scholarly journals Effect of Statins on the Clinical Outcomes of Patients with Sepsis

2011 ◽  
Vol 39 (6) ◽  
pp. 1051-1055 ◽  
Author(s):  
J. Goodin ◽  
C. Manrique ◽  
M. Dulohery ◽  
J. Sampson ◽  
M. Saettele ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Length Of Stay ◽  
Hospital Mortality ◽  
Sequential Organ Failure Assessment ◽  
Organ Failure ◽  
Icu Mortality ◽  
Icu Length Of Stay ◽  
Failure Assessment ◽  
Secondary Outcomes ◽  
Statin Use

Despite numerous attempts at novel intervention and tests to aid in earlier diagnosis and improved treatment, there has been an increased incidence of overall mortality related to sepsis, despite improvements in in-hospital mortality. Statins have emerged as potential immunomodulatory and antioxidant agents that might impact on sepsis outcomes. Definitive evidence to support the routine use of statins in patients with sepsis has not yet been elicited. We retrospectively analysed data from patients who presented with sepsis, severe sepsis or septic shock, stratifiying them according to statin use into two groups (statin and no statin). Sequential Organ Failure Assessment was used to evaluate severity of illness. The primary outcome was hospital mortality. Secondary outcomes included intensive care unit (ICU) mortality, hospital and ICU length of stay, and mechanical ventilation and vasopressor therapy duration. Five hundred and sixty-eight patients were included. Patients with prior statin use (statin group) were older, more obese and had higher prevalence of smoking, diabetes and ischaemic heart disease. There was no difference in Sequential Organ Failure Assessment scores and mortality did not vary between the two groups (19.6 vs 16.9%). Furthermore, secondary outcomes including ICU mortality, hospital and ICU length of stay, mechanical ventilation and vasopressor duration did not differ. Multivariate analysis revealed age and Sequential Organ Failure Assessment score were independent predictors of survival, while history of statin use was not (P=0.403). This current retrospective study did not find any benefit of statin use on primary and secondary outcomes of the patients admitted to an academic hospital with sepsis.

scholarly journals The association between the quick sequential organ failure assessment score prior to emergency ICU admission and outcomes in adults with suspected infection

2020 ◽  
pp. 149-154
Author(s):  
S Pillay ◽  
T Kisten ◽  
HM Cassimjee
Keyword(s):  
Hospital Mortality ◽  
Sequential Organ Failure Assessment ◽  
Organ Failure ◽  
Icu Mortality ◽  
Suspected Infection ◽  
Icu Admission ◽  
Icu Stay ◽  
Failure Assessment ◽  
Qsofa Score ◽  
Length Of Icu Stay

Background: Sepsis and septic shock are leading causes of mortality world-wide. In patients outside the intensive care unit (ICU) a rising qSOFA (quick Sequential Organ Failure Assessment) score correlates with mortality risk. We sought to investigate if the duration of a qSOFA score ≥ 2 prior to ICU admission further affects outcomes, namely: ICU mortality, in-hospital mortality and length of ICU stay. Method: A retrospective chart review was performed using the electronic ICU database at a quaternary level hospital in Durban, KwaZulu-Natal, examining entries from 1 January 2008 to 31 December 2017. The review included 235 emergency in-hospital adult admissions with suspected infection, of which 144 had a qSOFA score ≥ 2 prior to ICU admission. Results: There was no significant association between the duration of a qSOFA score ≥ 2 prior to ICU admission and ICU mortality (p = 0.975), in-hospital mortality (p = 0.918) and length of ICU stay until demise (p = 0.848) or discharge (p = 0.624). The qSOFA score was significantly associated with ICU mortality with scores of 0, 1, 2 and 3 resulting in ICU mortality rates of 0%, 22.5%, 53.7% and 84.6% respectively (p < 0.001). Conclusion: The duration of a qSOFA score ≥ 2 prior to emergency ICU admission was not significantly associated with ICU mortality, in-hospital mortality or length of ICU stay in adults with suspected infection.

scholarly journals The prognostic accuracy of systemic inflammatory response syndrome, quick sequential organ failure assessment and sequential organ failure assessment scores in estimating the 28 day in-hospital mortality

