Comparison of QSOFA score and SIRS criteria as screening mechanisms for emergency department sepsis

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

BMC Infectious Diseases ◽

10.1186/s12879-020-05102-7 ◽

2020 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Sheng-En Chu ◽

Chen-June Seak ◽

Tse-Hsuan Su ◽

Chung-Hsien Chaou ◽

Hsiao-Jung Tseng ◽

...

Keyword(s):

Emergency Department ◽

Hospital Mortality ◽

Prognostic Accuracy ◽

Qsofa Score ◽

Sirs Criteria

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Diverticular Disease of the Appendix Is Associated with Complicated Appendicitis

GE Portuguese Journal of Gastroenterology ◽

10.1159/000511822 ◽

2020 ◽

pp. 1-7

Author(s):

Ming Li Chia ◽

Shaun Wen Yang Chan ◽

Vishal G. Shelat

Keyword(s):

Diverticular Disease ◽

Clinical Pathology ◽

Vermiform Appendix ◽

Complicated Appendicitis ◽

Perioperative Outcomes ◽

Alvarado Score ◽

Single Center Experience ◽

Modified Alvarado Score ◽

Qsofa Score ◽

Sirs Criteria

Introduction: Diverticular disease of the vermiform appendix (DDA) has an incidence of 0.004 to 2.1% in appendicectomy specimens. DDA is variably associated with perforation and malignancy. We report a single-center experience of DDA. The primary aim is to validate the association of DDA with complicated appendicitis or malignancy, and the secondary aim is to validate systemic inflammatory response syndrome (SIRS) criteria and quick Sepsis-related Organ Failure Assessment (qSOFA) scores. Methods: The histopathology reports of 2,305 appendicectomy specimens from January 2011 to December 2015 were reviewed. Acute appendicitis was found in 2,164 (93.9%) specimens. Histology of the remaining 141 (6.1%) patients revealed: normal appendix (n = 110), DDA (n = 22), endometriosis of appendix (n = 6), and an absent appendix (n = 3). Patient demographics, clinical profile, operative data, and perioperative outcomes of DDA patients are studied. Modified Alvarado score, Andersson score, SIRS criteria, and qSOFA scores were retrospectively calculated. Results: The incidence of DDA was 0.95%. Ten patients (45.5%) had diverticulitis. The mean age of DDA patients was 39.5 years (range 23–87), with male preponderance (n = 12, 54.5%). The median Modified Alvarado score was 8 (range 4–9), and the median Andersson score was 5 (range 2–8). Fourteen patients (63.6%) had SIRS, and none had a high qSOFA score. Eight patients (36.4%) had complicated appendicitis (perforation [n = 2] or abscess [n = 6]). Eleven (50%) patients underwent laparoscopic appendicectomy. There were three 30-day readmissions and no mortality. Conclusion: DDA is a distinct clinical pathology associated with complicated appendicitis.

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Mortality risk prediction in lupus patients complicated with invasive infection in the emergency department: LUPHAS score

Therapeutic Advances in Musculoskeletal Disease ◽

10.1177/1759720x19885559 ◽

2019 ◽

Vol 11 ◽

pp. 1759720X1988555 ◽

Cited By ~ 1

Author(s):

Wanlong Wu ◽

Jun Ma ◽

Yuhong Zhou ◽

Chao Tang ◽

Feng Zhao ◽

...

Keyword(s):

