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P K R, Kumar A, Sahu AK, Malhotra C, Gopinath B, Bhoi S, Jamshed N, Mishra P, Ekka M. Novel sepsis screening tool for low and middle income country in a high volume emergency department - A validation study. Am J Emerg Med 2024; 82:202-204. [PMID: 38862343 DOI: 10.1016/j.ajem.2024.05.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 05/22/2024] [Accepted: 05/24/2024] [Indexed: 06/13/2024] Open
Affiliation(s)
- Roshan P K
- Department of Emergency Medicine, Travancore Medicity, Kollam, India
| | - Akshay Kumar
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India.
| | - Ankit Kumar Sahu
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Charu Malhotra
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Bharath Gopinath
- Colchester General Hospital, East Suffolk and North Essex NHS Foundation Trust, United Kingdom
| | - Sanjeev Bhoi
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Nayer Jamshed
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Prakash Mishra
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Meera Ekka
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
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2
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Castello LM, Gavelli F. Sepsis scoring systems: Mindful use in clinical practice. Eur J Intern Med 2024; 125:32-35. [PMID: 38782628 DOI: 10.1016/j.ejim.2024.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 04/28/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024]
Affiliation(s)
- Luigi Mario Castello
- Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy; Division of Internal Medicine, Azienda Ospedaliero-Universitaria "Santi Antonio e Biagio e Cesare Arrigo", Alessandria, Italy
| | - Francesco Gavelli
- Department of Translational Medicine, Università degli Studi del Piemonte Orientale, Novara, Italy; Emergency Medicine Department, Azienda Ospedaliero-Universitaria "Maggiore della Carità di Novara", Novara, Italy
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Cressman AM, Wen B, Saha S, Jun HY, Waters R, Lail S, Jabeen A, Koppula R, Lapointe-Shaw L, Sheehan KA, Weinerman A, Daneman N, Verma AA, Razak F, MacFadden D. A simple electronic medical record-based predictors of illness severity in sepsis (sepsis) score. PLoS One 2024; 19:e0299473. [PMID: 38924010 PMCID: PMC11206954 DOI: 10.1371/journal.pone.0299473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 02/10/2024] [Indexed: 06/28/2024] Open
Abstract
OBJECTIVE Current scores for predicting sepsis outcomes are limited by generalizability, complexity, and electronic medical record (EMR) integration. Here, we validate a simple EMR-based score for sepsis outcomes in a large multi-centre cohort. DESIGN A simple electronic medical record-based predictor of illness severity in sepsis (SEPSIS) score was developed (4 additive lab-based predictors) using a population-based retrospective cohort study. SETTING Internal medicine services across four academic teaching hospitals in Toronto, Canada from April 2010-March 2015 (primary cohort) and 2015-2019 (secondary cohort). PATIENTS We identified patients admitted with sepsis based upon receipt of antibiotics and positive cultures. MEASUREMENTS AND MAIN RESULTS The primary outcome was in-hospital mortality and secondary outcomes were ICU admission at 72 hours, and hospital length of stay (LOS). We calculated the area under the receiver operating curve (AUROC) for the SEPSIS score, qSOFA, and NEWS2. We then evaluated the SEPSIS score in a secondary cohort (2015-2019) of hospitalized patients receiving antibiotics. Our primary cohort included 1,890 patients with a median age of 72 years (IQR: 56-83). 9% died during hospitalization, 18.6% were admitted to ICU, and mean LOS was 12.7 days (SD: 21.5). In the primary and secondary (2015-2019, 4811 patients) cohorts, the AUROCs of the SEPSIS score for predicting in-hospital mortality were 0.63 and 0.64 respectively, which were similar to NEWS2 (0.62 and 0.67) and qSOFA (0.62 and 0.68). AUROCs for predicting ICU admission at 72 hours, and length of stay > 14 days, were similar between scores, in the primary and secondary cohorts. All scores had comparable calibration for predicting mortality. CONCLUSIONS An EMR-based SEPSIS score shows a similar ability to predict important clinical outcomes compared with other validated scores (qSOFA and NEWS2). Because of the SEPSIS score's simplicity, it may prove a useful tool for clinical and research applications.
