ИСПОЛЬЗОВАНИЕ ШКАЛЫ QSOFA В ДИАГНОСТИКЕ СЕПСИСА. РЕЗУЛЬТАТЫ РОССИЙСКОГО МНОГОЦЕНТРОВОГО ИССЛЕДОВАНИЯ РИСЭС

Subjects and methods. The multi-center, prospective, and observational trial was conducted. The following data were analyzed in the patients admitted to intensive care wards: number of qSOFAscores, the presence of SIRS criteria, levels of lactate, procalcitonin, C-reactive protein in blood, the presence of sepsis according to Sepsis-3 criteria. The value of qSOFA scores, SIRS criteria, and biomarkers for sepsis diagnostics was assessed by means of ROC-analysis.Results. The following areas under ROC-curves were defined during diagnostics of sepsis in the patients in intensive care wards: qSOFA – 0.679 (95%CI 0.646–0.712); SIRS – 0.714 (95% CI0.682–0.745), p = 0.099; when qSOFA exceeding 1 score: procalcitonin – 0.788 (95% CI 0.689–0.867), C-reactive protein – 0.787 (95% CI 0.688–0.866), p = 0.970.Conclusion. qSOFA score is compatible with SIRS criteria for diagnostics of sepsis among the patients in intensive care wards. qSOFA score is highly sensitive, but it is of low specificity for sepsis diagnostics. Should there be at least 1 score of qSOFA, it is recommended to test levels of procalcitonin or C-reactive protein in order to increase the specificity of this score for diagnostics of sepsis.Цель исследования: определить информационную ценность шкалы qSOFA в диагностике сепсиса у пациентов, госпитализированных в отделения реанимации и интенсивной терапии (ОРИТ) лечебных учреждений Российской Федерации.Материалы и методы. Многоцентровое, проспективное, обсервационное исследование. Проанализирована следующая информация о пациентах при поступлении в ОРИТ: количество баллов по шкале qSOFA, наличие критериев SIRS, уровень лактата, прокальцитонина, С-реактивного белка крови, наличие сепсиса согласно критериям «Сепсис-3». Проведен ROC-анализ информационной значимости шкалы qSOFA, критериев SIRS, биомаркеров в диагностике сепсиса.Результаты. В диагностике сепсиса у пациентов ОРИТ определены следующие площади под ROC-кривыми: qSOFA – 0,679 (95%-ный ДИ 0,646–0,712); SIRS – 0,714 (95%-ный ДИ0,682–0,745), p = 0,099; при qSOFA не менее 1 балла: прокальцитонин – 0,788 (95%-ный ДИ 0,689–0,867), С-реактивный белок – 0,787 (95%-ный ДИ 0,688–0,866), p = 0,970.Заключение. В популяции пациентов ОРИТ в диагностике сепсиса шкала qSOFA сравнима с критериями SIRS. Шкала qSOFA имеет высокую чувствительность, но низкую специфичность в диагностике сепсиса. При наличии по крайней мере 1 балла по шкале qSOFA целесообразно выполнить измерение уровня прокальцитонина или С-реактивного белка крови для повышения специфичности шкалы в диагностике сепсиса

ИСПОЛЬЗОВАНИЕ ШКАЛЫ qSOFA В ПРОГНОЗЕ ИСХОДА У ПАЦИЕНТОВ С СЕПСИСОМ В ОРИТ (результаты российского многоцентрового исследования РИСЭС)

The objective of the study: to define the informative value of qSOFA score in the prediction of sepsis outcomes in the patients admitted to the intensive care wards of medical units in the Russian Federation.Subjects and methods. The multi-center, prospective, and observational trial was conducted. The following data were analyzed in the patients admitted to intensive care wards: number of qSOFA and SOFA scores, the presence of SIRS criteria, levels of lactate, and the outcome of the admission to the intensive care wards. The informative value of different scores and lactate level was analyzed using ROC-analysis.Results. The following areas under ROC-curves were defined for prediction of a lethal outcome in the patients with sepsis: qSOFA – 0.644 (95% CI 0.593–0.693); SOFA – 0.731 (95% CI 0.683–0.776); SIRS – 0.508 (95% CI 0.456–0.560); [qSOFA + lactate ≥ 4 mmol/L] – 0.713 (95% CI 0.646–0.774).Conclusion. To predict a lethal outcome in the patients with sepsis admitted to intensive care wards, qSOFA surpasses SIRS criteria, but it is not as good as SOFA score. The informative value of the prediction model [qSOFA+lactate ≥ 4 mmol/L] surpasses qSOFA score in the prediction of the outcome in sepsis patients, and it is as good as SOFA score.Цель исследования: определить информационную ценность шкалы qSOFA в прогнозе летального исхода у пациентов с сепсисом, госпитализированных в отделения реанимации и интенсивной терапии (ОРИТ) лечебных учреждений Российской Федерации.Материалы и методы. Многоцентровое, проспективное, обсервационное исследование. Проанализирована следующая информация о пациентах с сепсисом при поступлении в ОРИТ: количество баллов по шкалам qSOFA и SOFA, наличие критериев SIRS, уровень лактата крови, а также исход госпитализации при оказании помощи в ОРИТ. Проведен ROC-анализ информационной значимости различных шкал и уровня лактата крови.Результаты. В прогнозе летального исхода пациентов с сепсисом определены следующие площади под ROC-кривыми: qSOFA – 0,644 (95%-ный ДИ 0,593–0,693); SOFA – 0,731 (95%-ный ДИ 0,683–0,776); SIRS – 0,508 (95%-ный ДИ 0,456–0,560); [qSOFA + лактат ≥ 4 ммоль/л] – 0,713 (95%-ный ДИ 0,646–0,774).Заключение. В прогнозе летального исхода у пациентов с сепсисом при поступлении в ОРИТ шкала qSOFA превосходит критерии SIRS, но уступает шкале SOFA. Информационная ценность прогностической модели [qSOFA + лактат ≥ 4 ммоль/л] превосходит шкалу qSOFA в прогнозе исхода у пациентов с сепсисом и не уступает шкале SOFA

