Diagnosis accuracy of quick sequential organ failure assessment score for adult sepsis patient with soft tissue infection / 中华危重病急救医学

ABSTRACT

To assess the diagnosis accuracy of the quick sequential organ failure assessment (qSOFA) score for adult sepsis patient with soft tissue infection, and to assess the prognostic accuracy of the qSOFA score for septic shock. Methods A retrospective study was conducted. The patients with soft tissue infection admitted to the general surgery department of Beijing Hospital and the burns and plastic surgery department of Fourth Medical Center of PLA General Hospital from January 2012 to December 2018 were enrolled. Patients were divided into the sepsis group and the non-sepsis group according to whether sepsis occurred within 48 hours after diagnosis of infection. The baseline data, prognosis, and qSOFA, the change of sequential organ failure assessment (&Delta;SOFA), systemic inflammatory response syndrome (SIRS) scores were compared between the two groups, and the receiver operating characteristic (ROC) curves were also drawn to assess the diagnosis accuracy of the qSOFA and SIRS scores for adult sepsis patients with soft tissue infection and to assess the prognostic accuracy of the qSOFA, &Delta;SOFA and SIRS scores for septic shock of these patients. Results 192 patients were included in the study. Sepsis occurred in 79 patients (41.1%) within 48 hours after diagnosis of infection. Septic shock occurred in 28 patients (14.6%) during 28-day hospitalization and 6 patients (3.1%) died. Compared with non-sepsis group, more proportion of necrotizing fasciitis, septic shock and patients received mechanical ventilation (21.5% vs. 4.4%, 31.6% vs. 2.7%, 16.5% vs. 4.4%, all P < 0.01), with higher mortality (7.6% vs. 0%, P = 0.003) in sepsis group. ROC curve analysis showed that when the cut-off value of qSOFA ≥ 2, the sensitivity, specificity, positive predictive value, negative predictive value and area under ROC curve (AUC) were 48.1%, 92.0%, 80.8%, 71.7% and 0.824 [95% confidence interval (95%CI) = 0.764-0.884, P < 0.01] respectively for diagnosis of sepsis caused by soft tissue infection. When the cut-off value of SIRS score ≥ 3, the sensitivity, specificity, positive predictive value, negative predictive value and AUC were 89.8%, 48.6%, 55.0%, 87.3% and 0.721 (95%CI = 0.677-0.765, P < 0.01) respectively for diagnosis of sepsis caused by soft tissue infection. All scores of qSOFA ≥ 2, &Delta;SOFA ≥ 2 and SIRS score ≥3 could be used to predict septic shock (all P < 0.01). The AUC of &Delta;SOFA, qSOFA and SIRS scores were 0.767 (95%CI = 0.665-0.869), 0.840 (95%CI = 0.757-0.923) and 0.716 (95%CI = 0.596-0.835) respectively. Conclusions qSOFA ≥ 2 can be used as a rapid sepsis screening tool for adult patients with soft tissue infection. It is suggested that qSOFA or SIRS scores can be used to predict septic shock of adult patients with soft tissue infection initially.