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Affiliation(s)
- Alex M. Cressman
- Temerty Faculty of Medicine, University of Toronto, Toronto, Toronto, Ontario, Canada
- Division of General Internal Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Bijun Wen
- Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | - Sudipta Saha
- Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | - Hae Young Jun
- Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | - Riley Waters
- Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | - Sharan Lail
- Unity Health Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, Temerty Faculty of Medicine, Toronto, Canada
| | - Aneela Jabeen
- Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | - Radha Koppula
- Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
| | - Lauren Lapointe-Shaw
- Temerty Faculty of Medicine, University of Toronto, Toronto, Toronto, Ontario, Canada
- Division of General Internal Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kathleen A. Sheehan
- Temerty Faculty of Medicine, University of Toronto, Toronto, Toronto, Ontario, Canada
- Division of Psychiatry, The University of Toronto, Toronto, Ontario, Canada
| | - Adina Weinerman
- Temerty Faculty of Medicine, University of Toronto, Toronto, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Nick Daneman
- Temerty Faculty of Medicine, University of Toronto, Toronto, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Amol A. Verma
- Temerty Faculty of Medicine, University of Toronto, Toronto, Toronto, Ontario, Canada
- Division of General Internal Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
- Unity Health Toronto, Toronto, Ontario, Canada
| | - Fahad Razak
- Temerty Faculty of Medicine, University of Toronto, Toronto, Toronto, Ontario, Canada
- Division of General Internal Medicine, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
- Unity Health Toronto, Toronto, Ontario, Canada
| | - Derek MacFadden
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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4
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Bowyer L, Cutts BA, Barrett HL, Bein K, Crozier TM, Gehlert J, Giles ML, Hocking J, Lowe S, Lust K, Makris A, Morton MR, Pidgeon T, Said J, Tanner HL, Wilkinson L, Wong M. SOMANZ position statement for the investigation and management of sepsis in pregnancy 2023. Aust N Z J Obstet Gynaecol 2024. [PMID: 38922822 DOI: 10.1111/ajo.13848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 05/19/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND The Society of Australia and New Zealand (SOMANZ) published its first sepsis in pregnancy and the postpartum period guideline in 2017 (Aust N Z J Obstet Gynaecol, 57, 2017, 540). In the intervening 6 years, maternal mortality from sepsis has remained static. AIMS To update clinical practice with a review of the subsequent literature. In particular, to review the definition and screening tools for the diagnosis of sepsis. MATERIALS AND METHODS A multi-disciplinary group of clinicians with experience in all aspects of the care of pregnant women analysed the clinical evidence according to the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system following searches of Cochrane, Medline and EMBASE. Where there were conflicting views, the authors reviewed the topic and came to a consensus. All authors reviewed the final position statement. RESULTS This position statement has abandoned the use of the quick Sequential Organ Failure Assessment score (qSOFA) score to diagnose sepsis due to its poor performance in clinical practice. Whilst New Zealand has a national maternity observation chart, in Australia maternity early warning system charts and vital sign cut-offs differ between states. Rapid recognition, early antimicrobials and involvement of senior staff remain essential factors to improving outcomes. CONCLUSION Ongoing research is required to discover and validate tools to recognize and diagnose sepsis in pregnancy. Australia should follow New Zealand and have a single national maternity early warning system observation chart.
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Affiliation(s)
- Lucy Bowyer
- Department of Obstetrics, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Briony A Cutts
- Department of Obstetric Medicine, Joan Kirner Women's and Children's at Sunshine Hospital, Melbourne, Victoria, Australia
| | - Helen L Barrett
- Department of Obstetric Medicine, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Kendall Bein
- Emergency Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Timothy M Crozier
- Department of Intensive Care, Monash Health, Department of Intensive Care Services, Eastern Health, Melbourne, Victoria, Australia
| | - Jessica Gehlert
- Department of Obstetrics and Gynaecology, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Michelle L Giles
- Department of Obstetrics and Gynaecology, Department of Infectious Diseases, Monash University, Melbourne, Victoria, Australia
| | - Jennifer Hocking
- Australian Breastfeeding Association, Melbourne, Victoria, Australia
| | - Sandra Lowe
- Department of Obstetric Medicine, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Karin Lust
- Department of Obstetric Medicine, Women's and Newborn Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Angela Makris
