乳酸改良的快速序贯器官衰竭评估预测脓毒血症预后的系统评价和meta分析

杨伟.乳酸改良的快速序贯器官衰竭评估预测脓毒血症预后的系统评价和meta分析[J].内科急危重症杂志,2025,31(1):49-53

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DOI：10.11768/nkjwzzzz20250108

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作者	单位	E-mail
杨伟	新疆医科大学第一附属医院	lichenximed@163.com

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中文摘要:

摘要目的：评价快速序贯器官衰竭评估（qSOFA）系统与乳酸改良的快速序贯器官衰竭评估（LqSOFA）系统对脓毒血症预后进行早期预测的效能。方法：计算机检索PubMed、EMBase、Medline、Cochrane图书馆、维普中文科技期刊数据库、万方数据库，检索时限为建库至2022年5月，收集采用qSOFA和LqSOFA两项评分预测脓毒血症预后的研究，进行筛选和质量评价，采用Stata15.1统计软件进行数据分析，使用双变量meta分析模型评价两项评估量表在预测高死亡率方面的效能。采用双变量随机效应回归模型对研究的灵敏度、特异性、诊断优势比（DOR）、阳性似然比（PLR）、阴性似然比（NLR）进行综合分析。构建汇总受试者工作特征（ROC）曲线以评估诊断准确性。结果：共纳入7项研究、26937例患者。qSOFA与LqSOFA均与脓毒血症患者较高死亡风险相关，采用随机效应模型，合并风险比（RR）分别为1.46（95% CI ：1.23~1.74）和1.21（95% CI ：1.08~1.35），均有统计学差异（ P 均<0.0001）。在预测死亡方面，LqSOFA具有更高的灵敏度0.82（95% CI ：0.71~0.90），qSOFA具有更高的特异性0.74（95% CI ：0.59~0.85）。结论：qSOFA和LqSOFA对脓毒血症患者的高死亡风险均有一定的预测效能，LqSOFA灵敏度更高，对早期预后预测更有价值。

英文摘要:

Abstract Objective: To systematically review the efficacy of quick sequential organ failure assessment (qSOFA) score and lactate-modified quick sequential organ failure assessment (LqSOFA) score in early prediction of the prognosis of sepsis to provide evidence-based reference for clinical practice. Methods: Available publications were searched from PubMed, EMBase, Medline, the Cochrane Library, VIP and Wanfang database. The retrieval time was from the establishment of the database to May 2022. We collected studies with two scales for prognostic prediction of sepsis and evaluated the quality of studies that met the inclusion criteria. Stata 15.1 statistical software was applied for meta-analysis. We used a bivariate meta-analysis model to determine the prognostic value in predicting mortality. The bivariate random-effects regression model was used to pool the individual sensitivity, specificity, diagnostic odds ratio (DOR), positive likelihood ratio (PLR), and negative likelihood ratio (NLR). The summary receiver operating characteristic curve (SROC) was constructed to assess the overall diagnostic accuracy. Results: A total of 7 studies with a total of 26 937 patients were included. Both qSOFA and LqSOFA scoring scales were associated with a higher risk of death in patients with sepsis. The combined hazard ratios (RR) calculated with a random-effects model were 1.46 （95%CI: 1.23, 1.74) and 1.21 (95%CI: 1.08, 1.35) respectively, with a statistical difference (P< 0.0001). Compared the performance of qSOFA and LqSOFA in predicting mortality, LqSOFA had better sensitivity of 0.82 (95%CI: 0.71, 0.90) while qSOFA had better specificity of 0.74 (95%CI: 0.59, 0.85). Conclusion: Both qSOFA and LqSOFA scores were strongly related to the mortality in sepsis. By contrast with qSOFA, LqSOFA was more sensitive and valuable in predicting the prognosis of sepsis in the early stage.