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Tirandi A, Arboscello E, Ministrini S, Liberale L, Bonaventura A, Vecchié A, Bertolotto M, Giacobbe DR, Castellani L, Mirabella M, Minetti S, Bassetti M, Montecucco F, Carbone F. Early sclerostin assessment in frail elderly patients with sepsis: insights on short- and long-term mortality prediction. Intern Emerg Med 2023; 18:1509-1519. [PMID: 36943596 PMCID: PMC10412666 DOI: 10.1007/s11739-023-03223-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 02/08/2023] [Indexed: 03/23/2023]
Abstract
Unmet needs challenge clinical management of sepsis especially concerning patient profiling, enhancing recovery, and long-term sequelae. Here, we preliminarily focused on sclerostin (SOST) as a candidate biomarker to encompass such a broad range of clinical needs related to sepsis. Seventy-three septic patients were enrolled at internal medicine wards between January 2017 and December 2019 in this pilot study. Clinical examination and blood sample analyses were collected at enrollment and after 7 and 14 days. SOST levels were assessed on serum by ELISA. Thirty-day mortality was set as primary outcome. In-hospital and long-term mortality (2.5 years of median follow-up) were assessed as secondary outcomes. Patients were frail, elderly, and heterogeneous in terms of comorbidity burden. SOST levels were associated with age, cardiovascular comorbidities, and time to early death (30 days). When regression models were built, SOST displayed a high predictive value toward 30-day mortality (OR 13.459 with 95% CI 1.226-148.017) with ever better performance than validated scoring scales for critical ill patients. Such a predictive value of SOST was further confirmed for in-hospital (HR 10.089 with 95% CI 1.375-74.013) and long-term mortality (HR 5.061 with 95% CI 1.379-18.570). SOST levels generally decreased over 7 to 14 days after enrollment (p for trend < 0.001). The degree of this variation further predicted long-term mortality (HR for Δ SOST T0-day 14: 1.006 with 95% CI 1.001-1.011). Our results suggest a role for SOST in both short- and long-time prediction of worse outcome in septic elderly admitted to internal medicine wards.
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Affiliation(s)
- Amedeo Tirandi
- Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132, Genoa, Italy
| | - Eleonora Arboscello
- IRCCS Ospedale Policlinico San Martino, 10 Largo Rosanna Benzi, 16132, Genoa, Italy
| | - Stefano Ministrini
- Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, 8952, Schlieren, Switzerland
- Internal Medicine, Angiology and Atherosclerosis, Department of Medicine and Surgery, Università Degli Studi di Perugia, piazzale Gambuli 1, 06129, Perugia, Italy
| | - Luca Liberale
- Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, 10 Largo Rosanna Benzi, 16132, Genoa, Italy
| | - Aldo Bonaventura
- Medicina Generale 1, Medical Center, Ospedale di Circolo e Fondazione Macchi, ASST Sette Laghi, Varese, Italy
| | | | - Maria Bertolotto
- Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132, Genoa, Italy
| | - Daniele Roberto Giacobbe
- IRCCS Ospedale Policlinico San Martino, 10 Largo Rosanna Benzi, 16132, Genoa, Italy
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Luca Castellani
- IRCCS Ospedale Policlinico San Martino, 10 Largo Rosanna Benzi, 16132, Genoa, Italy
| | - Michele Mirabella
- IRCCS Ospedale Policlinico San Martino, 10 Largo Rosanna Benzi, 16132, Genoa, Italy
| | - Silvia Minetti
- Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132, Genoa, Italy
| | - Matteo Bassetti
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Fabrizio Montecucco
- Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, 10 Largo Rosanna Benzi, 16132, Genoa, Italy
| | - Federico Carbone
- Department of Internal Medicine, University of Genoa, 6 viale Benedetto XV, 16132, Genoa, Italy.
- IRCCS Ospedale Policlinico San Martino, 10 Largo Rosanna Benzi, 16132, Genoa, Italy.