Epidemiology of intra-abdominal infection and sepsis in critically ill patients: “AbSeS”, a multinational observational cohort study and ESICM Trials Group Project

Purpose: To describe the epidemiology of intra-abdominal infection in an international cohort of ICU patients according to a new system that classifies cases according to setting of infection acquisition (community-acquired, early onset hospital-acquired, and late-onset hospital-acquired), anatomical disruption (absent or present with localized or diffuse peritonitis), and severity of disease expression (infection, sepsis, and septic shock). Methods: We performed a multicenter (n = 309), observational, epidemiological study including adult ICU patients diagnosed with intra-abdominal infection. Risk factors for mortality were assessed by logistic regression analysis. Results: The cohort included 2621 patients. Setting of infection acquisition was community-acquired in 31.6%, early onset hospital-acquired in 25%, and late-onset hospital-acquired in 43.4% of patients. Overall prevalence of antimicrobial resistance was 26.3% and difficult-to-treat resistant Gram-negative bacteria 4.3%, with great variation according to geographic region. No difference in prevalence of antimicrobial resistance was observed according to setting of infection acquisition. Overall mortality was 29.1%. Independent risk factors for mortality included late-onset hospital-acquired infection, diffuse peritonitis, sepsis, septic shock, older age, malnutrition, liver failure, congestive heart failure, antimicrobial resistance (either methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, extended-spectrum beta-lactamase-producing Gram-negative bacteria, or carbapenem-resistant Gram-negative bacteria) and source control failure evidenced by either the need for surgical revision or persistent inflammation. Conclusion: This multinational, heterogeneous cohort of ICU patients with intra-abdominal infection revealed that setting of infection acquisition, anatomical disruption, and severity of disease expression are disease-specific phenotypic characteristics associated with outcome, irrespective of the type of infection. Antimicrobial resistance is equally common in community-acquired as in hospital-acquired infection

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

QSOFA SCORE FOR PREDICTION OF SEPSIS OUTCOME IN THE PATIENTS STAYING IN INTENSIVE CARE WARDS (results of the russian multi-center trial of RISES)

The objective of the study: to define the informative value of qSOFA score in the prediction of sepsis outcomes in the patients admitted to the intensive care wards of medical units in the Russian Federation.Subjects and methods. The multi-center, prospective, and observational trial was conducted. The following data were analyzed in the patients admitted to intensive care wards: number of qSOFA and SOFA scores, the presence of SIRS criteria, levels of lactate, and the outcome of the admission to the intensive care wards. The informative value of different scores and lactate level was analyzed using ROC-analysis.Results. The following areas under ROC-curves were defined for prediction of a lethal outcome in the patients with sepsis: qSOFA – 0.644 (95% CI 0.593–0.693); SOFA – 0.731 (95% CI 0.683–0.776); SIRS – 0.508 (95% CI 0.456–0.560); [qSOFA + lactate ≥ 4 mmol/L] – 0.713 (95% CI 0.646–0.774).Conclusion. To predict a lethal outcome in the patients with sepsis admitted to intensive care wards, qSOFA surpasses SIRS criteria, but it is not as good as SOFA score. The informative value of the prediction model [qSOFA+lactate ≥ 4 mmol/L] surpasses qSOFA score in the prediction of the outcome in sepsis patients, and it is as good as SOFA score

QSOFA SCORE FOR DIAGNOSTICS OF SEPSIS. RESULTS OF THE RUSSIAN MULTI-CENTER TRIAL OF RISES

Subjects and methods. The multi-center, prospective, and observational trial was conducted. The following data were analyzed in the patients admitted to intensive care wards: number of qSOFAscores, the presence of SIRS criteria, levels of lactate, procalcitonin, C-reactive protein in blood, the presence of sepsis according to Sepsis-3 criteria. The value of qSOFA scores, SIRS criteria, and biomarkers for sepsis diagnostics was assessed by means of ROC-analysis.Results. The following areas under ROC-curves were defined during diagnostics of sepsis in the patients in intensive care wards: qSOFA – 0.679 (95%CI 0.646–0.712); SIRS – 0.714 (95% CI0.682–0.745), p = 0.099; when qSOFA exceeding 1 score: procalcitonin – 0.788 (95% CI 0.689–0.867), C-reactive protein – 0.787 (95% CI 0.688–0.866), p = 0.970.Conclusion. qSOFA score is compatible with SIRS criteria for diagnostics of sepsis among the patients in intensive care wards. qSOFA score is highly sensitive, but it is of low specificity for sepsis diagnostics. Should there be at least 1 score of qSOFA, it is recommended to test levels of procalcitonin or C-reactive protein in order to increase the specificity of this score for diagnostics of sepsis