Emergency Department ◽

Prediction Model ◽

Risk Score ◽

Roc Curve ◽

Curve Analysis ◽

Multivariable Logistic Regression Analysis ◽

Invasive Infection ◽

Roc Curve Analysis ◽

All Cause Mortality ◽

Qsofa Score

Background: Infection remains a major cause of morbidity and mortality in patients with systemic lupus erythematosus (SLE). This study aimed to establish a clinical prediction model for the 3-month all-cause mortality of invasive infection events in patients with SLE in the emergency department. Methods: SLE patients complicated with invasive infection admitted into the emergency department were included in this study. Patient’s demographic, clinical, and laboratory characteristics on admission were retrospectively collected as baseline data and compared between the deceased and the survivors. Independent predictors were identified by multivariable logistic regression analysis. A prediction model for all-cause mortality was established and evaluated by receiver operating characteristic (ROC) curve analysis. Results: A total of 130 eligible patients were collected with a cumulative 38.5% 3-month mortality. Lymphocyte count <800/ul, urea >7.6mmol/l, maximum prednisone dose in the past ⩾60 mg/d, quick Sequential Organ Failure Assessment (qSOFA) score, and age at baseline were independent predictors for all-cause mortality (LUPHAS). In contrast, a history of hydroxychloroquine use was protective. In a combined, odds ratio-weighted LUPHAS scoring system (score 3–22), patients were categorized to three groups: low-risk (score 3–9), medium-risk (score 10–15), and high-risk (score 16–22), with mortalities of 4.9% (2/41), 45.9% (28/61), and 78.3% (18/23) respectively. ROC curve analysis indicated that a LUPHAS score could effectively predict all-cause mortality [area under the curve (AUC) = 0.86, CI 95% 0.79–0.92]. In addition, LUPHAS score performed better than the qSOFA score alone (AUC = 0.69, CI 95% 0.59–0.78), or CURB-65 score (AUC = 0.69, CI 95% 0.59–0.80) in the subgroup of lung infections ( n = 108). Conclusions: Based on a large emergency cohort of lupus patients complicated with invasive infection, the LUPHAS score was established to predict the short-term all-cause mortality, which could be a promising applicable tool for risk stratification in clinical practice.

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Use of the qSOFA Score in the Emergency Department

JAMA ◽

10.1001/jama.2017.3504 ◽

2017 ◽

Vol 317 (18) ◽

pp. 1909 ◽

Cited By ~ 1

Author(s):

Christian S. Scheer ◽

Sven-Olaf Kuhn ◽

Sebastian Rehberg

Keyword(s):

Emergency Department ◽

Qsofa Score

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Does inappropriate initial antibiotic therapy affect in-hospital mortality of patients in the emergency department with Escherichia coli and Klebsiella pneumoniae bloodstream infections?

International Journal of Immunopathology and Pharmacology ◽

10.1177/2058738420942375 ◽

2020 ◽

Vol 34 ◽

pp. 205873842094237

Author(s):

Fu-Cheng Chen ◽

Yu-Ni Ho ◽

Hsien-Hung Cheng ◽

Chien-Hung Wu ◽

Meng-Wei Change ◽

...

Keyword(s):

Escherichia Coli ◽

Emergency Department ◽

Logistic Regression ◽

Mortality Rate ◽

Klebsiella Pneumoniae ◽

Hospital Mortality ◽

Multiple Logistic Regression ◽

E Coli ◽

Time To Antibiotics ◽

Qsofa Score

Extended-spectrum β-lactamase (ESBL)-positive bloodstream infection (BSI) is on the rise worldwide. The purpose of this study is to evaluate the impact of inappropriate initial antibiotic therapy (IIAT) on in-hospital mortality of patients in the emergency department (ED) with Escherichia coli and Klebsiella pneumoniae BSIs. This retrospective single-center cohort study included all adult patients with E. coli and K. pneumoniae BSIs between January 2007 and December 2013, who had undergone a blood culture test and initiation of antibiotics within 6 h of ED registration time. Multiple logistic regression was used to adjust for bacterial species, IIAT, time to antibiotics, age, sex, quick Sepsis Related Organ Failure Assessment (qSOFA) score ⩾ 2, and comorbidities. A total of 3533 patients were enrolled (2967 alive and 566 deceased, in-hospital mortality rate 16%). The patients with K. pneumoniae ESBL-positive BSI had the highest mortality rate. Non-survivors had qSOFA scores ⩾ 2 (33.6% vs 9.5%, P < 0.001), more IIAT (15.0% vs 10.7%, P = 0.004), but shorter mean time to antibiotics (1.70 vs 1.84 h, P < 0.001). A qSOFA score ⩾ 2 is the most significant predictor for in-hospital mortality; however, IIAT and time to antibiotics were not significant predictors in multiple logistic regression analysis. In subgroup analysis divided by qSOFA scores, IIAT was still not a significant predictor. Severity of the disease (qSOFA score ⩾ 2) is the key factor influencing in-hospital mortality of patients with E. coli and K. pneumoniae BSIs. The time to antibiotics and IIAT were not significant predictors because they in turn were affected by disease severity.