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Shibata J, Osawa I, Ito H, Soeno S, Hara K, Sonoo T, Nakamura K, Goto T. Risk factors of sepsis among patients with qSOFA<2 in the emergency department. Am J Emerg Med 2021; 50:699-706. [PMID: 34879489 DOI: 10.1016/j.ajem.2021.09.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 09/02/2021] [Accepted: 09/10/2021] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Studies have suggested that qSOFA can be used for early detection of sepsis immediately upon arrival at the emergency department (ED). Despite this, little is known about the risk factors associated with the subsequent diagnosis of sepsis among patients with qSOFA<2 in the ED. METHODS This is a retrospective cohort study using ED data from a large tertiary medical center in Japan, 2018-2020. We included adult patients (aged ≥18 years) presenting to the ED with suspected infection (e.g., having a fever) and qSOFA<2. We identified patients who developed sepsis based on the Sepsis-3 criteria, and compared patient characteristics (e.g., demographics, vital signs upon the initial triage, chief complaint, and comorbidities) between patients who developed sepsis or not. Additionally, we identified the potential risk factors of sepsis among patients with qSOFA<2 using a multivariable logistic regression model. RESULTS We identified 151 (7%) patients who developed sepsis among 2025 adult patients with suspected infection and qSOFA<2. Compared with patients who did not develop sepsis, patients who developed sepsis were likely to be older and have vital signs suggestive of imminent sepsis (e.g., high respiratory rate). In the multivariable logistic regression model, the potential risk factors of sepsis among patients with qSOFA<2 were older age (adjusted OR, 1.92 [95%CI 1.19-3.19]), vital signs suggestive of imminent sepsis (e.g., adjusted OR of altered mental status, 3.50 [95%CI 2.25-5.50]), receipt of oxygen therapy upon arrival at the ED (adjusted OR, 1.91 [95%CI 1.38-2.26]), chief complaint of sore throat (adjusted OR, 2.15 [95%CI 1.08-4.13]), and the presence of comorbid diabetes mellitus, ischemic heart disease, and chronic kidney disease (e.g., adjusted OR of diabetes mellitus, 1.47 [95%CI 1.10-1.96]). On the contrary, chief complaint of abdominal and chest pain were associated with a lower risk of sepsis (e.g., adjusted OR of abdominal pain, 0.26 [95%CI 0.14-0.45]). CONCLUSIONS We found that older age, vital signs prognosticating sepsis, and the presence of some comorbidities were the potential risk factors of sepsis in patients with qSOFA<2. These potential risk factors could be useful to efficiently recognize patients who might develop sepsis in the ED.
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Affiliation(s)
| | - Itsuki Osawa
- Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, Tokyo, Japan.
| | - Honoka Ito
- Nursing Course, College of Nursing, School of Medicine and Health Sciences, University of Tsukuba, Japan
| | - Shoko Soeno
- Department of Palliative Care, Southern Tohoku General Hospital, Fukushima, Japan
| | - Konan Hara
- Department of Economics, University of Arizona, AZ, United States; TXP Medical Co. Ltd., Tokyo, Japan
| | - Tomohiro Sonoo
- TXP Medical Co. Ltd., Tokyo, Japan; Department of Emergency and Critical Care Medicine, Hitachi General Hospital, Ibaraki, Japan
| | - Kensuke Nakamura
- Department of Emergency and Critical Care Medicine, Hitachi General Hospital, Ibaraki, Japan
| | - Tadahiro Goto
- TXP Medical Co. Ltd., Tokyo, Japan; Department of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Alberto L, Marshall AP, Walker RM, Pálizas F, Aitken LM. Sensitivity and specificity of a quick sequential [Sepsis-Related] organ failure assessment sepsis screening tool. Int J Clin Pract 2021; 75:e14874. [PMID: 34529874 DOI: 10.1111/ijcp.14874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 08/06/2021] [Accepted: 09/10/2021] [Indexed: 11/30/2022] Open
Abstract
AIM There is limited evidence on the diagnostic accuracy of a quick Sequential [Sepsis-Related] Organ Failure Assessment (qSOFA) sepsis screening (SS) tool in developing nation health settings. The aim of this study was to test the diagnostic accuracy of a qSOFA-based SS tool, and the predictive validity of the qSOFA score in hospital ward patients from Argentina. METHODS Prospective observational study. Patients (≥18 years, without sepsis) were recruited within 24-48 hours of admission to a 169-bed tertiary referral private hospital in Buenos Aires. The index test was the qSOFA-based SS tool, and the reference standard sepsis diagnosed at discharge blindly evaluated with reference to the Sepsis-3. RESULTS In 1151 patients (median age 69.9 [IQR, 29.0]); 47 (4.1%) had sepsis, 413 (35.9%) had infection and 691 (60.0%) other diagnoses at discharge. The qSOFA-based SS tool (index test) had moderate sensitivity (60%), good specificity (89%), a very low positive (19%) and very high negative (98%) predictive value for sepsis diagnosed at discharge according to the Sepsis-3 criteria (reference standard). For the same outcome, the qSOFA score in isolation had a reasonable predictive validity area under receiver operating characteristics curve 0.77 (95% CI 0.70-0.83) P < 0.001. CONCLUSION The qSOFA score could reasonably discriminate patients at risk of developing sepsis; qSOFA-based screening may be valuable where no screening criteria are in place.
