The Values Of SOFA Score,qSOFA Score And SIRS Criteria In Predicting The Prognosis Of Adult Patients With Infection

ObjectiveTo investigate the clinical value of SOFA score,q SOFA score and SIRS in predicting the prognosis of infection in the emergency department.MethodsA retrospective study was conducted to select the adult patients who were admitted to the emergency outpatient department of the hospital from January 2015 to April 2017(age >18).All the patients in the emergency room visits recorded when its name,gender,age,vital signs,past medical history,routine blood,arterial blood gas and liver and kidney function,CRP and PCT,the BNP and other biomarkers,diagnosis and judgment of the infection.After admission,follow-up was carried out,with a clear record of infection,and SOFA score,q SOFA score,and SIRS score for patients in 24 h.The prognosis of patients included improvement,ICU treatment and 30 days of death.The outcome measures were recorded in patients with 30 days of death or in the treatment of ICU,and the outcome of the patients was recorded and the validity of each score was tested.The gender,age,mortality rate,SOFA score,q SOFA score,SIRS score,laboratory test results,infection range,basic disease distribution and prognosis were analyzed.The above parameters were compared and analyzed respectively.To draw the area(AUROC)under the working characteristic curve of each score,and to compare the mortality rate and the predictive ability of ICU treatment.ResultsA total of 487 patients were enrolled in this study,including 263 males and 224 females,aged 18 to 93 years.Among them,there were 380 patients who were discharged from the discharge group(group 0).There were 83 cases in the ICU treatment group(1 group),and 24 cases in the death group(2 groups).The proportion of males in group 1 was significantly higher than that in group 0,and the age of group 2 was significantly higher than that of group 0(P<0.05).There was no significant difference in age between the 0 groups and the 1 groups,and there was no difference in the male ratio between the 2 groups.The parameters of q SOFA and SIRS score were analyzed,all parameters were significantly different between group 1 and group 0.Between group 2 and group 0,only systolic blood pressure and unconscious change were different.In the analysis of biomarkers,between the 1 groups and the 0 groups,except for the 3 items of platelet,total bilirubin and CRP,the other 1 groups were significantly higher than the 0 groups.The 2 and 0 groups were only different from the arterial blood lactate and brain natriuretic peptide.Lower respiratory tract infection is the most common lesion.There were more than 0 groups of urinary tract infection in the 1 groups(P<0.05).There was no difference in infection rates between group 2 and group 0.One group of chronic lung disease,chronic kidney disease and congestive heart failure were significantly more than in group 0(P<0.05).In the two groups,chronic kidney disease,congestive heart failure and paralysis were significantly more than 0 group(P<0.05).Between group 0 and group 1,SOFA score,q SOFA score,SIRS standard and q SOFA-WBC score were compared,and the differences were statistically significant(P<0.05).In addition to the SIRS standard,SOFA score,q SOFA score and q SOFA-WBC score were compared between group 0 and group 2,and the differences were statistically significant(P<0.05).The AUROC from high to low in the hospital mortality rate was SOFA,q SOFA-WBC,q SOFA,SIRS.SOFA score was the best predictor of inpatient mortality(AUROC,0.922)higher than q SOFA-WBC(AUROC 0.797),q SOFA (AUROC 0.764),and SIRS(AUROC 0.608).QSOFA and q SOFA-WBC had no difference(P>0.05),which was superior to the SIRS score(P<0.05).SOFA score is superior to other ratings(AUROC 0.900)for the need for ICU treatment(q SOFA-WBC: AUROC 0.772,q SOFA: AUROC 0.771,SIRS: AUROC 0.65).SOFA scores was better than other scores in predicting overall results(in-patient mortality or requiring ICU treatment).QSOFA score and q SOFA-WBC score were second only to SOFA scores in predicting the prognosis,and there was no difference in the overall accuracy of prognostic prediction(P >0.05),which was superior to the SIRS standard(P<0.05).Compared with the SIRS standard,patients who scored >1 had a higher specificity of q SOFA score(94.47%),but the sensitivity was lower(44.86%).Although the SIRS standard has a higher sensitivity(77.57%),the specificity is lower(42.63%).When we add white blood cells(< 4 * 109 / L or > 10 * 109 / L)after the condition,compared with q SOFA score,score > 1 patients,q SOFA-the WBC VS44.86 %(73.83%)had higher sensitivity,higher negative predictive value(90.7% VS85.8 %),specificity is higher than the SIRS criteria VS42.63 %(71.84%),lower than q SOFA score(VS94.47%71.84%).QSOFA-WBC is good for low risk prediction.Among all patients with a score of 0 in q SOFA-WBC,only 6 cases(negative predictive value 94.2%)were the result of death or requiring ICU treatment.Conclusion:1.In predicting in-hospital mortality and or requiring ICU treatment,SOFA scores had the best predictive power,better than q SOFA-WBC scores,q SOFA scores,and SIRS criteria.There was no difference between q SOFA and q SOFA-WBC,which were all better than SIRS standard(P<0.05).2.When we added the condition of leukocyte abnormality(<4*109/L or >10*109/L),compared with the q SOFA score,q SOFA-WBC had higher sensitivity(73.83%VS44.86%)and higher negative predictive value(90.7%VS85.8%)than the qSOFA score.The specificity was higher than the SIRS standard(71.84% VS42.63%),which was lower than the q SOFA score(71.84%VS94)..47%).3.qSOFA-WBC is a good predictor of low risk.In all patients with q SOFA-WBC score of 0,the final outcome is death or ICU treatment,and only 6 cases(negative predictive value 94.2%).