- Department of Nephrology, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Mark R Morton
- Women's and Babies Division, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Tara Pidgeon
- Emergency Department, St Vincent's Private Hospital, Toowoomba, Queensland, Australia
| | - Joanne Said
- Department of Maternal Fetal Medicine, Joan Kirner Women's and Children's at Sunshine Hospital, Melbourne, Victoria, Australia
| | - Helen L Tanner
- Department of Obstetric Medicine, Women's and Newborn Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Lucille Wilkinson
- Department of Medicine, Northland District Health Board, Auckland, New Zealand
| | - Maggie Wong
- Department of Anaesthesia, Royal Women's Hospital, Melbourne, Victoria, Australia
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Turcato G, Zaboli A, Sibilio S, Brigo F. Estimated plasma volume status is a simple and quick tool that could help define the severity of patients with infection on arrival at the emergency department. Am J Med Sci 2024; 367:343-351. [PMID: 38354776 DOI: 10.1016/j.amjms.2024.02.003] [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: 06/14/2023] [Revised: 12/18/2023] [Accepted: 02/08/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND Infectious states are subtle and rapidly evolving conditions observed daily in the emergency department (ED), and their prognostic evaluation remains a complex clinical challenge. Recently, estimated plasma volume status (ePVS) has been suggested to have a prognostic role in conditions where volemic alteration is central to the pathophysiology. The aim of this study was to verify whether ePVS recorded at ED admission can provide prognostic indications of 30-day mortality in patients with infection. METHODS A prospective observational study was performed between 1 January 2021 and 31 December 2021 at the ED of the Merano Hospital. All patients with infection were enrolled. ePVS values were derived from haemoglobin and haematocrit measured on the immediate arrival of patients in the ED. The predictive power of ePVS for 30-day mortality was assessed using a multivariate model adjusted for severity, comorbidity and urgency. Kaplan-Meier analysis was also performed. RESULTS Of the 949 patients with infection enrolled in the study (47.9%, SOFA ≥2), 8.9% (84/949) died at 30 days. The median ePVS value was higher in patients who died at 30 days than in patients who survived (5.83 vs. 4.61, p < 0.001). Multivariate analysis revealed that ePVS in both continuous and categorical form around the median was an independent risk factor for 30-day mortality even after adjusting for severity, comorbidity and urgency. Kaplan-Meier analysis confirmed an increased risk of death in patients with high ePVS values. CONCLUSIONS ePVS recorded on ED admission of patients with infection was an independent predictor of risk for 30-day mortality.
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Affiliation(s)
- Gianni Turcato
- Department of Internal Medicine, Intermediate Care Unit, Hospital Alto Vicentino (AULSS-7), Santorso, Italy.
| | - Arian Zaboli
- Department of Emergency Medicine, Hospital of Merano-Meran (SABES-ASDAA), Merano-Meran, Italy; Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität, Salzburg, Austria
| | - Serena Sibilio
- Department of Emergency Medicine, Hospital of Merano-Meran (SABES-ASDAA), Merano-Meran, Italy; Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität, Salzburg, Austria
| | - Francesco Brigo
- Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität, Salzburg, Austria; Department of Neurology, Hospital of Merano-Meran (SABES-ASDAA), Merano-Meran, Italy
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6
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Zhang TY, Du YJ, Hou YZ, Du Q, Dou HR, Gao XM. Heart/breathing rate ratio (HBR) as a predictor of mortality in critically ill patients. Heliyon 2024; 10:e31187. [PMID: 38803872 PMCID: PMC11128922 DOI: 10.1016/j.heliyon.2024.e31187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 05/08/2024] [Accepted: 05/12/2024] [Indexed: 05/29/2024] Open
Abstract
Objectives The early prediction of death is a challenge for medical staff. We evaluated the ability of the heart/breathing rate ratio (HBR) to predict mortality. Methods This was a single-center retrospective observational study of adult patients who had fever with or without respiratory symptoms, who survived at least 2 h after visiting the hospital, and whose lactate levels and vital signs were tested. We evaluated the distribution of mortality at different HBR levels and compared HBR with lactate. Results A total of 18,872 fever clinic visits were screened, and 183 patients whose lactate levels were tested were recruited. Patients who had HBR values lower than 4·5 or higher than 5·5 had greater mortality than patients who had HBR values between 4·5 and 5·5 (21·3 % vs. 3·4 %, p = 0·003; 28·9 % vs. 3·4 %, p < 0·001, respectively). In patients whose HBR was <5, the AUROC for HBR for mortality was 0·762 (95 % CI: 0.643-0·880), and that for lactate was 0·701 (95 % CI: 0·564-0·837). In patients whose HBR was ≥5, the AUROC for HBR for mortality was 0·721 (95 % CI: 0·584-0·857), and that for lactate was 0·742 (95 % CI: 0·607-0·848). Conclusions HBR is helpful for stratifying mortality risk among critically ill patients in acute care clinics for infectious diseases.
