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Gysling S, Shanmuganathan S, Szafranek A, Stewart ID, Caruana EJ. Validation of NEWS2, SIRS, and qSOFA in Postoperative Cardiac Patients: A Retrospective Cohort Study. J Surg Res 2024; 293:364-372. [PMID: 37806223 DOI: 10.1016/j.jss.2023.08.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 07/31/2023] [Accepted: 08/26/2023] [Indexed: 10/10/2023]
Abstract
INTRODUCTION The 'quick Sepsis Related Organ Failure Assessment' (qSOFA), 'Systemic Inflammatory Response Syndrome' (SIRS), and 'National Early Warning Score' 2 (NEWS2) scores are yet to be comparatively validated in ward-based cardiac surgical patients despite widespread routine use in clinical practice. We sought to assess the predictive validity of NEWS, SIRS, and qSOFA in identifying postoperative, ward-level cardiac surgical patients at risk of poor short-term mortality. METHODS All adult patients who underwent cardiac surgery at a single tertiary center between November 2014 and October 2017 were identified. Data for bedside observations, hematological results, and microbiology requests were obtained from electronic health records. Survival data were acquired from a national registry. The primary outcome was the discriminatory ability, measured by the area under the receiver operating characteristic (AUROC), of each score for in-hospital mortality. RESULTS One thousand five hundred forty three (male n = 1101, 71%) patients were included. Overall in-hospital mortality was 2.4%. There was no significant difference in discriminatory ability of NEWS (AUROC 0.5060), SIRS (AUROC 0.4874), and qSOFA (AUROC 0.5139) for in-hospital mortality (P = 0.881). Sensitivity for this outcome was ubiquitously low (13.51-40.54%). CONCLUSIONS Current illness-severity scores show a low discriminatory ability for in-hospital mortality in ward-based cardiac surgical patients. Caution should be used in the application of these prognostic screening tools for early detection of poor outcomes in this population.
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Affiliation(s)
- Savannah Gysling
- Academic Colorectal Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK.
| | | | - Adam Szafranek
- Cardiac Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Iain D Stewart
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Edward J Caruana
- Thoracic Surgery, University Hospitals of Leicester NHS Trust, Leicester, UK
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Sricharoen P, Chueluecha C, Yuksen C, Jenpanitpong C. The Use of qSOFA, SOFA, and Ramathibodi Early Warning Score (REWS) to Predict Severe Complications in Hematologic Malignancy Patients. Open Access Emerg Med 2022; 14:51-61. [PMID: 35153518 PMCID: PMC8827160 DOI: 10.2147/oaem.s345308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 01/26/2022] [Indexed: 11/23/2022] Open
Abstract
Background Sepsis causes high mortality in vulnerable groups such as hematologic malignancy (HM) patients. There are various early warning scores of sepsis, eg, qSOFA, SOFA, and Ramathibodi Early Warning Score (REWS). This study aimed to compare REWS, qSOFA, and SOFA in predicting severe complications in hematologic malignancy patients visiting ED. Methods The study was conducted as a retrospective cohort study at the ED of Ramathibodi Hospital, Bangkok, Thailand. Adult HM patients suspected of sepsis and have visited ED between March 2016 and December 2019. Results Among 124 patients in our cohort, 51 (41%) had serious complication in ED and 20 (16%) died within 28 days after admission. The AUROCs of SOFA and qSOFA indicate significantly higher predicting in serious complication in ED than REWS (SOFA, 0.81 [95% CI, 0.73–0.89], qSOFA, 0.73 [95% CI, 0.65–0.81], REWS, 0.62 [95% CI, 0.52–0.72] p=0.004) while the predicting in 28-day mortality is not statistically significantly different (SOFA, 0.73 [95% CI, 0.60–0.85], qSOFA, 0.69 [95% CI, 0.58–0.80], REWS, 0.60 [95% CI, 0.44–0.75] p=0.25). Conclusion The SOFA score is highest in predicting severe complications among hematologic malignancy patients.
