The early diagnosis and therapy of septic shock caused by soft tissue infection

Objective To assess the prognostic accuracy of the quick Sequential Organ Failure Assessment (qSOFA) score for septic shock of adults with soft tissue infections. The clinical characteristics of these patients were analyzed to provide reference for their multidisciplinary treatment. Methods A retrospective study was conducted. The patients with soft tissue infections admitted to the General Surgery Department of Beijing Hospital and the Burn and Plastic Surgery Department of Fourth Medical Center of PLA General Hospital from January 2012 to December 2018 were enrolled and patients combined with other infections were excluded. Patients were divided into the septic shock group and the non-septic group according to whether septic shock occurred during hospitalization. The baseline data, non-operative management and prognosis were compared between the two groups with Fisher's exact test. The sensitivity, specificity, positive predictive value, negative predictive value and the area under the receiver operating characteristic curve (AUC) of the qSOFA for diagnosis of sepsis and septic shock were calculated. Patients were also divided into four groups according to the etiology of soft tissue infection. The pathogens, surgical treatment and morbidity of septic shock among the four groups were also compared. Results A total of 192 patients were enrolled, including 28 (14.6%) patients with septic shock. Compared with the non-septic shock group, there were more proportion of patients with qSOFA≥2 (60.7% vs 18.3%, P=0.001) within 24 h of diagnosis of infection, and higher morbidity of sepsis (82.1% vs 32.9%, P<0.01) within 48 h of diagnosis of infection in the septic shock group. At the cut-off value of qSOFA≥2, the sensitivity, specificity, positive predictive value, negative predictive value and the AUC were 60.7%, 81.7%, 36.2%, 92.4% and 0.767 (95%CI: 0.665-0.869, P<0.01) respectively for diagnosis of septic shock. The morbidity of septic shock (36.4%) and 28-day mortality (13.6%) in patients with necrotizing fasciitis were higher than those in patients with other causes (both P<0.05). The most common pathogens were methicillin-sensitive Staphylococcus (6.8%), methicillin-resistant Staphylococcus (6.2%), Enterobacter (5.7%) and Enterococcus (5.2%). Conclusions qSOFA≥2 can be used as a rapid septic shock screening tool for adults with soft tissue infection. Early diagnosis of sepsis, thorough debridement and effective antibiotic treatment are essential for these patients. Key words: Skin soft-tissue infection; Sepsis; Septic shock; Quick Sequential Organ Failure Assessment