Evaluating the diagnostic performance of adult sepsis event criteria in the emergency department: impact of including isolated serum lactate elevations.

IF 4.7 2区 医学 Q1 CRITICAL CARE MEDICINE
Hyojun Park, Ryoung-Eun Ko, Hyo-Seok Oh, Jae Young Moon, Youjin Chang, Gee Young Suh
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引用次数: 0

Abstract

Background: The Adult Sepsis Event (ASE) criteria, developed by the US. Centers for Disease Control and Prevention (CDC), utilize electronic Sequential Organ Failure Assessment (eSOFA) scores derived from structured electronic health records to retrospectively detect organ dysfunction in patients with suspected sepsis. While validated primarily in inpatient cohorts, their applicability in emergency department (ED) populations remains uncertain. Moreover, the impact of including isolated serum lactate elevation as a marker of organ dysfunction in eSOFA has not been systematically evaluated.

Methods: We retrospectively reviewed data from 698 patients (aged ≥ 19 years) with suspected infections presenting to the EDs of three institutions from September 1 to 30, 2023. Blood cultures were obtained from all patients. Patients were classified according to Sepsis-3 (≥ 2-point SOFA score increase from baseline) and ASE-defined eSOFA (organ dysfunction occurring within ± 2 days of blood culture collection). Extended eSOFA additionally included isolated lactate elevation (≥ 2.0 mmol/L). Diagnostic performance was assessed using sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV).

Results: Among 698 patients, 456 (65.3%) met Sepsis-3 criteria, 251 (35.9%) met ASE-defined eSOFA, and 340 (48.7%) met extended eSOFA criteria. Mortality was highest (19.8%) among patients classified by both SOFA and eSOFA. ASE-defined eSOFA demonstrated moderate sensitivity (52.0%) and high specificity (94.2%), with a PPV of 94.4%. Extended eSOFA improved sensitivity (64.3%) but lowered specificity (80.6%). Mortality increased with the number of dysfunctional organ categories. Notably, the inclusion of isolated lactate elevations identified additional high-risk patients not captured by eSOFA.

Conclusion: ASE-defined eSOFA moderately aligns with Sepsis-3 criteria, effectively identifying high-risk ED sepsis cases. Extended eSOFA criteria with lactate enhance sensitivity but reduce specificity, suggesting tailored application based on clinical settings and available resources.

评估急诊成人脓毒症事件标准的诊断性能:包括分离血清乳酸升高的影响
背景:成人脓毒症事件(ASE)标准,由美国制定。疾病控制和预防中心(CDC)利用结构化电子健康记录的电子顺序器官衰竭评估(eSOFA)评分来回顾性检测疑似败血症患者的器官功能障碍。虽然主要在住院患者队列中验证,但它们在急诊科(ED)人群中的适用性仍不确定。此外,在eSOFA中纳入分离血清乳酸升高作为器官功能障碍标志物的影响尚未得到系统评估。方法:我们回顾性分析了2023年9月1日至30日在三家机构急诊科就诊的698例疑似感染患者(年龄≥19岁)的数据。所有患者均进行血培养。根据脓毒症-3 (SOFA评分较基线增加≥2分)和ase定义的eSOFA(血培养收集后±2天内发生器官功能障碍)对患者进行分类。扩展eSOFA还包括分离乳酸升高(≥2.0 mmol/L)。采用敏感性、特异性、阳性预测值(PPV)和阴性预测值(NPV)评估诊断效果。结果:698例患者中,456例(65.3%)符合脓毒症-3标准,251例(35.9%)符合ase定义的eSOFA标准,340例(48.7%)符合扩展eSOFA标准。SOFA和eSOFA分类的患者死亡率最高(19.8%)。ase定义的eSOFA具有中等敏感性(52.0%)和高特异性(94.2%),PPV为94.4%。扩展eSOFA提高了敏感性(64.3%),但降低了特异性(80.6%)。死亡率随着功能障碍器官种类的增加而增加。值得注意的是,纳入孤立的乳酸升高确定了eSOFA未捕获的额外高危患者。结论:ase定义的eSOFA中度符合脓毒症-3标准,有效识别ED脓毒症高危病例。乳酸盐的eSOFA扩展标准提高了敏感性,但降低了特异性,建议根据临床环境和可用资源定制应用。
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来源期刊
Journal of Intensive Care
Journal of Intensive Care Medicine-Critical Care and Intensive Care Medicine
CiteScore
11.90
自引率
1.40%
发文量
51
审稿时长
15 weeks
期刊介绍: "Journal of Intensive Care" is an open access journal dedicated to the comprehensive coverage of intensive care medicine, providing a platform for the latest research and clinical insights in this critical field. The journal covers a wide range of topics, including intensive and critical care, trauma and surgical intensive care, pediatric intensive care, acute and emergency medicine, perioperative medicine, resuscitation, infection control, and organ dysfunction. Recognizing the importance of cultural diversity in healthcare practices, "Journal of Intensive Care" also encourages submissions that explore and discuss the cultural aspects of intensive care, aiming to promote a more inclusive and culturally sensitive approach to patient care. By fostering a global exchange of knowledge and expertise, the journal contributes to the continuous improvement of intensive care practices worldwide.
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