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Affiliation(s)
- Pungkava Sricharoen
- Department of Emergency Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chaithawat Chueluecha
- Department of Emergency Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chaiyaporn Yuksen
- Department of Emergency Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Correspondence: Chaiyaporn Yuksen, Department of Emergency Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand, Email
| | - Chetsadakon Jenpanitpong
- Department of Emergency Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Kashyap R, Sherani KM, Dutt T, Gnanapandithan K, Sagar M, Vallabhajosyula S, Vakil AP, Surani S. Current Utility of Sequential Organ Failure Assessment Score: A Literature Review and Future Directions. Open Respir Med J 2021; 15:1-6. [PMID: 34249175 PMCID: PMC8227444 DOI: 10.2174/1874306402115010001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 12/13/2020] [Accepted: 01/13/2021] [Indexed: 02/08/2023] Open
Abstract
The Sequential Organ Failure Assessment (SOFA) score is commonly used in the Intensive Care Unit (ICU) to evaluate, prognosticate and assess patients. Since its validation, the SOFA score has served in various settings, including medical, trauma, surgical, cardiac, and neurological ICUs. It has been a strong mortality predictor and literature over the years has documented the ability of the SOFA score to accurately distinguish survivors from non-survivors on admission. Over the years, multiple variations have been proposed to the SOFA score, which have led to the evolution of alternate validated scoring models replacing one or more components of the SOFA scoring system. Various SOFA based models have been used to evaluate specific clinical populations, such as patients with cardiac dysfunction, hepatic failure, renal failure, different races and public health illnesses, etc. This study is aimed to conduct a review of modifications in SOFA score in the past several years. We review the literature evaluating various modifications to the SOFA score such as modified SOFA, Modified SOFA, modified Cardiovascular SOFA, Extra-renal SOFA, Chronic Liver Failure SOFA, Mexican SOFA, quick SOFA, Lactic acid quick SOFA (LqSOFA), SOFA in hematological malignancies, SOFA with Richmond Agitation-Sedation scale and Pediatric SOFA. Various organ systems, their relevant scoring and the proposed modifications in each of these systems are presented in detail. There is a need to incorporate the most recent literature into the SOFA scoring system to make it more relevant and accurate in this rapidly evolving critical care environment. For future directions, we plan to put together most if not all updates in SOFA score and probably validate it in a large database a single institution and validate it in multisite data base.
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Affiliation(s)
- Rahul Kashyap
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Khalid M Sherani
- Department of Internal Medicine, Jamaica Hospital Medical Center, Jamaica, NY 11418, USA.,Corpus Christi Medical Center, Corpus Christi, TX 78411, USA
| | - Taru Dutt
- Department of Neurology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester MN, USA and Hennepin County Medical Center, Minneapolis, MN 55905, USA
| | - Karthik Gnanapandithan
- Department of Internal Medicine, Yale-New Haven Hospital and Yale University School of Medicine, New Haven, CT 06510, USA
| | - Malvika Sagar
- Department of Pediatrics, McLane Children's Hospital, Baylor Scott and White Health, Temple, TX 76502, USA
| | | | - Abhay P Vakil
- Department of Pediatrics, McLane Children's Hospital, Baylor Scott and White Health, Temple, TX 76502, USA.,Critical Care Medicine, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Salim Surani
- Corpus Christi Medical Center, Corpus Christi, TX 78411, USA.,Texas A&M University System Health Science Center, Bryan, TX 77807, USA
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Zduniak A, Mihailescu SD, Lequesne J, Lenain P, Contentin N, Pepin LF, Ménard AL, Leprêtre S, Lemasle E, Lanic H, Stamatoullas-Bastard A, Tilly H, Tamion F, Jardin F, Camus V. Outcomes after intensive care unit admission in newly diagnosed diffuse large B-cell lymphoma patients: A real-life study. Eur J Haematol 2021; 106:788-799. [PMID: 33624346 DOI: 10.1111/ejh.13606] [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: 11/05/2020] [Accepted: 02/22/2021] [Indexed: 12/18/2022]
Abstract
We conducted a retrospective study to analyze the prognostic factors impacting the overall survival (OS) and progression-free survival (PFS) of diffuse large B-cell lymphoma (DLBCL) patients undergoing first-line therapy and admitted to intensive care unit (ICU) compared to a control cohort who did not required ICU admission. Between January 1, 2008, and December 31, 2018, 828 patients were diagnosed with DLBCL at our institution, including 72 patients who were required ICU admission during disease course. Among them, forty-five patients undergoing homogeneous first-line therapy with /R-CHOP-like regimen and ICU-admitted were selected for the present analysis. Control "non-ICU" DLBCL patients were matched by age, IPI score and treatment received. The median age at ICU admission was 65 years, 97.8% of patients displayed advanced-stage disease (III/IV), and 84.4% had a high IPI score (3-5). The main reasons for ICU admission were acute respiratory failure (40.0%) and septic shock (33.3%). The ICU mortality rate was 33.3%. The 2-year PFS was lower in ICU survivors patients than in non-ICU patients: 31.7% (95% CI 18.5-54.1) vs 60.8% (95% CI 51.2-72.1, P = .00049). Admission to the ICU is an event that clearly impacts the outcomes of patients with DLBCL, until 2 years after the event. ICU prognosis seems mainly related to critical patient severity at admission rather than lymphoma-related prognostic factors (IPIs), suggesting that ICU admission criteria should not be based only on the lymphoma prognosis.