2020 ◽  
Vol 8 (1) ◽  
pp. 45
Author(s):  
Malli Dorasanamma ◽  
Nikhil Nagireddi ◽  
Keerthana Bathyala
Keyword(s):  
Length Of Stay ◽  
Systemic Inflammatory Response Syndrome ◽  
Inflammatory Response ◽  
Hospital Mortality ◽  
Sequential Organ Failure Assessment ◽  
Organ Failure ◽  
General Medicine ◽  
Systemic Inflammatory Response ◽  
Prognostic Accuracy ◽  
Failure Assessment

Background: Sepsis is among the leading causes of death in the world. 31.5 million cases of sepsis and 19.4 million cases of septic shock have been the annual global incidence. The collaborative efforts have improved the outcomes, yet the in-hospital mortality rates remain high. This study is undertaken to ascertain the prognostic accuracy of systemic inflammatory response syndrome (SIRS), quick sequential organ failure assessment (qSOFA) and sequential organ failure assessment (SOFA) scores in estimating the in-hospital mortality.Methods:  A prospective observational study was done from the department of general medicine and intensive care units from December 2017 to September 2019. A total of 50 Sepsis patients were selected for the study. The patients have been monitored for 28 days. Data regarding demographics, illness severity, organ dysfunction, length of stay and outcome (for 28 days) of the patients are noted.Results: The SOFA score with AUROC of 0.82, had the best discrimination in predicting mortality.Conclusions: SOFA has better prognostic accuracy than SIRS and qSOFA in predicting mortality. As ICU mortality is high in this group and care should be resource-intensive due to increased length of stay.

scholarly journals Accuracy of the Sequential Organ Failure Assessment Score for In-Hospital Mortality by Race and Relevance to Crisis Standards of Care

2021 ◽  
Vol 4 (6) ◽  
pp. e2113891
Author(s):  
William Dwight Miller ◽  
Xuan Han ◽  
Monica E. Peek ◽  
Deepshikha Charan Ashana ◽  
William F. Parker
Keyword(s):  
Hospital Mortality ◽  
Sequential Organ Failure Assessment ◽  
Organ Failure ◽  
Standards Of Care ◽  
Assessment Score ◽  
Failure Assessment

Evaluation of qSOFA as a Predictor of Mortality Among ICU Patients With Positive Clinical Cultures—A Retrospective Cohort Study

2019 ◽  
Vol 35 (11) ◽  
pp. 1278-1284
Author(s):  
Barry Kelly ◽  
Johann Patlak ◽  
Shahzad Shaefi ◽  
Dustin Boone ◽  
Ariel Mueller ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Sequential Organ Failure Assessment ◽  
Organ Failure ◽  
Retrospective Cohort ◽  
Primary Outcome ◽  
Assessment Score ◽  
Failure Assessment ◽  
Discriminative Value

Objective: To compare the discriminative value of the quick-sequential organ failure assessment score (qSOFA) to SOFA in a critically ill population, in which a microbial pathogen was isolated within 48 hours of admission to intensive care. Design: Retrospective cohort study. Setting: Academic tertiary referral center from July 2008 to June 2017. Patients: Hospitalized patients admitted to intensive care unit. Interventions: None. Measurements and Main Results: The primary outcome was in-hospital mortality for all patients with confirmed positive microbiological cultures within 48 hours of admission to intensive care unit (ICU). Subgroup analysis was performed on patients with pathogenic bacteremia or positive cultures in cerebrospinal fluid. Of the 11 415 patients analyzed with positive microbiology specimens within 48 hours of admission, 2933 (25.7%) had a qSOFA ≥2. Of these, 16.6% reached the primary outcome of in-hospital mortality. Unsurprisingly, the discriminative value of qSOFA on admission was significantly worse than that of SOFA (0.73 vs 0.76; P = .0004), despite observing a significant association between qSOFA category and in-hospital mortality ( P < .0001). In secondary analyses, similar observations were found using qSOFA within 6 and 24 hours of ICU admission. When analysis was focused on patients with pathogenic bacteremia or positive cerebrospinal fluid (CSF) cultures (n = 1646), there was no significant difference between the discriminative value of qSOFA and SOFA (0.75 vs 0.78; P = .17). Conclusions: Quick-sequential organ failure assessment score at admission was not superior to SOFA in predicting in-hospital mortality in patients with positive clinical cultures within 48 hours of admission to ICU. Quick-sequential organ failure assessment score at admission to the ICU was associated with mortality and showed reasonable calibration and discrimination. When the analysis was focused on patients with pathogenic bacteremia or positive CSF cultures, qSOFA performed similarly to SOFA in discriminatory those who will die from sepsis.

