Prognostic accuracy of SIRS criteria, qSOFA score and GYM score for 30-day-mortality in older non-severely dependent infected patients attended in the emergency department

There are many clinical scoring systems that measure the severity in sepsis and septic shock. Therefore, our study aims to calculate prognostic accuracy of commonly used scoring system SOFA and qSOFA in emergency department as a predictor of mortality among sepsis patients.This was prospective observational study conducted in an emergency department for a period of seven months. 156 patients were studied and descriptive statistical analysis was done. The most common source of infection was respiratory. A positive and moderate correlation was seen between initial SOFA score and qSOFA score. The AUC of SOFA score and qSOFA for predicting the mortality were 0.978 and 0.886 with sensitivity of 96.9% and specificty of 57% for SOFA and sensitivity of 96.9% and specificity of 76.1% for qSOFA.SOFA and qSOFA both proved to be similar as a simple prognostic tool with discriminatory capacity in predicting prognosis in septic patient presenting to emergency department.

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Prognostic accuracy of qSOFA in predicting 28-day mortality among infected patients in an emergency department: a prospective validation study

Emergency Medicine Journal ◽

10.1136/emermed-2019-208456 ◽

2019 ◽

pp. emermed-2019-208456

Author(s):

S M Osama Bin Abdullah ◽

Rune Husås Sørensen ◽

Ram Benny Christian Dessau ◽

Saifullah Muhammed Rafid Us Sattar ◽

Lothar Wiese ◽

...

Keyword(s):

Emergency Department ◽

Predictive Value ◽

Characteristic Curve ◽

Likelihood Ratios ◽

Registration System ◽

Civil Registration ◽

Prognostic Accuracy ◽

Observational Cohort ◽

Sensitivity Specificity ◽

Sirs Criteria

BackgroundFew prospective studies have evaluated the quick Sequential (Sepsis-Related) Organ Failure Assessment (qSOFA) criteria in emergency department (ED)settings. The aim of this study was to determine the prognostic accuracy of qSOFA compared with systemic inflammatory response syndrome (SIRS) in predicting the 28-day mortality of infected patients admitted to an ED.MethodsA prospective observational cohort study of all adult (≥18 years) infected patients admitted to the ED of Slagelse Hospital, Denmark, was conducted from 1 October 2017 to 31 March 2018. Patients were enrolled consecutively and data related to SIRS and qSOFA criteria were obtained from electronic triage record. Information regarding mortality was obtained from the Danish Civil Registration System. The original cut-off values of ≥2 was used to determine the prognostic accuracy of SIRS and qSOFA criteria for predicting 28-day mortality and was assessed by analyses of sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratios and area under the receiver operating characteristic curve (AUROC) with 95% confidence intervals (CI).ResultsA total of 2112 patients were included in this study. A total of 175 (8.3%) patients met at least two qSOFA criteria, while 1012 (47.9%) met at least two SIRS criteria on admission. A qSOFA criteria of at least two for predicting 28-day mortality had a sensitivity of 19.5% (95% CI 13.6% to 26.5%) and a specificity of 92.6% (95% CI 91.4% to 93.7%). A SIRS criteria of at least two for predicting 28-day mortality had a sensitivity of 52.8% (95% CI 44.8% to 60.8%) and a specificity of 52.5% (95% CI 50.2% to 54.7%). The AUROC values for qSOFA and SIRS were 0.63 (95% CI 0.59 to 0.67) and 0.52 (95% CI 0.48 to 0.57), respectively.ConclusionBoth SIRS and qSOFA had poor sensitivity for 28-day mortality. qSOFA improved the specificity at the expense of the sensitivity resulting in slightly higher prognostic accuracy overall.

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Prognostic accuracy of qSOFA score for in-hospital mortality among influenza patients in the emergency department

10.21203/rs.3.rs-17308/v1 ◽

2020 ◽

Author(s):

Sheng-En Chu ◽

Chen-June Seak ◽

Tse‐Hsuan Su ◽

Chung-Hsien Chaou ◽

Hsiao-Jung Tseng ◽

...

Keyword(s):

Emergency Department ◽

Hospital Mortality ◽

Influenza Pandemic ◽

Characteristic Curve ◽

Poor Performance ◽

Rapid Screening ◽

Public Health Issue ◽

Research Database ◽

Prognostic Accuracy ◽

Qsofa Score

Abstract Background The annual seasonal influenza pandemic is an important public health issue around the world. Early prediction of patients with potentially worse outcome is important in the emergency department (ED). However, a simple and accurate predictor is yet to be developed. In this study, we aimed to investigate the effectiveness of the quick Sequential Organ Failure Assessment (qSOFA) score as a prognostic predictor of patients with influenza in the ED. Methods This is a single-center, retrospective cohort study. All the data were retrieved from a hospital-based research database. Adult patients (age ≥ 18 at admission) with a positive influenza rapid screening test or a positive influenza virus polymerase chain reaction (PCR) from 2010 to 2016 were enrolled for data analysis. qSOFA score and Systemic Inflammatory Response Syndrome (SIRS) in the ED were both collected. The primary outcome was the utility of each score in predicting in-hospital mortality. ResultsIn the study period, 3,561 patients met the inclusion criteria. The overall in-hospital mortality was 2.7% (95 patients). When the qSOFA score was 0, 1, 2, and 3, the percentage of in-hospital mortality was 0.6%, 7.2%, 15.9%, and 25%, respectively. Accordingly, the odds ratios were 7.72, 11.92, and 22.46, respectively. The sensitivity and specificity when qSOFA score ≥ 2 was 24% and 96.2%, respectively. The area under depicted receiver operating characteristic curve (AUC) was 0.864, which is significantly higher than with SIRS criteria, where the AUC was 0.786 (p < 0.01). Conclusions The qSOFA score is a useful prognostic tool for influenza and can be applied in the ED. However, it might not be a good screening triage tool because of poor sensitivity to detect high-risk patients. The SIRS score had poor performance in influenza to predict outcomes. Further studies should be performed to define its role in influenza.

