| Objective:To evaluate the diagnostic accuracy of the quick Sequential Organ Failure Assessment(qSOFA)for sepsis of adults with soft tissue infection,and to evaluate the prognostic accuracy of qSOFA for septic shock and mortality of these patients.The diagnostic efficiencies of qSOFA were also compared with the Systemic Inflammatory Response Syndrome(SIRS).The changes of qSOFA and SIRS in the course of sepsis to septic shock were also analyzed.Methods:A retrospective study was conducted.The patients with soft tissue infections admitted to the general surgery department of Beijing Hospital and the burn and plastic surgery department of Fourth Medical Center of PLA General Hospital from January 2012 until December 2018 were enrolled.Patients were assigned into the sepsis group and the non-sepsis group according to whether sepsis occurred within 48 hours after diagnosis of infection.The baseline data,treatment and prognosis were compared between two groups with Chi square test.The sensitivity,specificity,positive predictive value and negative predictive value of qSOFA?2,SIRS?2 and SIRS?3 for diagnosis of sepsis were calculated.The effectiveness of qSOFA and SIRS for diagnosis of sepsis were compared with the area under the receiver operating characteristic curve(AUC).The patients were divided into the septic shock group and the non-shock group according to whether septic shock occurred during hospitalization.The AUC of ? SOFA,qSOFA and SIRS for prognosis of septic shock and 28 day mortality were calculated and compared.The changes of qSOFA and SIRS scores from 24 hours after sepsis to 24 hours before septic shock were compared by paired t test.Results:1.A total of 192 patients were enrolled,including 79(41.6%)patients with sepsis within 48 hours after diagnosis of infection.Septic shock occurred in 28 patients(14.6%)during 28 days hospitalization and 6 patients(3.1%)died.There was no significant difference in age,gender and underlying disease between sepsis and non-sepsis group(all P>0.05).More patients received mechanical ventilation therapy(16.5%vs.4.4%,P=0.005)with higher mortality(7.6%vs.0%,P=0.003)in the sepsis group compared to the non-sepsis group.2.When qSOFA?2,SIRS?2 and SIRS?3 as the cut-off value,the sensitivity,specificity,positive predictive value and negative predictive value were 48.1%,92.0%,80.8%,71.7%and 96.2%,23.9%,46.9%,90.00%and 89.8%,48.6%,55.0%,87.3%respectively to diagnose sepsis caused by soft tissue infections.The AUC of qSOFA for sepsis diagnosis was 0.824(95%CI=0.764-0.884,P<0.001),which was larger than AUC area of the SIRS[0.721(95%CI=0.677-0.765,P<0.001)].3.The AUC of? SOFA,qSOFA and SIRS were 0.840(95%CI=0.757-0.923,P<0.001),0.767(95%CI=0.665-0.869,P<0.001)and 0.716(95%CI=0.596-0.835,P<0.001)for septic shock prognosis.4.The AUC of ? SOFA for 28 day mortality prognosis was 0.819(95%CI=0.705-0.933,P<0.01),which was better than qSOFA and SIRS(both P>0.05).5.The average time from sepsis to septic shock was 4.3±2.7 days in 28 septic shock patients.And 24 patients among them had an interval of more than 48 hours.The qSOFA in 24 hours before septic shock increased by 0.7(95%CI=0.4-1.0,P<0.001)compared with that within 24 hours after sepsis.And there was no significant change in the scores of SIRS during the same course(P>0.05).Conclusion:1.qSOFA equal to or more than two scores can be used as a rapid sepsis screening tool for adult patients with soft tissue infection,which has higher specificity and larger AUC than SIRS equal to or more than two or three scores.2.The accuracy of prognosis for septic shock caused by soft tissue infection with ? SOFA and qSOFA score were better than SIRS score.The accuracy of prognosis for 28 day mortality by qSOFA and SIRS is poor.3.The progressive increase of qSOFA indicates the risk of developing into septic shock for the adult patients with sepsis caused by soft tissue infection. |
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