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Affiliation(s)
- Laura Alberto
- School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Andrea P Marshall
- School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Gold Coast University Hospital, Gold Coast Hospital and Health Service, Gold Coast, Australia
| | - Rachel M Walker
- School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Division of Surgery, Princess Alexandra Hospital, Brisbane, Australia
| | - Fernando Pálizas
- Intensive Care Units, Clínicas Bazterrica and Santa Isabel, Ciudad de Buenos Aires, Argentina
| | - Leanne M Aitken
- School of Nursing and Midwifery, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- School of Health Sciences at City, University of London, London, UK
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Abdullah SMOB, Sørensen RH, Nielsen FE. Prognostic Accuracy of SOFA, qSOFA, and SIRS for Mortality Among Emergency Department Patients with Infections. Infect Drug Resist 2021; 14:2763-2775. [PMID: 34321893 PMCID: PMC8313375 DOI: 10.2147/idr.s304952] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 05/20/2021] [Indexed: 12/16/2022] Open
Abstract
Objective This study aimed to determine the prognostic accuracy of SOFA in comparison to quick-SOFA (qSOFA) and systemic inflammatory response syndrome (SIRS) in predicting 28-day mortality in the emergency department (ED) patients with infections. Methods A secondary analysis of data from a prospective study of adult patients with documented or suspected infections admitted to an ED in Denmark from Oct-2017 to Mar-2018. The SOFA scores were calculated after adjustment for chronic diseases. The prognostic accuracy was assessed by analysis of sensitivity, specificity, predictive values, likelihood ratios, and area under the receiver operating characteristic curve (AUROC) with 95% confidence intervals (CI). Results A total of 2045 patients with a median age of 73.2 (IQR: 60.9-82.1) years were included. The overall 28-day mortality was 7.7%. In patients meeting a SOFA score ≥2, qSOFA score ≥2, and SIRS criteria ≥2 the 28-day mortality was 13.6% (11.2-16.3), 17.8% (12.4-24.3) and 8.3% (6.7-10.2), respectively. SOFA ≥2 had a sensitivity of 61.4% (53.3-69.0) and specificity of 67.3% (65.1-69.4), qSOFA ≥2 had a sensitivity of 19.6% (13.7-26.7) and specificity of 92.4% (91.1-93.6), and SIRS ≥2 had a sensitivity of 52.5% (44.4-60.5) and specificity of 51.5% (49.2-53.7). The AUROC for SOFA compared to SIRS was: 0.68 vs 0.52; p<0.001 and compared to qSOFA: 0.68 vs 0.63; p=0.018. Conclusion A SOFA score of at least two had better prognostic accuracy for 28-day mortality than SIRS and qSOFA. However, the overall accuracy of SOFA was poor for the prediction of 28-day mortality.
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Affiliation(s)
| | | | - Finn Erland Nielsen
- Department of Emergency Medicine, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Slagelse, Denmark.,Copenhagen Center for Translational Research, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Slagelse, Denmark
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Liu S, He C, He W, Jiang T. Lactate-enhanced-qSOFA (LqSOFA) score is superior to the other four rapid scoring tools in predicting in-hospital mortality rate of the sepsis patients. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1013. [PMID: 32953813 PMCID: PMC7475464 DOI: 10.21037/atm-20-5410] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background The rising prevalence of early therapy for sepsis has led to the demand for rapid risk-stratification tools that can estimate the risk of in-hospital mortality for sepsis patients and the need for intensive care unit (ICU) admission. A robust risk-stratification tool is crucial for in-time sepsis treatment. This study aimed to compare the abilities of five rapid scoring systems, i.e., LqSOFA score, qSOFA score, SIRS, MEDS, and MEWS, in predicting the mortality in hospital and ICU admission for sepsis patients. Methods A retrospective observational clinical study was conducted in West China Hospital. Our cases included all patients admitted to the hospital with a diagnosis of sepsis (sepsis-3). We calculated five rapid prediction scores for the enrolled cases. We then compared each rapid score’s ability to predict in-hospital mortality and ICU admission. Results A total of 821 of mixed sepsis patients by sepsis-3 definition were included. The all-cause hospital mortality rate was 21.1%. The LqSOFA score presented the most significant discrimination with an area under the receiver operating characteristic curve (AUC) of 0.751. The AUC of the LqSOFA score for mortality in the hospital was significantly higher than qSOFA (AUC 0.717), SIRS (AUC 0.704), MEDS (AUC 0.670), and MEWS (AUC 0.685). Conclusions LqSOFA is a superior prognostic tool for predicting mortality in the hospital. It may provide more exact information for hospital mortality than the other 4 rapid scores in treating sepsis patients.
