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《天津医科大学学报》[ISSN:1006-8147/CN:12-1259/R]

卷:

27卷

期数:

2021年02期

页码:

122-126

栏目:

临床医学

出版日期:

2021-03-15

文章信息/Info

Title:

Analysis of the predictive value of SIRS standard，qSOFA score and qPitt score on the risk of death in patients with bacterial bloodstream infection

文章编号:

1006-8147（2021）02-0122-05

作者:

张安然; 陈倩倩; 田彬; 李静; 胡志东

（天津医科大学总医院医学检验科，天津 300052）

Author(s):

ZHANG An-ran; CHEN Qian-Qian; TIAN Bin; LI Jing; HU Zhi-dong

（Department of Medical Laboratory，General Hospital，Tianjin Medical University，Tianjin 300052，China）

关键词:

SIRS标准;  qSOFA评分;  qPitt评分; 细菌性血流感染

Keywords:

SIRS standard; qSOFA score; qPitt score; bacterial bloodstream infection

分类号:

R446

DOI:

-

文献标志码:

A

摘要:

目的：比较全身炎症反应综合征（SIRS）标准、快速序贯器官衰竭（qSOFA）评分及快速皮塔菌血症（qPitt）评分对细菌性血流感染患者死亡风险的预测价值。方法：回顾性分析2018年1月—2020年9月天津医科大学总医院急诊医学科110例发生细菌性血流感染患者的病例资料，以血培养阳性作为血流感染的诊断依据，计算血流感染发生24 h内SIR标准、qPitt评分、qSOFA评分，以28 d内患者预后作为依据分为存活组（81例）及死亡组（29例），应用受试者工作特征（ROC）曲线下面积（AUC）评估不同评分系统对患者预后的预测价值，Logistic回归分析不同评分系统与血流感染患者死亡风险的关系，Pearson相关分析不同评价系统之间的相关性。结果： 死亡组SIRS标准、qSOFA评分、qPitt评分分别为（2.76±1.12）、（1.59±0.87）、（1.52±0.87），与存活组的差异具有统计学意义（均P＜0.05）； ROC曲线显示qSOFA评分对血流感染患者预后的预测价值最大（AUC=0.866），SIRS标准、qSOFA评分、qPitt评分的最佳截断值分别为3分、1分、1分；通过Logistic回归分析发现SIRS标准≥3（OR=3.673，95%CI:1.213～11.126）、qSOFA评分≥1（OR=5.864，95%CI：1.205～28.549）、qPitt评分≥1（OR=4.456，95%CI：1.035～19.190）与细菌性血流感染患者的死亡风险显著相关；Pearson相关分析显示qPitt评分与qSOFA评分相关性最好( r=0.835，P＜0.01）。结论：SIRS标准、qPitt评分和qSOFA评分均能有效地预测细菌性血流感染患者的死亡风险，其中qSOFA评分对患者预后的预测价值最大。

Abstract:

Objective: To compare the predictive value，systemic inflammatory response syndrome（SIRS） criteria，rapid sequential organ failure（qSOFA） score and rapid Pitataemia（qPitt） score on the risk of death in patients with bacterial bloodstream infection. Methods: Retrospective analysis was performed on the data of 110 patients with bacterial bloodstream infection in the Department of Emergency Medicine，General Hospital，Tianjin Medical University from January 2018 to September 2020. Diagnostic criteria were based on the blood culture positive for bloodstream infections，and bloodstream infections occurred within 24 h of SIR standard，qPitt score，and qSOFA score were calculated. The patients were divided into the survival group（81 cases） and the death group（29 cases） according to the prognosis within 28 days. The area under the receiver operating characteristic（ROC） curve（AUC） was used to evaluate the predictive value of different scoring systems for the prognosis of patients，Logistic regression was used to analyze the relationship between different scoring systems and the death risk of patients with bloodstream infection，and Pearson correlation was used to analyze the correlation between different evaluation systems. Results: SIRS standard，qSOFA score and qPitt score in the death group were（2.76±1.12），（1.59±0.87） and （1.52±0.87），respectively，the differences were statistically significant （all P < 0.05） compared with the survival group. The ROC curve showed that qSOFA score had the greatest predictive value for the prognosis of patients with bloodstream infection（AUC=0.866）. The optimal cut-off values of SIRS standard，qSOFA score and qPitt score were 3 scores，1 score and 1 score，respectively. Logistic regression found that SIRS standard ≥3（OR=3.673，95%CI：1.213-11.126），qSOFA score ≥1（OR=5.864，95%CI:1.205-28.549）and qPitt score≥1（OR=4.456，95%CI:1.035-19.190） were significantly correlated with the risk of death in patients with bacterial bloodstream infection. Pearson correlation analysis showed that qPitt score had the best correlation with qSOFA score（r=0.835，P < 0.01）. Conclusion: SIRS standard，qPitt score and qSOFA score can effectively predict the risk of death in patients with bacterial bloodstream infection，among which qSOFA score has the greatest predictive value for the prognosis of patients.