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Affiliation(s)
- Tong Yan Zhang
- Infectious Diseases Department, Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Ya Jun Du
- TEDA International Cardiovascular Hospital, Tianjin, China
| | - Ya Zhu Hou
- Department of Cardiology, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Qian Du
- Department of Pharmacy, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hai Rong Dou
- Infectious Diseases Department, Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Xiu Mei Gao
- Tianjin State Key Laboratory of Modern Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
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Wang CP, Hsieh MS, Hu SY, Huang SC, Tsai CA, Shen CH. Risk Factors and Scoring Systems to Predict the Mortality Risk of Afebrile Adult Patients with Monomicrobial Gram-Negative Bacteremia: A 10-Year Observational Study in the Emergency Department. Diagnostics (Basel) 2024; 14:869. [PMID: 38732284 PMCID: PMC11083546 DOI: 10.3390/diagnostics14090869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 04/10/2024] [Accepted: 04/18/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND The mortality rate of afebrile bacteremia has been reported to be as high as 45%. This investigation focused on the risk factors and predictive performance of scoring systems for the clinical outcomes of afebrile patients with monomicrobial gram-negative bacteria (GNB) in the emergency department (ED). METHODS We conducted a retrospective analysis of afebrile adult ED patients with monomicrobial GNB bacteremia from January 2012 to December 2021. We dissected the demographics, clinical pictures, and laboratory investigations. We applied five scoring systems and three revised systems to predict the clinical outcomes. RESULTS There were 600 patients included (358 males and 242 females), with a mean age of 69.6 ± 15.4 years. The overall mortality rate was 50.17%, reaching 68.52% (74/108) in cirrhotic patients. Escherichia coli was the leading pathogen (42.83%). The non-survivors had higher scores of the original MEDS (p < 0.001), NEWS (p < 0.001), MEWS (p < 0.001), qSOFA (p < 0.001), and REMS (p = 0.030). In univariate logistic regression analyses, several risk factors had a higher odds ratio (OR) for mortality, including liver cirrhosis (OR 2.541, p < 0.001), malignancy (OR 2.259, p < 0.001), septic shock (OR 2.077, p = 0.002), and male gender (OR 0.535, p < 0.001). The MEDS demonstrated that the best predictive power with the maximum area under the curve (AUC) was measured at 0.773 at the cut-off point of 11. The AUCs of the original NEWS, MEWS, qSOFA, and REMS were 0.663, 0.584, 0.572, and 0.553, respectively. We revised the original MEDS, NEWS, and qSOFA by adding red cell distribution width, albumin, and lactate scores and found a better predictive power of the AUC of 0.797, 0.719, and 0.694 on the revised MEDS ≥11, revised qSOFA ≥ 3, and revised NEWS ≥ 6, respectively. CONCLUSIONS The original MEDS, revised MEDS, revised qSOFA, and revised NEWS were valuable tools for predicting the mortality risk in afebrile patients with monomicrobial GNB bacteremia. We suggested that clinicians should explore patients with the risk factors mentioned above for possible severe infection, even in the absence of fever and initiate hemodynamic support and early adequate antibiotic therapy in patients with higher scores of the original MEDS (≥11), revised MEDS (≥11), revised NEWS (≥6), and revised qSOFA (≥3).
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Affiliation(s)
- Chung-Pang Wang
- Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (C.-P.W.); (C.-H.S.)
| | - Ming-Shun Hsieh
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taoyuan Branch, Taoyuan 330, Taiwan;
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 11217, Taiwan
| | - Sung-Yuan Hu
- Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (C.-P.W.); (C.-H.S.)
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 11217, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 40201, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan;
| | - Shih-Che Huang
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan;
- Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
- Lung Cancer Research Center, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
| | - Che-An Tsai
- Division of Infectious Disease, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan;
| | - Chia-Hui Shen
- Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (C.-P.W.); (C.-H.S.)