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Affiliation(s)
- Sijia Liu
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Chengqi He
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Weilue He
- Department of Biomedical Engineering, Michigan Technological University, Houghton, Michigan, USA
| | - Tian Jiang
- Editorial Board of Journal of Sichuan University (Medical Science Edition), Chengdu, China
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Shahsavarinia K, Moharramzadeh P, Arvanagi RJ, Mahmoodpoor A. qSOFA score for prediction of sepsis outcome in emergency department. Pak J Med Sci 2020; 36:668-672. [PMID: 32494253 PMCID: PMC7260919 DOI: 10.12669/pjms.36.4.2031] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Objective: The third international consensus definition for sepsis and septic shock (sepsis 3) task force recently introduced qSOFA (quick sequential organ failure assessment) as a score for detection of patients at risk of sepsis outside of intensive care units. We performed this study to evaluate the validity of qSOFA for early detection and risk stratification of septic patients in emergency department. Methods: We conducted this study in an emergency department of the largest university affiliated hospital in northwest of Iran from Sept 2015 to Sept 2016. One hundred and forty patients who were SIRS positive with a suspected infection without alternative diagnosis and a microbiological proven infection were enrolled in this study. qSOFA was calculated for each patient and correlated with sepsis grades and mortality. Results: From 140 patients 84 (60%) had positive qSOFA score and 56 (40%) patients had negative qSOFA score. Our results showed that near half of patients with positive qSOFA expired during their stay in hospital while this was about 5% for patients with negative qSOFA. ROC curve of study regarding prediction of outcome with qSOFA showed an area under curve of 0.59. (P value: 0.04). Time spent to sepsis detection was 16 minutes shorter with qSOFA score compared to SIRS criteria in this study. Conclusion: In patients with suspected sepsis, qSOFA has acceptable value for risk stratification of severity, multi organ failure and mortality. It seems that education of medical staff and frequent screening of patients for warning signs can help to increase the value of qSOFA in prediction of mortality in critically ill septic patients.
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Affiliation(s)
- Kavous Shahsavarinia
- Kavous Shahsavarinia, Associate Professor, Road Traffic Injury Research Center, Department of Emergency Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Payman Moharramzadeh
- Payman Moharramzadeh, Associate Professor, Department of Emergency Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Reza Jamal Arvanagi
- Reza Jamal Arvanagi, Emergency Medicine Specialist, Department of Emergency Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ata Mahmoodpoor
- Prof. Dr. Ata Mahmoodpoor, Department of Anesthesiology and intensive care, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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Haas LEM, Termorshuizen F, Lange DW, Dijk D, Keizer NF. Performance of the quick SOFA in very old ICU patients admitted with sepsis. Acta Anaesthesiol Scand 2020; 64:508-516. [PMID: 31885070 DOI: 10.1111/aas.13536] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 11/07/2019] [Accepted: 12/21/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND The number of very elderly ICU patients (abbreviated to VOPs; ≥80 years) with sepsis increases. Sepsis was redefined in 2016 (sepsis 3.0) using the quick SOFA (qSOFA) score. Since then, multiple studies have validated qSOFA for prognostication in different patient categories, but the prognostic value in VOPs with sepsis is still unknown. METHODS Retrospective cohort study including patients admitted to Dutch ICUs with sepsis, in the period 2012 to 2016, evaluating the outcome and the performance of qSOFA, an extended qSOFA model, SOFA, SAPS II, and APACHE IV for hospital mortality. RESULTS 5969 patients were included, of which 935 VOPs. Crude hospital mortality rates were 19%, 28%, and 39% for patients aged 18-65, 65-80, and ≥80 years respectively. Discriminative performance of qSOFA for in-hospital mortality in VOPs was poor (AUC 0.596) and lower than that of SOFA, APACHE IV, and SAPS II (0.704, 0.722, and 0.780 respectively). A qSOFA model extended with several other characteristics (AUC 0.643) was non-inferior to the full SOFA, but still inferior to APACHE IV and SAPS II, for all age groups. The Hosmer-Lemeshow goodness-of-fit test showed non-significant p-values for all models. Accuracy for both qSOFA and the extended qSOFA was lower compared to APACHE IV and SAPS II (Brier scores 0.227, 0.223, 0.184, and 0.183 respectively). CONCLUSION The qSOFA showed worse discriminative performance to predict mortality than SOFA, APACHE IV, and SAPS II in both VOPs and younger patients admitted with sepsis.
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Affiliation(s)
- Lenneke E. M. Haas
- Department of Intensive Care Diakonessenhuis Utrecht Utrecht the Netherlands
| | - Fabian Termorshuizen
- Department of Medical Informatics Amsterdam Public Health Research Institute Amsterdam UMC University of Amsterdam Amsterdam the Netherlands
- National Intensive Care Evaluation (NICE) Foundation Amsterdam the Netherlands
| | - Dylan W. Lange
- Department of Intensive Care University Medical Center University Utrecht Utrecht the Netherlands
| | - Diederik Dijk
- Department of Intensive Care University Medical Center University Utrecht Utrecht the Netherlands
| | - Nicolette F. Keizer
- Department of Medical Informatics Amsterdam Public Health Research Institute Amsterdam UMC University of Amsterdam Amsterdam the Netherlands
- National Intensive Care Evaluation (NICE) Foundation Amsterdam the Netherlands
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Cutler NS. Diagnosing Sepsis: qSOFA is Not the Tool We're Looking For. Am J Med 2020; 133:265-266. [PMID: 31442389 DOI: 10.1016/j.amjmed.2019.07.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 07/04/2019] [Accepted: 07/04/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Nathan S Cutler
- Lieutenant Commander, Medical Corps, United States Navy, Fellow, Critical Care Medicine, Wake Forest Baptist Medical Center, Winston-Salem, NC.
