The Application Value Of QSOFA Score In Evaluating Potentially Critical Patients And Their Severity And Prognosis

Objective Observe the qSOFA scores of patients before entering the ICU,evaluate the application value of qSOFA scores in early identification of potentially critical patients and in evaluating the severity and prognosis of patients.Methods In this study,a retrospective study was used to collect the data of 755 patients admitted to the ICU of the General Hospital of Ningxia Medical University Cardiovascular and Cerebrovascular Hospital from 2018-01-01 to 2018-12-31.According to the inclusion criteria and exclusion criteria,556 patients who met the inclusion criteria were included in the study.1.Collect general information such as the age and gender of the patient.2.Perform qSOFA score and MEWS score every day 72 h,48h,24 h before entering the ICU,and perform qSOFA score and APACHEⅡ score 24 hours after the patient enter the ICU(all based on the daily worst value).3.Observe the patient’s ICU residence time,mechanical ventilation time,vasoactive drug use time,hospitalization expenditure,28-day survival,etc.4.Taking MEWS score as the standard:(1)Grouping: Divide the research subjects into critical high-risk group(MEWS≥5 points)and critical low-risk group(MEWS<5).(2)Calculate the sensitivity,the specificity,the positive predictive value,the negative predictive value,the Youden index and the area under the ROC curve of critical high-risk patients by calculating the qSOFA score.5.Taking APACHE II score as the standard:(1)Divide the study subjects into low-risk group(APACHEⅡ≤10 points),intermediate-risk group(11≤APACHEⅡ≤15),and high-risk group(APACHEⅡ>15).(2)Calculate the sensitivity,the specificity,the positive predictive value,the negative predictive value,and the area under the ROC curve of high-risk patients by calculating the qSOFA score.6.Draw the ROC curve with the patient’s 28-day survival as the outcome variable,and calculate the sensitivity,the specificity,the area under the curve of the qSOFA score to evaluate the prognosis of the patient.Results 1.A total of 556 patients were included in this study,including 335 males(60.1%),with a male-female ratio of 1.5:1.The average age was(65.0±15.4)years old,and the middle-aged and elderly patients aged ≥45 years old accounted for 89.7% of the total number.The source of the original department: 278 cases in emergency department(50.0%),217 cases in surgery(39%),and 61 cases in internal medicine(11%).2.(1)72h,48 h,24h before entering the ICU,there is no significant difference between the critical high-risk group and the critical low-risk group in terms of age,gender,and chronic disease history(P>0.05).(2)72h,48 h,and 24 h before entering the ICU,the qSOFA scores of patients in the critical and high-risk group are 1.67±0.58,1.80±0.45,and 1.95±0.64,respectively,and the qSOFA scores of the patients in the critical low-risk group are 0.19±0.43,0.41±0.56,0.95±0.69,respectively.With high criticality,the qSOFA scores of patients in the risk group are significantly higher than those in the critical and low-risk group(all P<0.05).(3)As the time of entering the ICU gets closer,the qSOFA scores of the critical high-risk group and the critical low-risk group both show an increasing trend.3.Using MEWS score as the gold standard to evaluate qSOFA score for critical and high-risk patients,the results show that:(1)The qSOFA score evaluation results of the patients before entering the ICU respectively show:(1)72h before entering the ICU(n=72):the sensitivity of the qSOFA score to determine critical and high-risk patients is 66.67%,the specificity is 98.55%,the positive prediction value is 66.67%,the negative predictive value is98.55%,and the Youden index is 0.65.(2)48h before entering the ICU(n=61): the sensitivity of qSOFA score to determine critical high-risk patients is 80.00%,the specificity is 96.43%,the positive predictive value is 66.67%,the negative predictive value is 98.18%,and the Youden index is 0.76.(3)24h before entering the ICU(n=556): the sensitivity of qSOFA score for judging critical high-risk patients is 78.38%,the specificity is 81.35%,the positive predictive value is 51.18%,the negative predictive value is 93.78%,and the Youden index is0.60.(4)Plot the receiver operating characteristic curve(ROC)of 72 h,48h,24 h qSOFA scores to determine critical and high-risk patients before entering the ICU.The areas under the ROC curve are 0.96(95%CI 0.89-0.99),0.95(95%CI 0.85-0.99),0.83(95%CI 0.80-0.86).When the qSOFA score ≥ 2 points,the sensitivity and the specificity for judging critical high-risk patients are 66.67%,98.55%;80.00%,96.43%;78.38%,81.35%;both are higher.(2)Continuous assessment results of qSOFA scores of patients before entering the ICU show that: Continuous assessment of qSOFA 72 h,48h,24 h before entering the ICU of 51patients:(1)72h before entering the ICU(n=51): the sensitivity of qSOFA score to determine critically high-risk patients is 66.67%,the specificity is 97.92%,the positive predictive value is 66.67%,the negative predictive value is 97.92%,and the Youden index is 0.65.