Hızlı Sofa skorunun plazma laktat konsantrasyonu ile birlikte kullanımı acil serviste enfeksiyon hastalarındaki mortaliteyi öngörebilir mi?

Year 2019, , 10 - 13, 15.03.2019

Mustafa Korkut , Cihan Bedel

https://doi.org/10.25000/acem.468057

Cited By: 1

Abstract

Amaç: Hızlı SOFA skorunun plazma laktat düzeyi ile
birlikte kullanımının hastane içi mortaliteyi öngörmedeki rolü ile ilgili çok
az çalışma vardır. Bu çalışmamızın amacı plazma laktat düzeyi ile kombine
bir hızlı SOFA skorunun, acil serviste enfeksiyonlu hastalarda hastane içi
mortalite için ilişkili olup olmadığını araştırmaktı.

Yöntemler: Mayıs 2017- Mart 2018 tarihleri arasında acil servise başvuran
60 hastanın qSOFA ve plazma laktat ölçümleri prospektif olarak toplandı.
Olguların qSOFA skorunun tek başına ve laktat ile birlikte kullanımının
mortaliteyi öngörmedeki analizi yapıldı.

Bulgular: On üç hasta (%21,6) hastaneye yatış süresinde öldü.
Laktat ölçümü ile kombine edilmiş qSOFA, qSOFA skoru tek başına kullanımına
göre daha başarılı bulunmuştur (sırasıyla AUC = 0,798 ve 0,885, sırasıyla
p<0,001). qSOFA için tek başına duyarlılık ve özgüllük %92 ve %54 iken,
laktat  ile kombine edilmesiyle sırasıyla %100 ve %43 olduğu saptandı
(p<0,001).

Sonuç: qSOFA'nın laktat ile kombine edilmesi,
qSOFA’nın tek başına kullanılmasına göre mortalite üzerinde daha yüksek
hassasiyete sahiptir.

Keywords

qSOFA, laktat, mortalite

Can the quick Sequential Organ Failure Assessment (qSOFA) score, combined with plasma lactate concentration, predict the mortality for patients with infections in the emergency department?

Abstract

Aim: Few studies have looked at the predictive role
of plasma lactate measure combined with the score of quick sequential
organ failure assessment (qSOFA) on hospital mortality. The aim of the study
was to investigate whether the score of qSOFA combined with
plasma lactate is independently associated with in-hospital mortality
among patients with infections in the emergency department (ED).

Methods: Scores of qSOFA and plasma lactate measurements of 60
patients in ED were collected prospectively from May 2017 to March 2018. We
used the area under receiver operating characteristic curve (AUC) and
sensitivity analysis to compare the applicability of qSOFA score alone and
qSOFA score combined with lactate level for patient mortality.

Results:
Thirteen patients (21.6%) died in
the hospitalization period. According to the qSOFA alone, qSOFA score combined
with lactate measurement was more successful (AUC = 0.798 vs. 0.885 p<0.001,
respectively). When qSOFA was used alone, sensitivity and specificity were 92%
and 54%, otherwise those of the combined with lactate measurement were 100% and
43%, respectively (p<0.001).

Conclusion: Combining the qSOFA with
lactate has higher sensitivity for patient mortality than that seen with qSOFA
alone.

Keywords

qSOFA, lactate, mortality

References

• 1. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock. JAMA. 2016;315:801-10.
• 2. Seymour CW, Liu VX, Iwashyna TJ, Brunkhorst FM, Rea TD, Scherag A, et al. Assessment of clinical criteria for sepsis: for the Third International Consensus Definitions for Sepsis and Septic Shock. JAMA. 2016;315:762-74.
• 3. Casserly B, Phillips GS, Schorr C, Dellinger RP, Townsend SR, Osborn TM, et al. Lactate measurements in sepsis-induced tissue hypoperfusion: results from the Surviving Sepsis Campaign database. Crit Care Med. 2015;43:567-73.
• 4. Mikkelsen ME, Miltiades AN, Gaieski DF, Goyal M, Fuchs BD, Shah CV, et al. Serum lactate is associated with mortality in severe sepsis independent of organ failure and shock. Crit Care Med. 2009;37:1670-7.
• 5. Del Portal DA, Shofer F, Mikkelsen ME, Dorsey Jr PJ, Gaieski DF, Goyal M, et al. Emergency department lactate is associated with mortality in older adults admitted with and without infections. Acad Emerg Med. 2010;17:260-8.
• 6. Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Crit Care Med. 2007;44:27-72.
• 7. Sartelli M, Kluger Y, Ansaloni L, Hardcastle TC, Rello J, Watkins RR, et al. Raising concerns about the Sepsis-3 definitions. World J Emerg Surg. 2018;13:6.
• 8. Williams JM, Greenslade JH, McKenzie JV, Chu K, Brown AF, Lipman J. Systemic inflammatory response syndrome, quick sequential organ function assessment, and organ dysfunction: insights from a prospective database of ED patients with infection. Chest. 2017;151:586-96.
• 9. Dorsett M, Kroll M, Smith CS, Asaro P, Liang SY, Moy HP. qSOFA has poor sensitivity for prehospital identification of severe sepsis and septic shock. Prehosp Emerg Care. 2017;21:489-97.
• 10. Shapiro NI, Wolfe RE, Moore RB, Smith E, Burdick E, Bates DW. Mortality in Emergency Department Sepsis (MEDS) score: a prospectively derived and validated clinical prediction rule. Crit Care Med. 2003;31:670-5.
• 11. Singer AJ, Ng J, Thode Jr HC, Spiegel R, Weingart S. Quick SOFA scores predict mortality in adult emergency department patients with and without suspected infection. Ann Emerg Med. 2017;69:475-9.
• 12. Chebl RB, El Khuri C, Shami A, Rajha E, Faris N, Bachir R, et al. Serum lactate is an independent predictor of hospital mortality in critically ill patients in the emergency department: a retrospective study. Scand J Trauma Resusc Emerg Med. 2017;25:69.
• 13. Lokhandwala S, Andersen LW, Nair S, Patel P, Cocchi MN, Donnino MW. Absolute lactate value vs relative reduction as a predictor of mortality in severe sepsis and septic shock. J Crit Care. 2017;37:179-84.
• 14. Shapiro NI, Fisher C, Donnino M, Cataldo L, Tang A, Trzeciak S, et al. The feasibility and accuracy of point-of-care lactate measurement in emergency department patients with suspected infection. J Emerg Med. 2010;39:89-94.