Prognostic Value Of QSOFA Score Combined With Serum Lactate And C-reactive Protein/Albumin Ratio In Patients With Abdominal Infection

Objective Because the quick SOFA(qSOFA)score is too simple and has poor sensitivity for sepsis risk assessment,in order to improve the sensitivity of qSOFA,in this study,serum lactate level and C reactive protein/albumin ratio(CAR)were added.The purpose of this study was to evaluate the prognostic value of combined serum lactate level and CAR qSOFA score(Lactic acid level and CAR combined qSOFA,LCqSOFA)in patients with abdominal infection,and to verify that serum lactate and CAR can improve the sensitivity of qSOFA in the prognostic evaluation of patients with abdominal infection.Methods In this study,we retrospectively analyzed 285 patients with intra-abdominal infection diagnosed in the Department of Hepatobiliary Surgery and the Department of Gastrointestinal Surgery of Tongde Hospital of Zhejiang Province from January 2008 to January 2021.The general information of the enrolled patients was collected,including gender,age,disease type,infection site,chronic disease and trauma.The worst indicators collected within 72 hours after admission were included:Oxygenation index,respiratory support,platelet count,total bilirubin levels,mean arterial pressure,dopamine use,dobutamine,epinephrine,norepinephrine and dose,Glasgow Coma Scale(GCS),serum creatinine,24-hour urine volume,respiratory rate,systolic blood pressure,C-reactive protein,serum albumin and serum lactic acid levels.The score of SOFA,qSOFA and lactic acid and CAR combined qSOFA(LCqSOFA)were calculated.The evaluation effect of different scoring methods on patient prognosis was evaluated by receiver operating characteristic(ROC)curve,and MedCalc software was used to carry out the areas under the curve of different scoring methods.To evaluate the effect of different scoring methods on the prognosis of patients with abdominal infection.Results A total of 285 cases were included,with an average age of(51.83±15.32)years;There were 159 males(55.79%)with an average age of(47.8±19.3)years.There were 126 females(44.21%)with an average age of(51.83±15.32)years.Of the 285 patients,36 patients who died within 28 days after the onset of abdominal infection were assigned to the death group and 249 patients who survived were assigned to the survival group.Oxygenation index(HR=0.784,P=0.036),24-hour urine volume(HR=0.873,P=0.045),creatinine(HR=1.327,P=0.034),platelet count(HR0.P=0.047),GCS score(HR=0.711,P=0.025),CAR(HR=1.894,P<0.001)and serum lactic acid(HR=1.959,P<0.001)were independent prognostic factors for abdominal infection.The sensitivity of LCqSOFA was significantly higher than that of qSOFA in predicting the prognosis of abdominal infection,and the AUC of LCqSOFA was significantly different from that of qSOFA(P=0.0002),but not significantly different from that of SOFA(P=0.1885).Conclusion LCqSOFA has better predictive performance and higher sensitivity than qSOFA alone in predicting the outcome of patients with abdominal infection,and has comparable predictive performance with the full SOFA.