores to facilitate recognition of sepsis lack prognostic accuracy.

Objective 

To identify the optimal time-point to determine NEWS, qSOFA and SIRS for the prediction of clinical deterioration in early sepsis and to determine whether the change in these scores over time improves their prognostic accuracy.

Design 

Post hoc analysis of prospectively collected data.

Settings and participants 

This study was performed in the emergency department (ED) of a tertiary-care teaching hospital. Adult medical patients with (potential) sepsis were included.

Outcome measures and analysis 

The primary outcome was clinical deterioration within 72 h after admission, defined as organ failure development, the composite outcome of ICU-admission and death. Secondary outcomes were the composite of ICU-admission/death and a rise in SOFA at least 2. Scores were calculated at the ED with 30-min intervals. ROC analyses were constructed to compare the prognostic accuracy of the scores.

Results 

In total, 1750 patients were included, of which 360 (20.6%) deteriorated and 79 (4.5%) went to the ICU or died within 72 h. The NEWS at triage (AUC, 0.62; 95% CI, 0.59–0.65) had a higher accuracy than qSOFA (AUC, 0.60; 95% CI, 0.56–0.63) and SIRS (AUC, 0.59; 95% CI, 0.56–0.63) for predicting deterioration. The AUC of the NEWS at 1 h (0.65; 95% CI, 0.63–0.69) and 150 min after triage (0.64; 95% CI, 0.61–0.68) was higher than the AUC of the NEWS at triage. The qSOFA had the highest AUC at 90 min after triage (0.62; 95% CI, 0.58–0.65), whereas the SIRS had the highest AUC at 60 min after triage (0.60; 95% CI, 0.56–0.63); both are not significantly different from triage. The NEWS had a better accuracy to predict ICU-admission/death <72 h compared with qSOFA (AUC difference, 0.092) and SIRS (AUC difference, 0.137). No differences were found for the prediction of a rise in SOFA at least 2 within 72 h between the scores. Patients with the largest improvement in any of the scores were more prone to deteriorate.

Conclusion 

NEWS had a higher prognostic accuracy to predict deterioration compared with SIRS and qSOFA; the highest accuracy was reached at 1 h after triage.



中文翻译:

国家早期预警评分系列评分测量、快速序贯器官衰竭评估和全身炎症反应综合征预测脓毒症早期临床结果的预后价值

背景和重要性 

脓毒症是一种常见且可能致命的综合征,早期识别对于防止病情恶化至关重要。然而,目前可用的有助于识别脓毒症的评分缺乏预后准确性。

客观的 

确定用于预测早期脓毒症临床恶化的 NEWS、qSOFA 和 SIRS 的最佳时间点,并确定这些分数随时间的变化是否会提高其预后准确性。

设计 

前瞻性收集数据的事后分析。

设置和参与者 

这项研究是在三级教学医院的急诊科 (ED) 进行的。包括患有(潜在)败血症的成年内科患者。

结果测量和分析 

主要结果是入院后 72 小时内的临床恶化,定义为器官衰竭发展、入住 ICU 和死亡的复合结果。次要结果是 ICU 入院/死亡和 SOFA 升高至少 2 的复合结果。分数是在 ED 以 30 分钟的间隔计算的。构建 ROC 分析以比较评分的预后准确性。

结果 

总共纳入了 1750 名患者,其中 360 名 (20.6%) 病情恶化,79 名 (4.5%) 进入 ICU 或在 72 小时内死亡。分诊时的 NEWS(AUC,0.62;95% CI,0.59-0.65)比 qSOFA(AUC,0.60;95% CI,0.56-0.63)和 SIRS(AUC,0.59;95% CI,0.56-0.63)具有更高的准确性)用于预测恶化。分类后 1 小时(0.65;95% CI,0.63-0.69)和 150 分钟(0.64;95% CI,0.61-0.68)的 NEWS 的 AUC 高于分类时 NEWS 的 AUC。qSOFA 在分诊后 90 分钟的 AUC 最高(0.62;95% CI,0.58-0.65),而 SIRS 在分诊后 60 分钟的 AUC 最高(0.60;95% CI,0.56-0.63);两者都与分类没有显着差异。与 qSOFA(AUC 差异,0.092)和 SIRS(AUC 差异,0.137)相比,NEWS 在预测 <72 小时的 ICU 入院/死亡方面具有更好的准确性。分数之间在 72 小时内 SOFA 至少升高 2 的预测没有发现差异。任何一项得分改善最大的患者更容易恶化。

结论 

与 SIRS 和 qSOFA 相比,NEWS 预测恶化的预后准确性更高;分流后 1 小时达到最高准确度。

更新日期:2022-09-05
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