The Significance Of QSOFA Combined With Special Inflammatory Factors In Emergency Diagnosis And Prognosis Of Sepsis

Objective:At present,no guidelines in our country or the world have clearly recommended indicators for the early diagnosis of sepsis in the emergency department.simple and unified joint diagnostic criteriais also scarce.Therefore,this study was designed to compare the rapid sequential organ failure score(qSOFA score)and levels of inflammatory factors among the patients with normal infection,sepsis,and sepsis shock.So that we can obtain reasonable combination of indicators for the early diagnosis,risk stratification,and prognosis evaluation of sepsis in the emergency department.Methods:A total of 79 patients with sepsis in the emergency department of Shenzhen People’s Hospital from December 2020 to June 2021 were enrolled,and 79 patients with common infection(non sepsis)were matched by age and sex in the same period.Then,sepsis patients were divided into different subgroups:(1)septic shock group(n=20)and septic non-shock group(n=59),and(2)septic survival group(n=67)and septic death group(n=12).The levels of tumor necrosis factor(TNF)-α,interleukin(IL)–1β,IL-6,IL-8,IL-10,procalcitonin(PCT),high-sensitivity C-reactive protein(HSCRP)in peripheral blood were detected in all subjects.SPSS13.0 software was used to analyze the data.T-test was used for the differences between the groups of measurement data conforming to normal distribution,and rank sum test was for the differences between the groups with non-normal distribution.X~2 test was used to compare the differences of count data between the two groups.Logistic regression was used to determine independent risk factors for sepsis/septic shock/death within 28 days.Receiver operating characteristic curve(ROC)was generated to assess the diagnostic efficacy,risk stratification and prognostic evaluation of qSOFA and inflammatory factors for sepsis.Linear correlation analysis was performed to evaluate the linear relationship between two variables.Results:1.Compared with patients with common infection,the levels of qSOFA score,TNF-a,IL-6,IL-8,HSCRP and PCT in patients with sepsis were significantly higher(all P<0.05).IL-6,IL-8,IL-10and PCT were positively correlated with qSOFA score(P=0.001,0.000,0.015 and 0.010,respectively).The logistic analysis revealed that PCT and qSOFA were independent risk factors for predicting sepsis in the emergency department.qSOFA score,TNF-a,IL-6,IL-8,PCT and HSCRP can be used for sepsis screening.The AUC value(0.819)of PCT was the largest in all the indicators,wih the cut-off value of 0.775ng/ml,and the sensitivity and specificity were 0.785 and0.709 respectively.Furthermore,the AUC value(0.842)of qSOFA combined PCT was the largest in the combination of two indicators,with the sensitivity of 0.722 and specificity of 0.848.2.Compared with septic non-shock patients,the levels of qSOFA,SOFA,APACHE II score,TNF-a,IL-6,IL-8,IL-10 and PCT were significantly higher in patients with septic shock(all P<0.05).The logistic analysis revealed that TNF-a and qSOFA were both independent risk factors for predicting septic shock.qSOFA score,SOFA score,APACHE II score,TNF-a,IL-6,IL-8,IL-10and PCT can be used for screening of septic shock.Among them,the AUC value(0.790)of qSOFA score was the largest,with the cut-off value of 1 score,and the sensitivity and specificity were 0.95and 0.458 respectively.Among the combination of two indexes,the AUC value(0.857)of qSOFA combined with PCT was the largest,with the sensitivity of 0.7 and specificity of 0.881.3.Compared with the survival patients with sepsis,the scores of qSOFA,SOFA,APACHE II,TNF-a,IL-6 and IL-8 in the non-survival patients were significantly higher(all P<0.05).The logistic analysis revealed that IL-6 was an independent risk factor for predicting death within 28days.qSOFA,SOFA,APACHE II score,TNF-a,IL-6 and IL-8 can be used to predict death within28 days.Among them,the AUC value(0.826)of IL-8 is the largest one,with the cut-off value of215 pg/ml,sensitivity and specificity are 0.667 and 0.895 respectively.Among the combination of two indexes,the AUC value(0.782)of qSOFA combined with IL-8 was the largest,with the sensitivity of 0.833 and specificityof 0.612.Conclusion:1.qSOFA combined with PCT can be used as an ideal combination for early diagnosis of sepsis in emergency department.qSOFA and PCT are both independent risk factors of sepsis.2.qSOFA combined with PCT can be used as an ideal combination for early diagnosis of septic shock in emergency department.qSOFA and TNF-a are both independent risk factors for septic shock.3.qSOFA combined with IL-8 can be used as an ideal combination for early prediction of death within 28 days in emergency department.IL-6 is an independent risk factor for death within 28days.