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Boekhoud L, Schaap HMEA, Huizinga RL, Olgers TJ, Ter Maaten JC, Postma DF, Bouma HR. Predictive performance of NEWS and qSOFA in immunocompromised sepsis patients at the emergency department. Infection 2024:10.1007/s15010-024-02247-4. [PMID: 38607592 DOI: 10.1007/s15010-024-02247-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 03/22/2024] [Indexed: 04/13/2024]
Abstract
PURPOSE Sepsis has a high incidence and a poor prognosis. Early recognition is important to facilitate timely initiation of adequate care. Sepsis screening tools, such as the (quick) Sequential Organ Failure Assessment ((q)SOFA) and National Early Warning Score (NEWS), could help recognize sepsis. These tools have been validated in a general immunocompetent population, while their performance in immunocompromised patients, who are particularly at risk of sepsis development, remains unknown. METHODS This study is a post hoc analysis of a prospective observational study performed at the emergency department. Inclusion criteria were age ≥ 18 years with a suspected infection, while ≥ two qSOFA and/or SOFA criteria were used to classify patients as having suspected sepsis. The primary outcome was in-hospital mortality. RESULTS 1516 patients, of which 40.5% used one or more immunosuppressives, were included. NEWS had a higher prognostic accuracy as compared to qSOFA for predicting poor outcome among immunocompromised sepsis patients. Of all tested immunosuppressives, high-dose glucocorticoid therapy was associated with a threefold increased risk of both in-hospital and 28-day mortality. CONCLUSION In contrast to NEWS, qSOFA underestimates the risk of adverse outcome in patients using high-dose glucocorticoids. As a clinical consequence, to adequately assess the severity of illness among immunocompromised patients, health care professionals should best use the NEWS.
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Affiliation(s)
- Lisanne Boekhoud
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, EB70, 9700 RB, Groningen, The Netherlands
| | - Helena M E A Schaap
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Rick L Huizinga
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Tycho J Olgers
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jan C Ter Maaten
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Douwe F Postma
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Hjalmar R Bouma
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, P.O. Box 30.001, EB70, 9700 RB, Groningen, The Netherlands.
- Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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9
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Heineman T, Orrick C, Phan TK, Denke L, Atem F, Draganic K. Clinical decision support tools useful for identifying sepsis risk. Nursing 2024; 54:50-56. [PMID: 38517502 DOI: 10.1097/01.nurse.0001007628.31606.ee] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
PURPOSE Evaluate the effectiveness of the clinical decision support tools (CDSTs), POC Advisor (POCA), and Modified Early Warning System (MEWS) in identifying sepsis risk and influencing time to treatment for inpatients, comparing their respective alert mechanisms. METHODS This study was conducted at two academic university medical center hospitals. Data from adult inpatients in medical-surgical and telemetry units were analyzed from January 1, 2020, to December 31, 2020. Criteria included sepsis-related ICD-10 codes, antibiotic administration, and ordered sepsis labs. Subsequent statistical analyses utilized Fisher's exact test and Wilcoxon Rank Sum test, focusing on mortality differences by age, sex, and race/ethnicity. RESULTS Among 744 patients, 143 sepsis events were identified, with 83% already receiving treatment upon CDST alert. Group 1 (POCA alert) showed reduced response time compared with MEWS, while Group 3 (MEWS) experienced longer time to treatment. Group 4 included sepsis events missed by both systems. Mortality differences were not significant among the groups. CONCLUSION While CDSTs play a role, nursing assessment and clinical judgment are crucial. This study recognized the potential for alarm fatigue due to a high number of CDST-driven alerts, while emphasizing the importance of a collaborative approach for prompt sepsis treatment and potential reduction in sepsis-related mortality.
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Affiliation(s)
- Theresa Heineman
- At the University of Texas Southwestern Medical Center in Dallas, Tx., Theresa Heineman is a rapid response RN, Cary Orrick is a performance improvement coordinator with the Office of Quality and Operational Excellence, Teresa K. Phan is a research manager, Linda Denke is a nurse scientist, Folefac Atem is an adjunct associate professor, and Keri Draganic is an NP with the Cardiovascular and Thoracic Surgery Department
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10
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Lee KJ, Kim YK, Jeon K, Ko RE, Suh GY, Oh DK, Lim SY, Lee YJ, Lee SY, Park MH, Lim CM, Park S. Shock indices are associated with in-hospital mortality among patients with septic shock and normal left ventricular ejection fraction. PLoS One 2024; 19:e0298617. [PMID: 38470900 DOI: 10.1371/journal.pone.0298617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 01/27/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND The understanding of shock indices in patients with septic shock is limited, and their values may vary depending on cardiac function. METHODS This prospective cohort study was conducted across 20 university-affiliated hospitals (21 intensive care units [ICUs]). Adult patients (≥19 years) with septic shock admitted to the ICUs during a 29-month period were included. The shock index (SI), diastolic shock index (DSI), modified shock index (MSI), and age shock index (Age-SI) were calculated at sepsis recognition (time zero) and ICU admission. Left ventricular (LV) function was categorized as either normal LV ejection fraction (LVEF ≥ 50%) or decreased LVEF (<50%). RESULTS Among the 1,194 patients with septic shock, 392 (32.8%) who underwent echocardiography within 24 h of time zero were included in the final analysis (normal LVEF: n = 246; decreased LVEF: n = 146). In patients with normal LVEF, only survivors demonstrated significant improvement in SI, DSI, MSI, and Age-SI values from time zero to ICU admission; however, no notable improvements were found in all patients with decreased LVEF. The completion of vasopressor or fluid bundle components was significantly associated with improved indices in patients with normal LVEF, but not in those with decreased LVEF. In multivariable analysis, each of the four indices at ICU admission was significantly associated with in-hospital mortality (P < 0.05) among patients with normal LVEF; however, discrimination power was better in the indices for patients with lower lactate levels (≤ 4.0 mmol/L), compared to those with higher lactate levels. CONCLUSIONS The SI, DSI, MSI, and Age-SI at ICU admission were significantly associated with in-hospital mortality in patients with septic shock and normal LVEF, which was not found in those with decreased LVEF. Our study emphasizes the importance of interpreting shock indices in the context of LV function in septic shock.