(2)48h before entering the ICU(n=51): the sensitivity of qSOFA score to determine critical high-risk patients is 80.00%,the specificity is 97.83%,the positive predictive value is 80.00%,the negative predictive value is 97.83%,and the Youden index is 0.78.(3)24h before entering the ICU(n=51): the sensitivity of qSOFA score to determine critical high-risk patients is 92.31%,the specificity is 73.68%,the positive predictive value is 54.55%,the negative predictive value is 96.55%,and the Youden index is 0.70.(4)Plot the receiver operating characteristic curve(ROC)of 72 h,48h,24 h qSOFA scores to determine critical and high-risk patients before entering the ICU.The best cut-off value was taken when qSOFA=2,and the area under the ROC curve was 0.94(95%CI 0.84-0.98),0.96(95%CI 0.86-0.99),and 0.84(95%CI0.71-0.93).(5)The qSOFA score and MEWS score of patients 72 h,48h,24 h before entering the ICU showed an increasing trend as the time of entering the ICU became closer.(6)Correlation analysis of qSOFA score and MEWS score in judging critical and high-risk patients,the correlation coefficient r value is all> 0.7,qSOFA score and MEWS score are highly correlated in the evaluation of critical and high-risk patients.(7)The qSOFA score and MEWS score are used to evaluate the consistency of the Kappa analysis of critical and high-risk patients.The K values are in the range of 0.4 to 0.75(all P<0.05).The qSOFA score and MEWS score are used to evaluate critical high-risk patients.Has medium to high consistency.4.Using APACHE Ⅱ score as the gold standard to evaluate qSOFA score in evaluating the severity of the patient’s condition(n=556)showed that:(1)The results of the qSOFA score evaluating the severity of patients are as follows:(1)qSOFA=0(n=121): 5(4.1%)high-risk patients,17/121(15.3%)deaths.(2)qSOFA=1(n=265): 64(24.2%)high-risk patients,89/265(32.4%)deaths.(3)qSOFA≥2 points(n=170): 116(68.2%)high-risk patients,107/170(62.9%)deaths.(2)Verify the effectiveness of qSOFA score in evaluating the severity of patients:(1)Using qSOFA=1 as the cut-off value for judging high-risk patients,the sensitivity for judging high-risk patients is 97.29%,the specificity is 31.26%,the positive predictive value is 41.37%,and the negative predictive value is 95.87%.(2)Using qSOFA=2 as the cut-off value for judging high-risk patients,the sensitivity for judging high-risk patients is 62.70%,the specificity is 85.44%,the positive predictive value is 68.24%,and the negative predictive value is 82.12%.(3)Using qSOFA=3 as the cut-off value for judging high-risk patients,the sensitivity for judging high-risk patients is 16.22%,the specificity is 98.65%,the positive predictive value is 85.71%,and the negative predictive value was 70.25%.(3)Using the patient’s disease severity(high risk)as the outcome variable,the receiver operating characteristic curve(ROC)analysis was performed on the qSOFA scores of 556 patients.When the qSOFA score ≥ 2 points,the sensitivity of judging high-risk patients is62.70%,the specificity is 85.44%,the positive predictive value is 68.24%,the negative predictive value is 82.12%,and the area under the ROC curve is 0.73(5%CI 0.70-0.77),which are all high.The qSOFA score and APACHE Ⅱ score are analyzed to determine the Kappa consistency of high-risk patients,and the K value is 0.50(P <0.05).The assessment of the severity of patients by qSOFA score have moderate to high consistency with the APACHEⅡ score.(4)Patients with qSOFA score ≥ 2 points are significantly higher than patients with qSOFA score<2 in terms of 28-day mortality,hospitalization costs,number of rescues,and the use of mechanical ventilation and vasoactive drugs(P<0.05);There is no significant difference between patients with qSOFA score ≥ 2 points and patients with qSOFA score <2points in total hospital stay,ICU retention time,days of mechanical ventilation,and vasoactive drug use days(P>0.05).5.The evaluation results of qSOFA score on the prognosis of patients show:(1)The overall 28-day mortality rate of the study subjects(n=556):(1)The mortality rate of patients with qSOFA=1 points: 32.36%.(2)The mortality rate of patients with qSOFA=2 points:60%.(3)The mortality rate of patients with qSOFA=3 points: 84%;(2)The area under the ROC curve between qSOFA score and 28-day survival of all patients is 0.70(95%CI 0.66-0.75);when the qSOFA score ≥ 2 points,the sensitivity and specificity of predicting patient death are 50.23% and 81.63%,respectively,which are both high.(3)The area under the receiver operating characteristic curve(ROC)curve(AUC)of the patient’s daily qSOFA score and the patient’s 28-day survival at 72 h,48h,and 24 h before admission to the ICU are 0.61,0.55,and 0.70,respectively.Conclusion 1.The qSOFA score can be used to identify potentially critical patients early in the hospital to a certain extent.2.The qSOFA score can be used to assess the severity and prognosis of patients.