| Objective:To explore the value of Sepsis 3.0 criteria in the diagnosis and prediction of 28-day mortality in patients with sepsis.Methods:From September 2017 to October.2018,patients who were infected or suspected of infection in intensive care unit(ICU)of five hospitals such as Jiangsu Subei People's Hospital,Yangzhou Chinese Medicine Hospital,Jiangdu People's Hospital,Gaoyou People's Hospital,Baoying People's Hospital were selected.The enrolled patients were divided into four groups:A,B,C,and D:Group A was in accordance with Sepsis 1.0 and Sepsis 3.0,Group B only met the Sepsis 1.0 standard,Group C only met the Sepsis 3.0 standard,and Group D was Sepsis 1.Both 0 and the Sepsis 3.0 standard do not match.Record age,gender,underlying disease,diagnosis and source of infection,vital signs within 24 hours of ICU,SIRS(Systemic Inflammatory Response Syndrome)score,SOFA(Sequential Organ Failure Assessment)score,APACHE(Acute Physiology and Chronic Health Evaluation)? score,The clinical data of qSOFA(quick Sequential Organ Failure Assessment)score,ICU hospitalization time,total hospitalization time,28-day mortality rate,etc.,the above collected data were compared and analyzed in groups,and the receiver operating characteristic curves of each scoring standard were drawn and calculated.The area under the curve(AUROC),using the Yoden index to identify the SOFA score,qSOFA score,SIRS score to predict the optimal cut-off value of 28-day mortality in patients with sepsis and its corresponding sensitivity and specificity.Result:A total of 527 patients with infection or suspected infection were enrolled in the study,including 324 patients in group A,113 patients in group B,22 patients in group C,68 patients in group D,and 28 patients in four groups.The mortality rates were 38.9%,17.7%,31.8%,and 11.6%,respectively.The difference between the groups was statistically significant(P<0.05).The SIRS scores of the four groups were[3.0(1.0),2.0(1.0),1.0(0.0),1.0(1.0),P<0.01],and the APACHE ? scores were[17.0(10.0),11.0(10.0),15.0,respectively.(8.0),12.0(8.0),P<0.01],qSOFA score[2.0(1.0),1.0(1.0),1.0(1.0),1.0(2.0),P<0.01],SOFA score[8.0(6.0),1.0(0.0),7.0(4.0),1.0(0.0),P<0.01]The difference between the four groups was statistically significant.Kaplan-Meier survival analysis:There was a statistically significant difference in 28-day survival rates among the four groups of sepsis patients with A,B,C,and D(X2=22.4,p<0.01).Univariate analysis of variables affecting 28-day mortality in patients with sepsis,and statistically significant differences between the two groups by logistic stepwise regression analysis showed that males(OR 2.34,95%CI:1.30-4.21,P=0.01),APACHE ? score(OR1.92,95%CI:1.88-1.96,P=0.01),SOFA score(OR 2.34,95%CI:1.60-3.08,P<0.01),total hospital stay(OR 1.05,95%CI:1.03-1.08,P<0.01),cardiac insuficiency(OR 1.42,95%CI:1.07-1.90,P=0.02)is an independent risk factor for increasing 28-day mortality in patients with sepsis.Three values of SIRS score,SOFA score and qSOFA score were evaluated by AUROC to predict the value of 28-day mortality.The results showed that SOFA was superior to qSOFA score and SIRS score,and AUROC was:(0.71(0.66-0.76)),0.59(0.54-0.64)and 0.57(0.52-0.62),P<0.01.According to the Yoden index,the best cut-off values for the 28-day mortality rate of SIRS scores,SOFA scores,and qSOFA scores for pre-sick sepsis were 2,7 and 2 points,respectively,and the sensitivity was 53.6%,69.4,respectively.%,60.1%;specificity:51.1%,61.8%,76.2%.Conclusion:The Sepsis 3.0 standard may be superior to the sepsis 1.0 standard in the diagnosis and prediction of 28-day mortality in patients with sepsis.The Sepsis 1.0 standard may cause overdiagnosis and miss a portion of patients with severe sepsis.qSOFA is a tool for rapid screening of high-risk sepsis patients at the bedside of the ICU and may be superior to the SIRS score.Male,APACHE ? score,SOFA score,total hospital stay,cardiac insufficiency were closely related to 28-day mortality in patients with sepsis. |
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