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Xia Y, Zou L, Li D, Qin Q, Hu H, Zhou Y, Cao Y. The ability of an improved qSOFA score to predict acute sepsis severity and prognosis among adult patients. Medicine (Baltimore) 2020; 99:e18942. [PMID: 32000414 PMCID: PMC7004789 DOI: 10.1097/md.0000000000018942] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
This study analyzed independent risk factors that could improve the qSOFA scoring system among sepsis patients.This retrospective study evaluated 821 patients (2015-2016) who fulfilled the 2001 International Sepsis Definitions Conference diagnostic criteria. Patients were classified based on their survival outcomes after 28 days, and the predictive values of various predictive scores at admission were compared.The independent risk factors for 28-day mortality were fibrinogen, plasma lactic acid, albumin, oxygenation index, and procalcitonin level >0.5 ng/mL (all P < .05). The "PqSOFA" score combined the qSOFA score with procalcitonin, which provided an area under the curve value of 0.751 (95% CI: 0.712-0.790) for predicting 28-day mortality. A cut-off score of 2 points provided sensitivity of 83.2%, specificity of 54.9%, negative predictive value (NPV) of 33.03%, positive predictive value (PPV) of 92.47%, positive-likelihood ratio (PLR) of 1.85, and negative-likelihood ratio (NLR) of 0.31. The area under the curve for predicting 28-day mortality was significantly greater for the PqSOFA score than for the qSOFA score (Z = 7.019, P < .0001). The PqSOFA score was comparable to the SOFA and APACHE II scores.The PqSOFA score independently predicted poor short-term outcomes among high-risk sepsis patients.
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Nieves Ortega R, Rosin C, Bingisser R, Nickel CH. Clinical Scores and Formal Triage for Screening of Sepsis and Adverse Outcomes on Arrival in an Emergency Department All-Comer Cohort. J Emerg Med 2019; 57:453-460.e2. [PMID: 31500993 DOI: 10.1016/j.jemermed.2019.06.036] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 06/17/2019] [Accepted: 06/22/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND Early recognition of sepsis remains a major challenge. The clinical utility of the Quick Sepsis-Related Organ Failure Assessment (qSOFA) score is still undefined. Several studies have tested its prognostic value. However, its ability to diagnose sepsis is still unknown. OBJECTIVE Our aim was to compare the performance of qSOFA, systemic inflammatory response syndrome (SIRS) criteria, National Early Warning Score (NEWS), and formal triage with the Emergency Severity Index (ESI) algorithm to identify patients with sepsis and predict adverse outcomes on arrival in an emergency department (ED) all-comer cohort. METHODS We included all patients presenting consecutively to the ED during a 3-week period. We used vital signs recorded at triage to calculate the study scores. Two independent assessors retrospectively assigned the primary outcome of sepsis according to Third International Consensus Definitions for Sepsis and Septic Shock criteria in a chart review process. RESULTS There were 2523 cases included in the analysis and 39 (1.6%) had the primary outcome of sepsis. The area under the curve for sepsis was 0.79 (95% confidence interval [CI] 0.71-0.86) for qSOFA, 0.81 (95% CI 0.73-0.87) for SIRS, 0.85 (95% CI 0.77-0.92) for NEWS, and 0.77 (95% CI 0.70-0.83) for ESI. CONCLUSIONS qSOFA offered high specificity for the prediction of sepsis and adverse outcomes. However, its low sensitivity does not support widespread use as a screening tool for sepsis. NEWS outperformed qSOFA for prediction of adverse outcomes and screening for sepsis.
