Prognostic values of SOFA score, qSOFA score, and LODS score for patients with sepsis.

BACKGROUND: Sepsis continues to carry a high rate of mortality, which makes effective and simple evaluation methods for predicting the prognosis of septic patients especially important. In this study, we retrospectively analyzed the relationships between three scoring systems including Sequential Organ Failure Assessment (SOFA) score, Quick SOFA (qSOFA) score, and Logistic Organ Dysfunction System (LODS) score and the prognoses of septic patients. METHODS: The baseline data, SOFA score, qSOFA score, LODS score, 28-day prognosis, and 90-day prognosis of patients who met the diagnostic criteria of sepsis were retrieved from the Medical Information Mart for Intensive Care III (MIMIC-III) database. Receiver operating characteristic (ROC) curves were drawn for various indicators, and comparisons were drawn between the areas under the ROC curves (AUC) of the different scoring systems. RESULTS: The 28-day AUC was 0.661 (0.652, 0.670) for SOFA, 0.558 (0.548, 0.568) for qSOFA, and 0.668 (0.658, 0.677) for LODS; AUC-qSOFA vs. AUC-LODS was 0.103 (0.087, 0.120) (P<0.001), and AUC-qSOFA vs. AUC-LODS was 0.110 (0.094, 0.125) (P<0.001). The 90-day AUC was 0.630 (0.621, 0.640) for SOFA, 0.551 (0.541, 0.560) for qSOFA, and 0.644 (0.635, 0.653) for LODS; AUC-SOFA vs. AUC-qSOFA was 0.079 (0.065, 0.094) (P<0.001), and AUC-qSOFA vs. AUC-LODS was 0.093 (0.079, 0.107) (P<0.001). CONCLUSIONS: SOFA score, qSOFA score, and LODS score can all be used to predict the prognosis of septic patients. LODS score and SOFA score have higher accuracy than qSOFA score; however, qSOFA is simpler to use, making it a more suitable tool in an emergency setting.

[Effect of Xuebijing injection on hemodynamics and endothelial function in patients with severe sepsis: a prospective study].

OBJECTIVE: To investigate the effects of Xuebijing injection on hemodynamics, cardiac function, and endothelial function in patients with severe sepsis in order to study the therapeutic effect of Xuebijing in the treatment of severe sepsis. METHODS: A prospective randomized controlled trial was conducted. Sixty-six severe sepsis patients admitted to the Department of Critical Care Medicine of Guangdong Hospital of Traditional Chinese Medicine from March 2013 to February 2014 were enrolled. The patients were divided into control group (n = 31) and Xuebijing group (n = 35). The patients in both groups were treated according to "2012 international guidelines for management of severe sepsis and septic shock", and the patients in Xuebijing group received Xuebijing injection of 50 mL(added with 100 mL of 0.9% sodium chloride injection) twice a day for 5 days, and those in control group received instead 150 mL of 0.9% sodium chloride injection for 5 days. The heart rate (HR), mean arterial pressure (MAP), central venous pressure (CVP), and dosage of vasoactive drugs before and 1 day and 5 days after treatment were determined for hemodynamics assessment. Blood lactic acid (Lac), central venous oxygen saturation (ScvO2), and difference in arterial-venous blood carbon dioxide pressure (Pv-aCO2) were determined for microcirculation assessment. The left ventricular ejection fraction (LVEF), cardiac output (CO), left ventricular end diastolic diameter (LVEDD), the ratio of blood flow of mitral orifice between rapid filling period and atrial systole period (E/A), and B-type natriuretic peptide (BNP) were determined for cardiac function assessment. Vascular endothelial growth factor (VEGF) and soluble receptor (sFLT-1) were assessed for endothelial function assessment. The relationship among the indexes of the hemodynamics, microcirculation, cardiac function, and endothelial function was analyzed with Pearson related-analysis. RESULTS: After treatment, HR, MAP, CVP, Lac, ScvO2, and Pv-aCO2 were improved in both groups compared with those before treatment, and the dosage of norepinephrine (NE) was decreased in Xuebijing group. Compared with control group, MAP at 5 days after treatment in Xuebijing group was significantly increased [mmHg (1 mmHg = 0.133 kPa): 74.9±10.7 vs. 70.2±6.6, P < 0.05], the dosage of NE was decreased [µg×kg-1×min-1: 0.01 (0.00, 0.22) vs. 0.10 (0.05, 0.80), P < 0.05], LVEF was significantly increased (0.617±0.125 vs. 0.533±0.129, P < 0.05), BNP was significantly decreased [ng/L: 117.3 (52.0, 443.0) vs. 277.2 (67.9, 2 370.2), P < 0.05], while VEGF showed no significant change (ng/L: 101.1±23.2 vs. 89.6±20.5, P > 0.05), and sFLT-1 was significantly decreased (ng/L: 245.7±86.2 vs. 295.1±95.1, P < 0.05). It was shown by Pearson coefficient bivariate correlation analysis that sFLT-1 was negatively correlated with MAP and ScvO2 (r = -0.569, P = 0.000; r = -0.341, P = 0.008) 5 days after treatment, while it was positively associated with Lac and acute physiology and chronic health evaluation II (APACHE II) score (r = 0.749, P = 0.000; r = 0.645, P = 0.000). CONCLUSIONS: After treatment, HR, MAP, CVP, Lac, ScvO2, and Pv-aCO2 were improved in both groups compared with those before treatment, and the dosage of norepinephrine (NE) was decreased in Xuebijing group. Compared with control group, MAP at 5 days after treatment in Xuebijing group was significantly increased [mmHg (1 mmHg = 0.133 kPa): 74.9±10.7 vs. 70.2±6.6, P < 0.05], the dosage of NE was decreased [µg×kg-1×min-1: 0.01 (0.00, 0.22) vs. 0.10 (0.05, 0.80), P < 0.05], LVEF was significantly increased (0.617±0.125 vs. 0.533±0.129, P < 0.05), BNP was significantly decreased [ng/L: 117.3 (52.0, 443.0) vs. 277.2 (67.9, 2 370.2), P < 0.05], while VEGF showed no significant change (ng/L: 101.1±23.2 vs. 89.6±20.5, P > 0.05), and sFLT-1 was significantly decreased (ng/L: 245.7±86.2 vs. 295.1±95.1, P < 0.05). It was shown by Pearson coefficient bivariate correlation analysis that sFLT-1 was negatively correlated with MAP and ScvO2 (r = -0.569, P = 0.000; r = -0.341, P = 0.008) 5 days after treatment, while it was positively associated with Lac and acute physiology and chronic health evaluation II (APACHE II) score (r = 0.749, P = 0.000; r = 0.645, P = 0.000).