Prognostic value of SOFA, SIRS, qSOFA score and lactate level in pediatric sepsis
WU Yunduo1,2 LIN Xiaofei2 GU Xiaohai2 ZHANG Jun2 LYU Yanguan2 WANG Jun1
1.Department of Pediatrics, the Affiliated Hospital of Xuzhou Medical University, Jiangsu Province, Xuzhou 221002, China;
2.Department of Pediatrics, Huai′an College of Women and Children Clinical Medicine Affiliated to Xuzhou Medical University, Jiangsu Province, Huai′an 223002, China
Abstract：Objective To investigate the prognostic value of sequential organ failure assessment (SOFA), systemic inflammatory response syndrome (SIRS) score, quick sequential organ failure assessment (qSOFA) score and lactate level in pediatric sepsis. Methods A total of 259 pediatric patients with Sepsis-3 diagnosis in general and intensive care units of Huai′an Maternal and Child Health Hospital of Jiangsu Province from January 2016 to December 2018 were retrospectively analyzed. They were divided into survival group (241 cases) and death group (18 cases) according to the prognosis. Receiver operating characteristic curve (ROC) was used to assessed the predictive value of lactate level, SOFA within 24 h and SIRS and qSOFA for prognosis of patients. Results Lactate level, SIRS, SOFA and qSOFA scores in death group were higher than those in survival group, and the differences were all highly statistically significant (all P < 0.01). The cut-off value for the death of sepsis by SOFA score was 7.5 points, the sensitivity was 68.8%, and the specificity was 80.0% respectively. The cut-off value for the death of sepsis by qSOFA score was 1.5 points, the sensitivity was 68.8%, and the specificity was 80.0%. The cut-off value for the death of sepsis by lactate value was 1.75 mmol/L, the sensitivity was 93.8%, and the specificity was 40.0%. Conclusion Compared with SIRS score, SOFA and qSOFA scores have better prognostic accuracy in predicting the prognosis of children with sepsis. Although lactate level has good sensitivity and is a reliable indicator for the prognosis of children with sepsis, but its specificity is low.
[1] Singer M，Deutschman CS，Seymour CW，et al. The third international consensus definitions for sepsis and septic shock（Sepsis-3）[J]. JAMA，2016，315（8）：801-810.
[2] Schlapbach LJ. Time for Sepsis-3 in children? [J]. Pediatr Crit Care Med，2017，18（8）：805-806.
[3] Schlapbach LJ，Kisson N. Pediatric sepsis definitions-an urgent need for change [J]. JAMA Pediatr，2018，20181（172）：4.
[4] Seymour CW，Liu VX，Iwashyna TJ，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）：762-774.
[5] Raith EP，Udy AA，Bailey M，et al. Prognostic accuracy of the SOFA score，SIRS criteria，and qSOFA score for in-hospital mortality among adults with suspected infection admitted to the intensive care unit [J]. JAMA，2017，317（3）：290-300.
[6] Wang JY，Chen YX，Guo SB，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）：1788-1793.
[7] Freund Y，Lemachatti N，Krastinova E，et al. Prognostic accuracy of Sepsis-3 criteria for in-hospital mortality among patients with suspected infection presenting to the emergency department [J]. JAMA，2017，317（3）：301-308.
[8] Vincent JL，Moreno R，Takala J，et al. The SOFA（Sepsis-related Organ Failure Assessment）score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine [J]. Intensive Care Med，1996，22（7）：707-710.
[9] Dorsett M，Kroll M，Smith CS，et al. qSOFA Has Poor Sensitivity for Prehospital Identification of Severe Sepsis and Septic Shock [J]. Prehosp Emerg Care. 2017，21（4）：489-497.
[10] Arvaniti V, D′Amico G, Fede G, et al. Infections in patients with cirrhosis increase mortality four-fold and should be used in determining prognosis [J]. Gastroenterology，2010，139（4）：1246-1256.e12565.
[11] Angus DC，Seymour CW，Coopersmith CM，et al. A Framework for the Development and Interpretation of Different Sepsis Definitions and Clinical Criteria [J]. Crit Care Med，2016，44（3）：e113-e121.
[12] Simpson SQ. New Sepsis Criteria：A Change We Should Not Make [J]. Chest，2016，149（5）：1117-1118.
[13] Matics TJ，Sanchez-Pinto LN. Adaptation and Validation of a Pediatric Sequential Organ Failure Assessment Score and Evaluation of the Sepsis-3 Definitions in Critically Ill Children [J]. JAMA Pediatr，2017，171（10）：e172352.
[14] Ha EJ，Kim S，Jin HS，et al. Early changes in SOFA score as a prognostic factor in pediatric oncology patients requiring mechanical ventilatory support [J]. J Pediatr Hematol Oncol，2010，32（8）：e308-e313.
[15] Jhang WK，Kim YA，Ha EJ，et al. Extrarenal sequential organ failure assessment score as an outcome predictor of critically ill children on continuous renal replacement therapy [J]. Pediatr Nephrol，2014，29（6）：1089-1095.
[16] Scott HF，Brou L，Deakyne SJ，et al. Association between early lactate levels and 30-day mortality in clinically suspected sepsis in children. [J]. JAMA Pediatr，2017， 171（3）：249-255.
[17] Schlapbach LJ，MacLaren G，Straney L. Venous vs arterial lactate and 30-day mortality in pediatric sepsis [J]. JAMA Pediatr，2017，171（8）：813.
[18] Tavaré A，O′Flynn N. Recognition，diagnosis，and early management of sepsis：NICE guideline [J]. Br J Gen Pract，2017，67（657）：185-186.
[19] Shetty A，MacDonald SP，Williams JM，et al. Lactate ≥2 mmol/L plus qSOFA improves utility over qSOFA alone in emergency department patients presenting with suspected sepsis [J]. Emerg Med Australas，2017，29（6）：626-634.
[20] 李玖军，邹凝，潘佳丽.儿童脓毒症诊断标准及鉴别诊断[J].中国中西医结合儿科学，2015，7（4）：289-292.
[21] Schlapbach LJ，MacLaren G，Festa M，et al. Prediction of pediatric sepsis mortality within 1 h of intensive care admission [J]. Intensive Care Med，2017，43（8）：1085-1096.
[22] Ceneviva G，Paschall JA，Maffei F，et al. Hemodynamic support in fluid-refractory pediatric septic shock [J]. Pediatrics，1998，102（2）：e19.
[23] Barea-Mendoza JA，Cortés-Puch I，Chico-Fernández M. Conflicts of interest in the new consensus based definition of sepsis and septic shock（sepsis-3）[J]. Med Intensiva，2017，41（1）：60-61.
2020, Vol. 17 
京公网安备 11010502046598号