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Affiliation(s)
| | - Christiane Rosin
- Department of Emergency Medicine, University Hospital Basel, Basel, Switzerland
| | - Roland Bingisser
- Department of Emergency Medicine, University Hospital Basel, Basel, Switzerland
| | - Christian H Nickel
- Department of Emergency Medicine, University Hospital Basel, Basel, Switzerland
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Prognostic Accuracy of Quick SOFA is different according to the severity of illness in infectious patients. J Infect Chemother 2019; 25:943-949. [PMID: 31182332 DOI: 10.1016/j.jiac.2019.05.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 04/25/2019] [Accepted: 05/15/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Sepsis-3 proposed the quick Sequential Organ Failure Assessment (qSOFA) to identify sepsis patients likely to have poor outcome. The clinical utility of qSOFA still remains controversial because its predictive accuracy for mortality is quite different across the validation studies. We hypothesized that one of the major causes for these controversial findings was the heterogeneity in severity across the studies, and evaluated the association between severity of illness and the prognostic accuracy of qSOFA. MATERIALS AND METHODS This was a post hoc analysis of a prospective nationwide cohort of consecutive adult patients with sepsis in 59 intensive care units in Japan. Regression trees analysis for survival was used to classify patients according to severity of illness as determined by SOFA score on registration. We conducted receiver operating characteristic (ROC) analyses and evaluated the differences in the area under the ROC curve (AUROC). As a subgroup analysis, we conducted the above evaluations in emergency department (ED) and non-ED patients separately. RESULTS We included 1114 patients fulfilling the criteria and classified them into three subsets according to severity. The AUROC for mortality was significantly different according to the severity of illness (p = 0.007), with the highest AUROC being in the low-severity subset (patients with SOFA score ≤ 7). Interestingly, our subgroup analysis revealed that a significant difference in the AUROC of qSOFA was observed only in ED patients. CONCLUSION This study suggested that lower severity of illness was associated with the relatively higher prognostic accuracy of qSOFA, especially in ED patients.
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Application of The Sepsis-3 Consensus Criteria in a Geriatric Acute Care Unit: A Prospective Study. J Clin Med 2019; 8:jcm8030359. [PMID: 30871231 PMCID: PMC6463250 DOI: 10.3390/jcm8030359] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 03/08/2019] [Accepted: 03/09/2019] [Indexed: 12/20/2022] Open
Abstract
The prognostic value of quick Sepsis-related Organ Failure Assessment (qSOFA) score in geriatric patients is uncertain. We aimed to compare qSOFA vs. Systemic Inflammatory Response Syndrome (SIRS) criteria for mortality prediction in older multimorbid subjects, admitted for suspected sepsis in a geriatric ward. We prospectively enrolled 272 patients (aged 83.7 ± 7.4). At admission, qSOFA and SIRS scores were calculated. Mortality was assessed during hospital stay and three months after discharge. The predictive capacity of qSOFA and SIRS was assessed by calculating the Area Under the Receiver Operating Characteristic Curve (AUROC), through pairwise AUROC comparison, and multivariable logistic regression analysis. Both qSOFA and SIRS exhibited a poor prognostic performance (AUROCs 0.676, 95% CI 0.609⁻0.738, and 0.626, 95% CI 0.558⁻0.691 for in-hospital mortality; 0.684, 95% CI 0.614⁻0.748, and 0.596, 95% CI 0.558⁻0.691 for pooled three-month mortality, respectively). The predictive capacity of qSOFA showed no difference to that of SIRS for in-hospital mortality (difference between AUROCs 0.05, 95% CI -0.05 to 0.14, p = 0.31), but was superior for pooled three-month mortality (difference between AUROCs 0.09, 95% CI 0.01⁻0.17, p = 0.029). Multivariable logistic regression analysis, accounting for possible confounders, including frailty, showed that both scores were not associated with in-hospital mortality, although qSOFA, unlike SIRS, was associated with pooled three-month mortality. In conclusion, neither qSOFA nor SIRS at admission were strong predictors of mortality in a geriatric acute-care setting. Traditional geriatric measures of frailty may be more useful for predicting adverse outcomes in this setting.
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Takauji S, Hayakawa M, Fujita S. A Nationwide Comparison Between Sepsis-2 and Sepsis-3 Definition in Japan. J Intensive Care Med 2019; 35:1389-1395. [PMID: 30636495 DOI: 10.1177/0885066618823151] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Currently, it remains controversial whether the Sepsis-3 definition provides the most appropriate criteria for clinical use. The purpose of this study was to compare between the Sepsis-2 and Sepsis-3 definitions using Japan's nationwide registry. METHODS Data were obtained from a multicenter registry conducted at 42 intensive care units (ICUs) throughout Japan, in which patients received treatment for severe sepsis or septic shock between January 2011 and December 2013. RESULTS A total of 2797 patients diagnosed using the Sepsis-2 criteria were included in the present study. These patients were categorized into "Severe sepsis" (n = 1154) and "Sepsis-2 shock" (n = 1643) groups. Among the "Sepsis-2 shock" group, patients who did not meet the Sepsis-3 criteria for septic shock were categorized into the "Sepsis-2 shock-only" (n = 448, 27.3%) group, while patients who met the Sepsis-3 criteria for septic shock were categorized into "Sepsis-3 shock (n = 1195, 72.7%)" group. The ICU mortality in the "Sepsis-3 shock" group, "Sepsis-2 shock-only" group, and "Severe sepsis" group was 28.5%, 10.9%, and 14.1%, respectively. We observed no significant difference between the "Severe sepsis" and "Sepsis-2 shock-only" groups in terms of in-hospital survival (P = .098), while the "Sepsis-3 shock" group had the highest in-hospital mortality rate (P < .001). In a multivariate logistic regression analysis, liver insufficiency and immunocompromised status were independent prognostic factors in the "Sepsis-2 shock-only" group. In contrast, chronic heart disease and chronic hemodialysis were independent prognostic factors in the "Sepsis-3 shock" group. CONCLUSIONS The ICU mortality of the "Sepsis-2 shock-only" group was significantly low. Besides septic shock diagnosed by the Sepsis-3 definition selects patients with more severe cases of sepsis among the "Sepsis-2 shock" group.
