Diagnostic Value Of SOFA,?SOFA And QSOFA Scale In The Elderly Patients With Sepsis

Objective: Sepsis has high morbidity and high mortality in critically ill patients.Multiple critical illness assessment scales are used to diagnose and assess their prognosis.It is not known whether the elderly critically ill patients are still fully applicable due to their special physiological functions.The purpose of this study was to investigate the diagnostic and prognostic value of SOFA,?SOFA and qSOFA in elderly sepsis patients.Methods:A retrospective analysis of 164 elderly patients with infection in the First Affiliated Hospital of Nanjing Medical University from January 2016 to January 2018 was reviewed.The clinical data of the patients were collected,and the patients were evaluated by SOFA,?SOFA and qSOFA score in 24 h after admission?112 cases of senile sepsis were diagnosed and 52 cases of non septic elderly infected patients?Senile sepsis were divided into the survival group and the death group according to the clinical outcome of 28 days.The general data,the SOFA,?SOFA and the qSOFA score of the two groups were compared,and the differences in the single factor analysis were compared.Multivariate logistic regression analysis was performed with statistically significant variables;based on whether patients were diagnosed with sepsis,the SOFA,?SOFA and qSOFA score were drawn(ROC)to evaluate their diagnostic value for the elderly patients with sepsis;According to the different truncation values of the ? SOFA and qSOFA score,the sensitivity,specificity,positive predictive value and negative predictive value of the diagnosis of sepsis were determined,and the specific truncation values of?SOFA and qSOFA score for the rapid diagnosis of the elderly patients with sepsis were discussed.Aaccording to the clinical outcome of 28 days,the SOFA,?SOFA and qSOFA score of the subjects' working characteristic curve(ROC)was drawn to evaluate the predictive value of the prognosis in the elderly patients with sepsis.Results: 1.single factor analysis showed that the age,number of complications,GCS,APACHE II,SOFA,?SOFA,qSOFA score and death group were statistically significant in the elderly patients with sepsis(P <0.05),and the death group was higher than the survival group.Multi factor Logistic regression analysis showed that the elderly(OR= 3.205,95%CI = 1.967~ 15.378,P = 0),high APACHE II(OR = 4.235,95%CI = 4.325~ 32.623,P = 0.007),high SOFA(OR = 3.393,95%CI = 2.265~ 20.121,P = 0.012),high?SOFA(OR=4.158,95%CI=4.286~33.526,P=0.008),highqSOFA score(OR = 1.837,95%CI = 1.940~12.762,P = 0.020)are independent risk factors for the prognosis of sepsis in the elderly.2.The scores of SOFA,?SOFA and qSOFA scoring systems were statistically significant in the elderly sepsis and non septic groups(P<0.05);The ROC curve analysis showed that the SOFA(AUC=0.866,95%CI =0.724~0.886),?SOFA(AUC=0.861,95%CI=0.789~0.934)and qSOFA(AUC=0.805,95%CI =0.792~0.939)scoring system were all able to diagnose the elderly patients with sepsis.The?SOFA and qSOFA score of senile sepsis group were significanthigher than that of non sepsis group,The area under the curve(AUC)of ?SOFA score in elderly sepsis patients was 0.861(95%CI = 0.789~0.934).qSOFA score was 0.805(95%CI =0.792~0.939)in elderly patients with sepsis.When the value of?SOFA score was 1,the sensitivity was 99.11%,the specificity was 48.08%,the positive predictive value was 80.43%,the negative predictive value was 96.15%.When the?SOFA score was 2,the sensitivity was 98.21%,the specificity was 76.92%,the positive predictive value was 90.16%,the negative predictive value was 95.23%;when the ?SOFA score was 3,the sensitivity was 62.50%,the specificity was78.85%,the positive predictive value was 86.42%,the negative predictive value was 49.40%.When the?SOFA score was 4,the sensitivity was 21.43% and the specificity was 98.08%,the positive predictive value was 96.00% and the negative predictive value was 36.69%.When the value of qSOFA score was 1,the sensitivity of the early screening for sepsis was 94.64%,the specificity was 69.23%,the positive predictive value was 86.89%,the negative predictive value was 85.71%.When the value of the qSOFA score was 2,the sensitivity of the screening was 62.50%,the specificity was 73.07%,and the positive predictive value was 83.33%,The negative predictive value was 47.5%;when the value of qSOFA score was 3,the sensitivity of the screening for the senile sepsis was 21.43%,the specificity was 96.15%,the positive predictive value was 92.31%,and the negative predictive value was 36.23%.The diagnostic efficacy of theSOFA score was 89.29%,the specificity was 73.08%,the positive predictive value was 87.72%,the negative predictive value was 76%.The diagnostic efficacy of the?SOFA score was 98.21%,the specificity was 76.92%,the positive predictive value was 90.16%,the negative predictive value was 95.23%.The diagnostic efficacy of the qSOFA score was 62.50%,the specificity was 73.07%,the positive predictive value was 83.33%,and the negative predictive value was 47.5%.3.ROC curve analysis based on the 28 day clinical outcome of patients showed that SOFA,?SOFA and qSOFA scores could predict the prognosis of senile sepsis,of which the predictive efficacy of SOFA score was the strongest,the area under the ROC curve(AUC)was 0.739,the truncated value was 6.5 and the sensitivity was 87.1%,and the specificity was 52%.Conclusion: The diagnostic criteria for Sepsis 3 are also applicable to the elderly;SOFA > 4,SOFA 2 or qSOFA 1 can diagnose sepsis in the elderly,and the diagnostic efficiency of SOFA is more than 2 points,and qSOFA is more than 1;Prognosis,SOFA,SOFA and qSOFA scores can predict the prognosis of sepsis patients,but SOFA has the greatest predictive value.