bloodjourГематология и трансфузиологияRussian journal of hematology and transfusiology0234-57302411-3042ООО Издательский дом «Практика»10.35754/0234-5730-2022-67-3-398-405bloodjour-387Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL ARTICLESАнализ эффективности применения шкал SIRS, qSOFA и MEWS для идентификации сепсиса у онкогематологических больныхAnalysis of the effectiveness of the SIRS, qSOFA and MEWS scale for the sepsis identification in oncohematological patients. Gematologiya i transfuziologiyahttps://orcid.org/0000-0001-5509-5308ЛянгузовА. В.LyanguzovA. V.

Лянгузов Алексей Владимирович, кандидат медицинских наук, старший научный сотрудник

610027, Киров

Alexey V. Lyanguzov, Cand. Sci. (Med.), Senior Researcher

610027, Kirov

dedalex@bk.ruhttps://orcid.org/0000-0002-5016-210XЛучининА. С.LuchininA. S.

Лучинин Александр Сергеевич, кандидат медицинских наук, старший научный сотрудник

610027, Киров

Alexander S. Luchinin, Cand. Sci. (Med.), Senior Researcher

610027, Kirov

glivec@mail.ruФГБУН «Кировский научно-исследовательский институт гематологии и переливания крови Федерального медико-биологического агентства»РоссияKirov Research Institute of Hematology and Blood Transfusion of the Federal Medical Biological AgencyRussian Federation202222102022673398405Copyright © Лянгузов А.В., Лучинин А.С., 20222022Лянгузов А.В., Лучинин А.С.Lyanguzov A.V., Luchinin A.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.htjournal.ru/jour/article/view/387Введение

Введение. У онкогематологических больных сепсис является одной из причин высокой летальности. Для его своевременной диагностики используют скоринговые шкалы, точность которых различается между собой.

Цель — оценить эффективность применения шкал SIRS, qSOFA и MEWS для диагностики сепсиса у онкогематологических больных.

Материалы и методы

Материалы и методы. В исследование включили 202 онкогематологических больных, госпитализированных в отделение интенсивной терапии с инфекционными осложнениями, из них 112 (55 %) мужчин и 90 (45 %) женщин (медиана возраста — 57 лет). В качестве независимых предикторов сепсиса использовали показатели, входящие в шкалы SIRS, qSOFA и MEWS, и другие патофизиологически обоснованные критерии. С целью селекции предикторов применен метод «Boruta». Оценку прогностической значимости показателей производили методом многофакторной бинарной логистической регрессии. На основании уравнения регрессии рассчитывали вероятность развития сепсиса. Соответствие вероятности исхода и показателей диагностических шкал проверяли с помощью корреляционного анализа (коэффициент ранговой корреляции Кендалла).

Результаты

Результаты. Диагноз «сепсис» при использовании любой шкалы установлен у 95 из 202 (47 %) больных: SIRS — у 77 (81 %), qSOFA — у 31 (33 %), MEWS — у 65 (68 %). Из 19 первоначально включенных в исследование предикторов сепсиса в итоговую модель логистической регрессии вошли 6 (частота дыхания, частота сердечных сокращений, нарушение темпа диуреза, систолическое АД, температура тела и баллы по шкале комы Глазго), что соответствовало критериям шкалы MEWS. Медиана вероятности сепсиса составила 0,38 (0,079–0,921). Результаты рассчитанной вероятности сепсиса, согласно модели логистической регрессии, наиболее тесно коррелировали с балльной оценкой по шкале MEWS, в меньшей степени — с таковой по SIRS и qSOFA.

Заключение

Заключение. Шкала MEWS является более подходящим инструментом диагностики сепсиса, чем SIRS и qSOFA, у онкогематологических больных.

Introduction

Introduction. Sepsis is one of the main causes of high mortality in oncohematological patients. Sepsis is diagnosed using different scoring scales, but the accuracy of the diagnosis varies.

Aim — to determine the effectiveness of SIRS, qSOFA and MEWS scales for the diagnosis of sepsis in oncohematological patients.

Materials and methods

Materials and methods. Study participants included 202 patients hospitalized in the intensive care unit with infectious complications — 112 (55 %) male, 90 (45 %) female. The median age was 57 years. The estimated predictors were the criteria of SIRS, qSOFA and MEWS scales and other significant indicators. The Boruta method was employed to select the predictors. A multiple binomial logistic regression model was used to determine the prognostic value of the predictors. The probability of sepsis was calculated based on the regression equation. The correlation between sepsis probability and the prognostic scales was assessed using correlation analysis (Kendall rank correlation coefficient).

Results

Results. Diagnoses were confirmed by scales in 95 of 202 (47 %) patients: SIRS — in 77 (81 %), qSOFA — in 31 (33 %), MEWS — in 65 (68 %). Of the 19 predictors initially included in the study, the final logistic regression model included 6: respiratory rate, heart rate, impaired urine output, systolic blood pressure, body temperature, and Glasgow coma scale level, which matched MEWS criteria. The median probability of sepsis was 0.38 (0.079–0.921). The results of the calculated probability of sepsis, according to the logistic regression model, correlated most closely with the score on the MEWS scale, to a lesser extent — with that on SIRS and qSOFA.

Conclusion

Conclusion. The MEWS scale is a more suitable tool for the diagnosis of sepsis than SIRS and sofa in oncohematological patients.

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The authors declare that there are no conflicts of interest present.