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Head-to-head comparison of qSOFA and SIRS criteria in predicting the mortality of infected patients in the emergency department: a meta-analysis

Scandinavian Journal of Trauma Resuscitation and Emergency Medicine ◽

10.1186/s13049-018-0527-9 ◽

2018 ◽

Vol 26 (1) ◽

Cited By ~ 37

Author(s):

Jianjun Jiang ◽

Jin Yang ◽

Jing Mei ◽

Yongmei Jin ◽

Youjin Lu

Keyword(s):

Emergency Department ◽

Meta Analysis ◽

Sirs Criteria

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The impact of the Sepsis-3 definition on ICU admission of patients with infection

Scandinavian Journal of Trauma Resuscitation and Emergency Medicine ◽

10.1186/s13049-019-0680-9 ◽

2019 ◽

Vol 27 (1) ◽

Cited By ~ 2

Author(s):

Jenny Klimpel ◽

Lorenz Weidhase ◽

Michael Bernhard ◽

André Gries ◽

Sirak Petros

Keyword(s):

Emergency Department ◽

Blood Lactate ◽

Sofa Score ◽

High Specificity ◽

Receiver Operating Curve ◽

Predictive Values ◽

Icu Admission ◽

Sepsis Diagnosis ◽

Qsofa Score ◽

The Impact

Abstract Background Sepsis is defined as a life-threatening organ dysfunction due to a dysregulated inflammation following an infection. However, the impact of this definition on patient care is not fully clear. This study investigated the impact of the current definition on ICU admission of patients with infection. Methods We performed a prospective observational study over twelve months on consecutive patients presented to our emergency department and admitted for infection. We analyzed the predictive values of the quick sequential organ failure assessment (qSOFA) score, the SOFA score and blood lactate regarding ICU admission. Results We included 916 patients with the diagnosis of infection. Median age was 74 years (IQR 62–82 years), and 56.3% were males. There were 219 direct ICU admissions and 697 general ward admissions. A qSOFA score of ≥2 points had 52.9% sensitivity and 98.3% specificity regarding sepsis diagnosis. A qSOFA score of ≥2 points had 87.2% specificity but only 39.9% sensitivity to predict ICU admission. A SOFA score of ≥2 points had 97.4% sensitivity, but only 17.1% specificity to predict ICU admission, while a SOFA score of ≥4 points predicted ICU admission with 82.6% sensitivity and 71.7% specificity. The area under the receiver operating curve regarding ICU admission was 0.81 (95 CI, 0.77–0.86) for SOFA score, 0.55 (95% CI, 0.48–0.61) for blood lactate, and only 0.34 (95% CI, 0.28–0.40) for qSOFA on emergency department presentation. Conclusions While a positive qSOFA score had a high specificity regarding ICU admission, the low sensitivity of the score among septic patients as well as among ICU admissions considerably limited its value in routine patient management. The SOFA score was the better predictor of ICU admission, while the predictive value of blood lactate was equivocal.

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Prognostic Accuracy of SOFA Score and qSOFA as a predictor of mortality among sepsis patients presenting to Emergency Department in one of a tertiary Hospital in Kathmandu, Nepal

Nepal Medical College Journal ◽

10.3126/nmcj.v22i1-2.30025 ◽

2020 ◽

Vol 22 (1-2) ◽

pp. 18-21

Author(s):

Sameer Thapa ◽

AR Upreti ◽

R Bajracharya ◽

BK Lingden

Keyword(s):

Emergency Department ◽

Sofa Score ◽

Scoring Systems ◽

Tertiary Hospital ◽

Common Source ◽

Prognostic Accuracy ◽

Source Of Infection ◽

Clinical Scoring ◽

Qsofa Score ◽

Sepsis And Septic Shock

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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