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Affiliation(s)
| | - Sorina-Dana Mihailescu
- Department of Statistics and Clinical Research Unit, Centre Henri Becquerel, Rouen, France
| | - Justine Lequesne
- Department of Statistics and Clinical Research Unit, Centre Henri Becquerel, Rouen, France
| | - Pascal Lenain
- Department of Hematology, Centre Henri Becquerel, Rouen, France
| | | | - Louis-Ferdinand Pepin
- Department of Statistics and Clinical Research Unit, Centre Henri Becquerel, Rouen, France
| | | | | | - Emilie Lemasle
- Department of Hematology, Centre Henri Becquerel, Rouen, France
| | - Hélène Lanic
- Department of Hematology, Centre Henri Becquerel, Rouen, France
| | | | - Hervé Tilly
- Department of Hematology, Centre Henri Becquerel, Rouen, France
| | - Fabienne Tamion
- Intensive Care Unit, Charles Nicolle University Hospital, Rouen, France
| | - Fabrice Jardin
- Department of Hematology, Centre Henri Becquerel, Rouen, France
| | - Vincent Camus
- Department of Hematology, Centre Henri Becquerel, Rouen, France
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Bader MZ, Obaid AT, Al-Khateb HM, Eldos YT, Elaya MM. Developing Adult Sepsis Protocol to Reduce the Time to Initial Antibiotic Dose and Improve Outcomes among Patients with Cancer in Emergency Department. Asia Pac J Oncol Nurs 2020; 7:355-360. [PMID: 33062830 PMCID: PMC7529030 DOI: 10.4103/apjon.apjon_32_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 04/17/2020] [Indexed: 12/01/2022] Open
Abstract
Objective: Sepsis is a common cause of noncancer-related deaths among oncology patients. Delay in the initiation of efficient antimicrobial therapy will decrease the survival rate. This study aims to develop a sepsis protocol for adult oncology patients to decrease the time needed to receive the initial dose of antibiotic in an emergency department (ED), improve the early recognition of sepsis, and decrease the in-hospital mortality rate due to sepsis. Methods: A quasi-experimental research design was used. A total of 168 participants were assigned into pre- and post-intervention groups (n = 85) and (n = 83), respectively. The quick Sequential Organ Failure Assessment screening tool was used to screen patients in the triage room. Results: There was a significant difference in the proportions of receiving the initial antibiotic dose whether ≤1 h or >1 h between pre- and post-intervention groups. The results also showed that 89.4% of the postintervention group received their initial antibiotic dose in <1 h compared with 10.8% of the preintervention group. The median time needed for administering the initial antibiotic dose was decreased from 95 min to 45 min. The results of the changes in mortality rates are promising as it decreased 11.7% after applying the adult sepsis protocol. Conclusions: Applying an adult sepsis protocol in the ED significantly decreased the time needed to initiate antibiotic treatment. It is recommended to utilize a multidisciplinary and systematic approach in screening and treating sepsis.
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Affiliation(s)
- Mustafa Z Bader
- Department of Nursing, King Hussein Cancer Center, Amman, Jordan
| | - Abdullah T Obaid
- Department of Nursing, King Hussein Cancer Center, Amman, Jordan
| | | | | | - Moath M Elaya
- Department of Nursing, King Hussein Cancer Center, Amman, Jordan
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Shimada Y, Kawasaki Y, Nasu R, Nakamura F, Maruoka Y. Screening for dental focal infections in febrile patients with hematologic malignancies who received chemotherapy: a retrospective cohort study. Glob Health Med 2020; 2:255-258. [PMID: 33330816 DOI: 10.35772/ghm.2019.01034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 04/21/2020] [Accepted: 05/07/2020] [Indexed: 11/08/2022]
Abstract
Source of fever in chemotherapy patients is often unknown. Fever can also be fatal. No observational studies have determined the incidence of dental focal infection (DFI)-associated fever, despite oral cavity being a potential source of infection. We report the incidence of fever after chemotherapy in patients with hematological malignancies and their association with DFIs in 441 patients visiting our institution during a 6-year period. Dental treatments, including tooth extraction, were performed, and their oral and hematological profiles were monitored after chemotherapy. Fever was evident in 87 (38.5%) of 226 patients (≥ 38˚C) after the first cycle of chemotherapy. Sepsis due to DFIs (n = 4; 4.6%) was evaluated. Chemotherapy was delayed due to DFI in one case. Fever after chemotherapy should be differentiated from oral infections. Our study emphasizes the significance of DFI in patients with fever after chemotherapy and can help in improving the prognosis of patients.