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Prognostic accuracy of SIRS criteria and qSOFA score for in-hospital mortality among influenza patients in the emergency department

10.21203/rs.3.rs-17308/v2 ◽

2020 ◽

Author(s):

Sheng-En Chu ◽

Chen-June Seak ◽

Tse‐Hsuan Su ◽

Chung-Hsien Chaou ◽

Hsiao-Jung Tseng ◽

...

Keyword(s):

Emergency Department ◽

Hospital Mortality ◽

Primary Outcome ◽

Viral Infections ◽

Characteristic Curve ◽

Predictive Performance ◽

Public Health Issue ◽

Research Database ◽

Qsofa Score ◽

Sirs Criteria

Abstract Background: The seasonal influenza epidemic is an important public health issue worldwide. Early predictive identification of patients with potentially worse outcome is important in the emergency department (ED). Similarly as with bacterial infection, influenza can cause sepsis. This study was conducted to investigate the effectiveness of the Systemic Inflammatory Response Syndrome (SIRS) criteria and the quick Sequential Organ Failure Assessment (qSOFA) score as prognostic predictors for ED patients with influenza.Methods: This single-center, retrospective cohort study investigated data that was retrieved from a hospital-based research database. Adult ED patients (age ≥18 at admission) with laboratory-proven influenza from 2010 to 2016 were included for data analysis. The initial SIRS and qSOFA scores were both collected. The primary outcome was the utility of each score in the prediction of in-hospital mortality. Results: For the study period, 3,561 patients met the study inclusion criteria. The overall in-hospital mortality was 2.7% (95 patients). When the qSOFA scores were 0, 1, 2, and 3, the percentages of in-hospital mortality were 0.6%, 7.2%, 15.9%, and 25%, respectively. Accordingly, the odds ratios (ORs) were 7.72, 11.92, and 22.46, respectively. The sensitivity and specificity was 24% and 96.2%, respectively, when the qSOFA score was ≥2. However, the SIRS criteria showed no significant associations with the primary outcome. The area under the receiver operating characteristic curve (AUC) was 0.864, which is significantly higher than that with SIRS, where the AUC was 0.786 (P < 0.01).Conclusions: The qSOFA score potentially is a useful prognostic predictor for influenza and could be applied in the ED as a risk stratification tool. However, qSOFA may not be a good screening tool for triage because of its poor sensitivity. The SIRS criteria showed poor predictive performance in influenza for mortality as an outcome. Further research is needed to determine the role of these predictive tools in influenza and in other viral infections.

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Predicting mortality in adult patients with sepsis in the emergency department by using combinations of biomarkers and clinical scoring systems: a systematic review

BMC Emergency Medicine ◽

10.1186/s12873-021-00461-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Kirby Tong-Minh ◽

Iris Welten ◽

Henrik Endeman ◽

Tjebbe Hagenaars ◽

Christian Ramakers ◽

...

Keyword(s):

Systematic Review ◽

Emergency Department ◽

Scoring System ◽

Early Stage ◽

Area Under The Curve ◽

Scoring Systems ◽

Simplified Acute Physiology Score ◽

Prognostic Accuracy ◽

Clinical Scoring ◽

Qsofa Score

Abstract Background Sepsis can be detected in an early stage in the emergency department (ED) by biomarkers and clinical scoring systems. A combination of multiple biomarkers or biomarker with clinical scoring system might result in a higher predictive value on mortality. The goal of this systematic review is to evaluate the available literature on combinations of biomarkers and clinical scoring systems on 1-month mortality in patients with sepsis in the ED. Methods We performed a systematic search using MEDLINE, EMBASE and Google Scholar. Articles were included if they evaluated at least one biomarker combined with another biomarker or clinical scoring system and reported the prognostic accuracy on 28 or 30 day mortality by area under the curve (AUC) in patients with sepsis. We did not define biomarker cut-off values in advance. Results We included 18 articles in which a total of 35 combinations of biomarkers and clinical scoring systems were studied, of which 33 unique combinations. In total, seven different clinical scoring systems and 21 different biomarkers were investigated. The combination of procalcitonin (PCT), lactate, interleukin-6 (IL-6) and Simplified Acute Physiology Score-2 (SAPS-2) resulted in the highest AUC on 1-month mortality. Conclusion The studies we found in this systematic review were too heterogeneous to conclude that a certain combination it should be used in the ED to predict 1-month mortality in patients with sepsis. Future studies should focus on clinical scoring systems which require a limited amount of clinical parameters, such as the qSOFA score in combination with a biomarker that is already routinely available in the ED.

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