scholarly journals Sequential Organ Failure Assessment Component Score Prediction of In-hospital Mortality From Sepsis

2018 ◽  
Vol 35 (8) ◽  
pp. 810-817 ◽  
Author(s):  
Tushar Gupta ◽  
Michael A. Puskarich ◽  
Elizabeth DeVos ◽  
Adnan Javed ◽  
Carmen Smotherman ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Sequential Organ Failure Assessment ◽  
Organ Failure ◽  
Sofa Score ◽  
Statistical Significance ◽  
Predictive Ability ◽  
Hospital Death ◽  
Icu Stay ◽  
Relative Contribution ◽  
Failure Assessment

Objectives: Early organ dysfunction in sepsis confers a high risk of in-hospital mortality, but the relative contribution of specific types of organ failure to overall mortality is unclear. The objective of this study was to assess the predictive ability of individual types of organ failure to in-hospital mortality or prolonged intensive care. Methods: Retrospective cohort study of adult emergency department patients with sepsis from October 1, 2013, to November 10, 2015. Multivariable regression was used to assess the odds ratios of individual organ failure types for the outcomes of in-hospital death (primary) and in-hospital death or ICU stay ≥ 3 days (secondary). Results: Of 2796 patients, 283 (10%) experienced in-hospital mortality, and 748 (27%) experienced in-hospital mortality or an ICU stay ≥ 3 days. The following components of Sequential Organ Failure Assessment (SOFA) score were most predictive of in-hospital mortality (descending order): coagulation (odds ratio [OR]: 1.60, 95% confidence interval [CI]: 1.32-1.93), hepatic (1.58, 95% CI: 1.32-1.90), respiratory (OR: 1.33, 95% CI: 1.21-1.47), neurologic (OR: 1.20, 95% CI: 1.07-1.35), renal (OR: 1.14, 95% CI: 1.02-1.27), and cardiovascular (OR: 1.13, 95% CI: 1.01-1.25). For mortality or ICU stay ≥3 days, the most predictive SOFA components were respiratory (OR: 1.97, 95% CI: 1.79-2.16), neurologic (OR: 1.72, 95% CI: 1.54-1.92), cardiovascular (OR: 1.38, 95% CI: 1.23-1.54), coagulation (OR: 1.31, 95% CI: 1.10-1.55), and renal (OR: 1.19, 95% CI: 1.08-1.30) while hepatic SOFA (OR: 1.16, 95% CI: 0.98-1.37) did not reach statistical significance ( P = .092). Conclusion: In this retrospective study, SOFA score components demonstrated varying predictive abilities for mortality in sepsis. Elevated coagulation or hepatic SOFA scores were most predictive of in-hospital death, while an elevated respiratory SOFA was most predictive of death or ICU stay >3 days.

scholarly journals A Modified Sequential Organ Failure Assessment Score for Critical Care Triage

2010 ◽  
Vol 4 (4) ◽  
pp. 277-284 ◽  
Author(s):  
Colin K. Grissom ◽  
Samuel M. Brown ◽  
Kathryn G. Kuttler ◽  
Jonathan P. Boltax ◽  
Jason Jones ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Confidence Interval ◽  
Sequential Organ Failure Assessment ◽  
Organ Failure ◽  
Sofa Score ◽  
Laboratory Measurement ◽  
Receiver Operating Curve ◽  
Failure Assessment

