Evaluation Of Early Diagnosis And Prognosis Of Patients With Sepsis In ICU By Different Diagnostic Criteria

Objective:To evaluate the value of SIRS,SOFA,qSOFA scores in diagnosis and prognosis of sepsis in ICU patientsMethod:A total of 892 patients admitted to the First Affiliated hospital of Soochow University ICU department from Sep 2014 to Sep 2016 were eligible for inclusion in this retrospective study.627 patients included in this study were excluded from patients with incomplete history or hospitalization less than 24 hours.The SIRS,SOFA,and qSOFA scores were compared between the infected group and the non-infected group.The criteria for sepsis refer to the definition of ICD-9-CM coding.Evaluation of SIRS,SOFA,qSOFA in the diagnosis and prognosis of patients with sepsis by using the receiver characteristic curve(ROC curve),and calculate the area under the curve(AUC),sensitivity,specificity,positive predictive value,negative predictive value,the optimal cut-off value and confidence interval.Result:498(79.5%)patients who were infected or suspected of infection within 24 hours were divided into infected group and the remaining 129(20.5%)were non-infected group.The PCT level,SIRS,SOFA and qSOFA scores in the infected group were significantly higher than those in the non-infected group(P <0.05);Among ICU encounters in the infection group(n = 498),the predictive validity for diagnosis of sepsis was higher for SOFA(AUC 0.770 [95% CI0.705-0.826])than SIRS(AUC 0.628 [95% CI 0.557-0.695])and qSOFA(AUC 0.657 [95% CI 0.586-0.722])(P < 0.05 for both);The predictive validity for prognosis of sepsis was higher for SOFA(AUC 0.748 [95% CI 0.682-0.807])than SIRS(AUC 0.647 [95% CI 0.576-0.713])and qSOFA(AUC 0.667 [95% CI 0.603-0.737])(P < 0.05 for both);The cut-off value of the ROC curve in this study suggests that infected patients with SIRS ? 3 and SOFA ? 6 had a more accurate sensitivity and specificity for the diagnosis and prognosis of sepsis compared to those with SIRS ? 2(Sepsis 1.0)and SOFA ? 2(Sepsis 3.0).Conclusions:Among ICU encounters with suspected infection,the predictive validity for diagnosis and prognosis of SOFA was statistically greater than the SIRS and qSOFA,supporting sepsis3.0 is more suitable as a clinical criteria for sepsis.Relative to SOFA?2 and SIRS?2,encounters with SOFA ?3 and SIRS?6 are more accurate for predicting diagnosis and prognosis of sepsis.