参考文献/References:

[1] Diego D R，Pasquale S，Sabina G，et al. Microbiologic characteristics and predictors of mortality in bloodstream infections in intensive care unit patients：a 1-year，large，prospective surveillance study in 5 Italian hospitals[J]. Am J Infect Control，2015，43（11）：1178
[2] Prusakowski M K，Chen A P. Pediatric Sepsis[J]. Emerg Med Clin North Am，2017，35（1）：123
[3] Zheng S H，Cao S J，Xu H，et al. Risk factors，outcomes and genotypes of carbapenem-nonsusceptible Klebsiella pneumoniae bloodstream infection：a three-year retrospective study in a large tertiary hospital in Northern China[J]. Infect Dis ，Lond，2018，50（6）：443
[4] 中华人民共和国卫生部. 医院感染诊断标准（试行）[J]．中华医学杂志，2001，81（5）：314
[5] Chen L，Yang X Y，Xu X M，et al. Evaluation of the effect of strengthening the management of carbapenem antibiotics[J]. Chin J Nosocomiol，2017，27（8）:1897
[6] Bone R C，Balk R A，Cerra F B，et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine[J] .Chest，1992， 101（6）：1644
[7] Battle S E，Augustine M R，Watson C M，et al. Derivation of a quick Pitt bacteremia score to predict mortality in patients with Gram-negative bloodstream infection[J]. Infection，2019，47（4）：571
[8] Seymour C W，Liu V X，Iwashyna T J，et al. Assessment of clinical criteria for sepsis：for the third international consensus definitions for sepsis and septic shock，sepsis-3[J] . JAMA，2016，315（8）：762
[9] Wallace M C，Macy D L. Reduction of central line-associated bloodstream infection rates in patients in the adult intensive care unit[J]. J Infus Nurs，2016，39（1）：47
[10] Chang H Y，Wei J，Zhou W Q，et al. Risk factors and mortality for patients with bloodstream infections of Klebsiella pneumoniae during 2014-2018：clinical impact of carbapenem resistance in a large tertiary hospital of China[J]. J Infect Public Health，2020，13（5）：784
[11] Kaukonen K M，Bailey M，Pilcher D，et al. Systemic inflammatory response syndrome criteria in defining severe sepsis[J] .N Engl J Med，2015，372（17）：1629
[12] 冒东林，耿永勇. 急性胃肠穿孔继发脓毒症的临床特征和预后影响因素评价[J]. 中外医疗，2018，37（19）:82
[13] Singer M，Deutschman C S，Seymour C W，et al. The third international consensus definitions for sepsis and septic shock，sepsis-3[J]. JAMA，2016，315（8）：801
[14] Bone R C，Balk R A，Cerra F B，et al. American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference：definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis[J]. Crit Care Med，1992，20（6）：864
[15] Chen Y X，Wang J Y，Guo S B. Use of CRB-65 and quick sepsis-related organ failure assessment to predict site of care and mortality in pneumonia patients in the emergency department：a retrospective study[J]. Crit Care，2016，20（1）：167
[16] Wang J Y，Chen Y X，Guo S B，et al. Predictive performance of quick sepsis-related organ failure assessment for mortality and ICU admission in patients with infection at the ED[J]. Am J Emerg Med，2016， 34（9）：1788

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备注/Memo

备注/Memo:

作者简介 张安然(1997-),女,硕士在读，研究方向：临床微生物；通信作者：胡志东,E-mail:huzhidong27@163.com。

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更新日期/Last Update: 2021-03-10