| BackgroundSepsis is a systematic response of the body caused by infection,which can lead to organ dysfunction and even death as the disease progresses.Because of the high incidence,high mortality,and high medical costs of sepsis,which affect a wide range of people.Many surviving patients will also face long-term impairment in physiological,psychological,and cognitive.Therefore,the early identification of sepsis patients is particularly important.However,the clinical diagnostic criteria of sepsis have been controversial for a long time.The concept and criteria of sepsis-1 was proposed in 1991,and sepsis-2 was subsequently published in 2001,but sepsis-1 and sepsis-2 did not differ significantly in the definition.In other words,the diagnostic criteria for sepsis have not changed substantially for more than two decades.In 2016,the task force proposed new definition and diagnostic criteria,called sepsis-3,which has been controversial since it was released.ObjectiveThis study evaluated the clinical value of the sepsis-1 and sepsis-3 criteria,by comparing patient characteristics in the intensive care unit(ICU)with sepsis-1 and sepsis-3 criteria,respectively.MethodsUsing the MIMIC-III database,a structured query language was used to extract adult infectious patients based on 1097 diagnostic codes for ICD-9 infection.Infected patients(sepsis-1 standard)meeting the criteria of two or more SIRS on the first day of ICU admission and sepsis-3 patients of SOFA score>2 on the first day were extracted.The number of patients and the 21-day mortality were compared to analyze the rate of misdiagnosis.Infected patients with a qSOFA score>2 on the first day of admission to the ICU were compared for mortality with sepsis patients fulfilled sepsis-3 standard.According to the patients' past medical records,the infected patients were divided into the general group(group A),the one without previous chronic organ dysfunction group(group B)and the one with previous chronic organ dysfunction group(group C)for subgroup analysis.Sepsis-1/1,Sepsis-3/1,Sepsis-1/0,and Sepsis-3/0 were used to indicate patients with and without chronic organ dysfunction in different diagnostic criteria.1 means with chronic organ dysfunction,0 means no previous chronic organ dysfunction.The ROC curve and area under the curve(AUC)for the SIRS criteria,SOFA score,and qSOFA score predicting 21-day deaths were calculated among infected patients in the different subgroups.The sensitivity,specificity,predictive value,and likelihood ratio for the 21-day mortality predicted by SIRS>2,SOFA>2,and qSOFA>2 were also calculated.ResultsA total of 21,491 adult patients with infection were identified after screening 58,976 hospital admissions from the MIMIC-? database.19,710 met two or more SIRS criteria on the first day of ICU admission,suggesting an incidence rate of 91.7%for sepsis-1,whereas 18,348 fell into the category of sepsis-3,indicating an incidence rate of 85.4%for sepsis-3.Of those meeting the diagnostic criteria for sepsis-1,13.42%did not satisfy sepsis-3 criteria,and this population had a 21-day mortality rate of 6.96%.In contrast,7.00%of the patients meeting sepsis-3 criteria did not meet sepsis-1 criteria,and their 21-day mortality rate was 10.76%.When excluding preexisting organ conditions,18.41%of patients with sepsis-1 did not meet sepsis-3 criteria,with a 21-day mortality rate of 6.39%,and 6.00%of patients with sepsis-3 did not meet sepsis-1 criteria,with a 21-day mortality rate of 9.11%.Similarly,we found that 4.92%of the patients with sepsis-1/1 were sepsis-1 specific,and their 21-day mortality rate was 8.45%;8.55%of the patients with sepsis-3/1 were sepsis-3 specific,and their 21-day mortality rate was 11.45%,which was not significantly different from their sepsis-1/1 counterpart(P = 0.153).In the total infected patients(group A),the area under the ROC curve predicted by SOFA score for 21-day all-cause mortality was 0.713(95%CI:0.705?0.722),higher than the SIRS criteria(AUC=0.591,95%CI:0.582?0.600),higher than qSOFA Score(AUC=0.604,95%CI:0.595?0.613),and the difference between the three scores was statistically significant(P<0.05).When two or more SIRS criteria or SOFA score>2 points were applied to predict 21-day all-cause mortality in infected patients without prior chronic organ dysfunction(group B),the sensitivity was 96.0%or 91.0%,respectively and the specificity was 21.9%and 8.3%,respectively.Although the areas under the receiver operator curve of both SOFA and SIRS criteria could be used for predicting mortality,SOFA score represented the severity of the condition,whereas SIRS score represented a clinically evident host response to infection.There was a slight difference in hospital mortality between sepsis patients with sepsis-3 criteria and the infected patients with qSOFA>2 points.And the 60-day mortality rate in patients with qSOFA>2 points was as high as 27.35%.ConclusionCompared with the sepsis-1 diagnostic criteria,the sepsis-3 standard narrows down the diagnostic population of sepsis,contrary to the purpose of early identification,which may lead to the delay of diagnosis;This statistical approach may be inappropriate to compare the prediction performance of SIRS and SOFA criteria when sepsis-3 criteria were defined;The qSOFA score is simple to operate and can be used as an effective screening tool for infected patients to screen patients at high risk of death in the ICU. |
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