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Affiliation(s)
- Shuhei Takauji
- Department of Emergency Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Mineji Hayakawa
- Emergency and Critical Care Center, Hokkaido University Hospital, Sapporo, Japan
| | - Satoshi Fujita
- Department of Emergency Medicine, Asahikawa Medical University, Asahikawa, Japan
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Lo RSL, Leung LY, Brabrand M, Yeung CY, Chan SY, Lam CCY, Hung KKC, Graham CA. qSOFA is a Poor Predictor of Short-Term Mortality in All Patients: A Systematic Review of 410,000 Patients. J Clin Med 2019; 8:jcm8010061. [PMID: 30626160 PMCID: PMC6351955 DOI: 10.3390/jcm8010061] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 12/28/2018] [Accepted: 01/02/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND To determine the validity of the Quick Sepsis-Related Organ Failure Assessment (qSOFA) in the prediction of outcome (in-hospital and 1-month mortality, intensive care unit (ICU) admission, and hospital and ICU length of stay) in adult patients with or without suspected infections where qSOFA was calculated and reported; Methods: Cochrane Central of Controlled trials, EMBASE, BIOSIS, OVID MEDLINE, OVID Nursing Database, and the Joanna Briggs Institute EBP Database were the main databases searched. All studies published until 12 April 2018 were considered. All studies except case series, case reports, and conference abstracts were considered. Studies that included patients with neutropenic fever exclusively were excluded. RESULTS The median AUROC for in-hospital mortality (27 studies with 380,920 patients) was 0.68 (a range of 0.55 to 0.82). A meta-analysis of 377,623 subjects showed a polled AUROC of 0.68 (0.65 to 0.71); however, it also confirmed high heterogeneity among studies (I² = 98.8%, 95%CI 98.6 to 99.0). The median sensitivity and specificity for in-hospital mortality (24 studies with 118,051 patients) was 0.52 (range 0.16 to 0.98) and 0.81 (0.19 to 0.97), respectively. Median positive and negative predictive values were 0.2 (range 0.07 to 0.38) and 0.94 (0.85 to 0.99), respectively.
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Affiliation(s)
- Ronson S L Lo
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Hong Kong, China.
| | - Ling Yan Leung
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Hong Kong, China.
| | - Mikkel Brabrand
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Hong Kong, China.
- Department of Emergency Medicine, Hospital of South West Denmark, Finsensgade 35, DK-6700 Esbjerg, Denmark.
| | - Chun Yu Yeung
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Hong Kong, China.
| | - Suet Yi Chan
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Hong Kong, China.
| | - Cherry C Y Lam
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Hong Kong, China.
| | - Kevin K C Hung
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Hong Kong, China.
| | - Colin A Graham
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Hong Kong, China.
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Tan TL, Tang YJ, Ching LJ, Abdullah N, Neoh HM. Comparison of Prognostic Accuracy of the quick Sepsis-Related Organ Failure Assessment between Short- & Long-term Mortality in Patients Presenting Outside of the Intensive Care Unit - A Systematic Review & Meta-analysis. Sci Rep 2018; 8:16698. [PMID: 30420768 PMCID: PMC6232181 DOI: 10.1038/s41598-018-35144-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 10/30/2018] [Indexed: 12/29/2022] Open
Abstract
The purpose of this meta-analysis was to compare the ability of the qSOFA in predicting short- (≤30 days or in-hospital mortality) and long-term (>30 days) mortality among patients outside the intensive care unit setting. Studies reporting on the qSOFA and mortality were searched using MEDLINE and SCOPUS. Studies were included if they involved patients presenting to the ED with suspected infection and usage of qSOFA score for mortality prognostication. Data on qSOFA scores and mortality rates were extracted from 36 studies. The overall pooled sensitivity and specificity for the qSOFA were 48% and 86% for short-term mortality and 32% and 92% for long-term mortality, respectively. Studies reporting on short-term mortality were heterogeneous (Odd ratio, OR = 5.6; 95% CI = 4.6-6.8; Higgins's I2 = 94%), while long-term mortality studies were homogenous (OR = 4.7; 95% CI = 3.5-6.1; Higgins's I2 = 0%). There was no publication bias for short-term mortality analysis. The qSOFA score showed poor sensitivity but moderate specificity for both short and long-term mortality, with similar performance in predicting both short- and long- term mortality. Geographical region was shown to have nominal significant (p = 0.05) influence on qSOFA short-term mortality prediction.