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Affiliation(s)
- Yasuyuki Shimada
- Department of Oral and Maxillofacial Surgery, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yohei Kawasaki
- Biostatistics Section, Clinical Research Center, Chiba University Hospital, Chiba, Japan.,Faculty of Nursing, Japanese Red Cross College of Nursing, Tokyo, Japan
| | - Ryo Nasu
- Department of Hematology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Fumihiko Nakamura
- Department of Hematology, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yutaka Maruoka
- Department of Oral and Maxillofacial Surgery, National Center for Global Health and Medicine, Tokyo, Japan.,Department of Oral and Maxillofacial Surgery, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
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Lambden S, Laterre PF, Levy MM, Francois B. The SOFA score-development, utility and challenges of accurate assessment in clinical trials. Crit Care 2019; 23:374. [PMID: 31775846 PMCID: PMC6880479 DOI: 10.1186/s13054-019-2663-7] [Citation(s) in RCA: 391] [Impact Index Per Article: 78.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 10/29/2019] [Indexed: 12/29/2022] Open
Abstract
The Sequential Organ Failure Assessment or SOFA score was developed to assess the acute morbidity of critical illness at a population level and has been widely validated as a tool for this purpose across a range of healthcare settings and environments.In recent years, the SOFA score has become extensively used in a range of other applications. A change in the SOFA score of 2 or more is now a defining characteristic of the sepsis syndrome, and the European Medicines Agency has accepted that a change in the SOFA score is an acceptable surrogate marker of efficacy in exploratory trials of novel therapeutic agents in sepsis. The requirement to detect modest serial changes in a patients' SOFA score therefore means that increased clarity on how the score should be assessed in different circumstances is required.This review explores the development of the SOFA score, its applications and the challenges associated with measurement. In addition, it proposes guidance designed to facilitate the consistent and valid assessment of the score in multicentre sepsis trials involving novel therapeutic agents or interventions.ConclusionThe SOFA score is an increasingly important tool in defining both the clinical condition of the individual patient and the response to therapies in the context of clinical trials. Standardisation between different assessors in widespread centres is key to detecting response to treatment if the SOFA score is to be used as an outcome in sepsis clinical trials.
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Affiliation(s)
- Simon Lambden
- Department of Medicine, Addenbrooke's Hospital, University of Cambridge, Cambridge, CB20Q, UK
| | - Pierre Francois Laterre
- St Luc University Hospital, Université Catholique de Louvain, Avenue Hippocrate 12, 1200, Brussels, Belgium
| | - Mitchell M Levy
- Rhode Island Hospital, Alpert Medical School, Brown University, Providence, RI, USA
| | - Bruno Francois
- Intensive care unit & Inserm CIC 1435 & Inserm UMR 1092, Dupuytren University Hospital, Limoges, France.
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Demandt AMP, Geerse DA, Janssen BJP, Winkens B, Schouten HC, van Mook WNKA. The prognostic value of a trend in modified SOFA score for patients with hematological malignancies in the intensive care unit. Eur J Haematol 2017; 99:315-322. [PMID: 28656589 DOI: 10.1111/ejh.12919] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2017] [Indexed: 01/17/2023]
Abstract
BACKGROUND Patients with hematological malignancies admitted to an intensive care unit (ICU) have a poor prognosis. The Sequential Organ Failure Assessment (SOFA) score is used to monitor patients on the ICU. Little is known about the value of this score in hematology patients. Therefore, the prognostic value of the SOFA score and a modified hematological SOFA score (SOFAhem) was studied. METHODS Patients with hematological malignancies admitted to the ICU between 1999 and 2009 were analyzed in a retrospective cohort study. The SOFAhem score was defined as the original SOFA score omitting the coagulation and neurological parameters. RESULTS In 149 admissions, ICU mortality was 52%. Mortality was significantly associated with higher SOFA and SOFAhem scores on admission, and trend in SOFAhem scores. An unchanged and increased SOFAhem score compared to decreasing SOFAhem scores was associated with a higher mortality rate (53% resp 67% resp 25%). CONCLUSIONS Trends in SOFA or SOFAhem score are both suitable as prognostic parameter. The trend in SOFAhem score seems to be independently related to mortality in hematological patients admitted to the ICU, and because of the higher odds ratios and lower P-values compared to the SOFA score, it is probably stronger related to mortality than the classical score, but its prognostic value should be tested in a larger cohort.
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Affiliation(s)
- Astrid M P Demandt
- Division of Hematology, Department of Internal Medicine, GROW, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Daniël A Geerse
- Division of Nephrology, Department of Internal Medicine, Bravis Hospital, Roosendaal, The Netherlands
| | - Bram J P Janssen
- Department of Anaesthesiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Bjorn Winkens
- Department of Methodology and Statistics, CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Harry C Schouten
- Division of Hematology, Department of Internal Medicine, GROW, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Walther N K A van Mook
- Department of Intensive Care Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
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