ABSTRACTObjective: The Sequential Organ Failure Assessment (SOFA) score has been recommended for triage during a mass influx of critically ill patients, but it requires laboratory measurement of 4 parameters, which may be impractical with constrained resources. We hypothesized that a modified SOFA (MSOFA) score that requires only 1 laboratory measurement would predict patient outcome as effectively as the SOFA score.Methods: After a retrospective derivation in a prospective observational study in a 24-bed medical, surgical, and trauma intensive care unit, we determined serial SOFA and MSOFA scores on all patients admitted during the 2008 calendar year and compared the ability to predict mortality and the need for mechanical ventilation.Results: A total of 1770 patients (56% male patients) with a 30-day mortality of 10.5% were included in the study. Day 1 SOFA and MSOFA scores performed equally well at predicting mortality with an area under the receiver operating curve (AUC) of 0.83 (95% confidence interval 0.81-.85) and 0.84 (95% confidence interval 0.82-.85), respectively (P = .33 for comparison). Day 3 SOFA and MSOFA predicted mortality for the 828 patients remaining in the intensive care unit with an AUC of 0.78 and 0.79, respectively. Day 5 scores performed less well at predicting mortality. Day 1 SOFA and MSOFA predicted the need for mechanical ventilation on day 3, with an AUC of 0.83 and 0.82, respectively. Mortality for the highest category of SOFA and MSOFA score (>11 points) was 53% and 58%, respectively.Conclusions: The MSOFA predicts mortality as well as the SOFA and is easier to implement in resource-constrained settings, but using either score as a triage tool would exclude many patients who would otherwise survive.(Disaster Med Public Health Preparedness. 2010;4:277-284)

scholarly journals Clinical experience in management of bloodstream infection in emergency medical ward: A preliminary report

2019 ◽  
pp. 102490791989049
Author(s):  
Ying Cheung ◽  
Shing Ko ◽  
Oi Fung Wong ◽  
Hoi Shiu Bosco Lam ◽  
Hing Man Ma ◽  
...  
Keyword(s):  
Emergency Medicine ◽  
Critical Care ◽  
Hospital Mortality ◽  
Sequential Organ Failure Assessment ◽  
Organ Failure ◽  
Blood Stream Infection ◽  
Blood Stream ◽  
System P ◽  
Failure Assessment ◽  
Emergency Medicine Ward

Background: Bloodstream infection is a life-threatening clinical condition posing significant morbidities and mortalities. An “Emergency Critical Care Management Program” has been implemented in the Emergency Medicine Ward at North Lantau Hospital as a pilot critical care service model in the local emergency medicine wards. Patients with blood stream infection are recruited in the program and managed under pre-defined guideline. Objectives: We report our experience in managing patients with blood stream infection in the Emergency Medicine Ward and analyzed their clinical outcomes. Methods: This was a retrospective cohort study including a total of 64 patients with blood stream infection admitted to the Emergency Medicine Ward from 1 March 2015 and 31 March 2018. Patients’ characteristics, microbiology, and risk factors associated with adverse outcomes including in-hospital mortality were analyzed. Results: The most common organism isolated from blood cultures was Escherichia coli (56%). Eight patients were transferred to the tertiary hospital. The overall in-hospital mortality was 7.8% (5/64). From the univariate analysis, advanced age (p < 0.001), higher Sequential Organ Failure Assessment score and quick Sequential Organ Failure Assessment score (p < 0.001), higher Charlson Comorbidity Index (p = 0.003), more organ dysfunction (p < 0.001), pre-existing medical history of chronic liver disease (p = 0.001), dysfunction in respiratory system (p = 0.032), cardiovascular system (p = 0.044) and the central nervous system (p < 0.001), presence of septic shock (p = 0.004), and need for higher level of organ support from the use of inotropes (p < 0.001) and mechanical ventilation (p = 0.024) were associated with in-hospital mortality. In the subgroup analysis, the in-hospital mortality rate for the patients with Sequential Organ Failure Assessment score less than 6 was 1.56% (1/64). Among the five in-hospital mortality cases, four of them were managed in the Emergency Medicine Ward under the End-of-Life Care Program. Decision for withholding and withdrawing life-sustaining therapy was made with the patients’ families. Conclusion: This preliminary report demonstrated that with careful patient selection, adoption of guidelines, and availability of expertise, critical care service can be safely implemented in the emergency medicine ward.

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