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Affiliation(s)
- Toh Leong Tan
- Department of Emergency Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
- Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000, Cheras, Kuala Lumpur, Malaysia.
| | - Ying Jing Tang
- Department of Emergency Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000, Cheras, Kuala Lumpur, Malaysia
| | - Ling Jing Ching
- Department of Emergency Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000, Cheras, Kuala Lumpur, Malaysia
| | - Noraidatulakma Abdullah
- UKM Medical Molecular Biology Institute (UMBI), Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000, Cheras, Kuala Lumpur, Malaysia
| | - Hui-Min Neoh
- UKM Medical Molecular Biology Institute (UMBI), Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000, Cheras, Kuala Lumpur, Malaysia
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A Cabrita J, Pinheiro I, Menezes Falcão L. Rethinking the concept of sepsis and septic shock. Eur J Intern Med 2018; 54:1-5. [PMID: 29921471 DOI: 10.1016/j.ejim.2018.06.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 05/23/2018] [Accepted: 06/04/2018] [Indexed: 12/14/2022]
Abstract
Sepsis is a major global health problem and represents a challenge for physicians all over the world. The knowledge of sepsis and septic shock is a topic of interest among the scientific community and society in general. New guidelines for management of sepsis and septic shock were developed in 2016, providing an update on this area. In Sepsis-3 new definitions for sepsis and septic shock were published. The purpose of this narrative review is to discuss and compare the new criteria of 2016 with the old criteria, purposing at the same time an alternative approach for this topic. SOFA criteria (Sequential Organ Failure Assessment Score) are more complete, but too extensive and usually difficult to apply outside the intensive care units, therefore inducing potentially delay in the proper treatment. We purpose combined criteria for the selection of sepsis patients. Initially, we could apply qSOFA (quick Sepsis Related Organ Failure Assessment) criteria, due to its easy application, associated with the SIRS (systemic inflammatory response syndrome) criteria, allowing to select the patients who are infected and need faster treatment. In that way we would use the best of old and newest criteria, allowing the early selection of patients who are infected and require faster treatment, while the search for a better and faster tool continues.
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Affiliation(s)
| | | | - L Menezes Falcão
- Hospital de Santa Maria/CHLN, Portugal; Faculdade de Medicina de Lisboa, Portugal.
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Maitra S, Som A, Bhattacharjee S. Accuracy of quick Sequential Organ Failure Assessment (qSOFA) score and systemic inflammatory response syndrome (SIRS) criteria for predicting mortality in hospitalized patients with suspected infection: a meta-analysis of observational studies. Clin Microbiol Infect 2018; 24:1123-1129. [PMID: 29605565 DOI: 10.1016/j.cmi.2018.03.032] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 03/13/2018] [Accepted: 03/20/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To identify sensitivity, specificity and predictive accuracy of quick sequential organ failure assessment (qSOFA) score and systemic inflammatory response syndrome (SIRS) criteria to predict in-hospital mortality in hospitalized patients with suspected infection. METHODS This meta-analysis followed the Meta-analysis of Observational Studies in Epidemiology (MOOSE) group consensus statement for conducting and reporting the results of systematic review. PubMed and EMBASE were searched for the observational studies which reported predictive utility of qSOFA score for predicting mortality in patients with suspected or proven infection with the following search words: 'qSOFA', 'q-SOFA', 'quick-SOFA', 'Quick Sequential Organ Failure Assessment', 'quick SOFA'. Sensitivity, specificity, area under receiver operating characteristic (ROC) curves with 95% confidence interval (CI) of qSOFA and SIRS criteria for predicting in-hospital mortality was collected for each study and a 2 × 2 table was created for each study. RESULTS Data of 406 802 patients from 45 observational studies were included in this meta-analysis. Pooled sensitivity (95% CI) and specificity (95% CI) of qSOFA ≥2 for predicting mortality in patients who were not in an intensive care unit (ICU) was 0.48 (0.41-0.55) and 0.83 (0.78-0.87), respectively. Pooled sensitivity (95% CI) of qSOFA ≥2 for predicting mortality in patients (both ICU and non-ICU settings) with suspected infection was 0.56 (0.47-0.65) and pooled specificity (95% CI) was 0.78 (0.71-0.83). CONCLUSION qSOFA has been found to be a poorly sensitive predictive marker for in-hospital mortality in hospitalized patients with suspected infection. It is reasonable to recommend developing another scoring system with higher sensitivity to identify high-risk patients with infection.
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Affiliation(s)
- S Maitra
- Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - A Som
- Department of Anaesthesiology, MAMBS, Max Super Specialty Hospital, Saket, New Delhi, India.
| | - S Bhattacharjee
- Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, New Delhi, India
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