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Affiliation(s)
- Kyu Jin Lee
- Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Yong Kyun Kim
- Department of Infection, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
| | - Kyeongman Jeon
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Ryoung-Eun Ko
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Gee Young Suh
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dong Kyu Oh
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sung Yoon Lim
- Department of Pulmonary and Critical Care Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Yeon Joo Lee
- Department of Pulmonary and Critical Care Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Su Yeon Lee
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Mi-Hyeon Park
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Chae-Man Lim
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sunghoon Park
- Department of Pulmonary, Allergy and Critical Care Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea
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Nuckchady DC. The value of the INFECTIONS scoring system in identifying bacterial infections among patients presenting at the emergency department of a middle-income country: A pilot study. Chin J Traumatol 2024; 27:77-82. [PMID: 37690867 DOI: 10.1016/j.cjtee.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 07/30/2023] [Accepted: 08/19/2023] [Indexed: 09/12/2023] Open
Abstract
PURPOSE To investigate which scoring system is the most accurate tool in predicting mortality among the infected patients who present to the emergency department in a middle-income country, and to validate a new scoring system to predict bacterial infections. METHODS This was a retrospective, single-center study among patients who were admitted via the emergency department of a public hospital. All patients who were started on antibiotics were included in the study, while patients aged < 18 years were excluded. Data collected includeding patients' demographics, vital signs and basic laboratory parameters like white blood cell count and creatinine. The sensitivity and specificity of different scoring systems were calculated as well as their negative and positive predictive values. Logistic regression was used to derive a novel early warning system for bacterial infections. The area under the receiver operating characteristic (AUROC) was computed for each scoring model. RESULTS In total, 109 patients were included in this study. The quick sequential organ failure assessment (qSOFA), search out severity and rapid acute physiology score had the highest AUROC (≥ 0.89) for predicting mortality, while qSOFA and universal vital assessment were the simplest scoring systems with an AUROC > 0.85; however, these scoring systems failed to predict whether patients were truly infected. The INFECTIONS (short for impaired mental status, not conscious, fast heart rate, elevated creatinine, high temperature, on inotrope, low oxygen, high neutrophils and high sugar) model reached an AUROC of 0.88 to more accurately predict the infectious state of a patient. CONCLUSIONS Middle-income countries should use the qSOFA or universal vital assessment score to identify the sickest patients in emergency department. The INFECTIONS score may help recognize patients with bacterial infections, but it should be further validated in multiple countries prior to widely use.
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Lam RPK, Hung KKC, Lui CT, Kwok WS, Lam WWT, Lau EHY, Sridhar S, Ng PYT, Cheng CH, Tsang TC, Tsui MSH, Graham CA, Rainer TH. Early sepsis care with the National Early Warning Score 2-guided Sepsis Hour-1 Bundle in the emergency department: hybrid type 1 effectiveness-implementation pilot stepped wedge randomised controlled trial (NEWS-1 TRIPS) protocol. BMJ Open 2024; 14:e080676. [PMID: 38307529 PMCID: PMC10836386 DOI: 10.1136/bmjopen-2023-080676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 01/24/2024] [Indexed: 02/04/2024] Open
Abstract
INTRODUCTION Early sepsis treatment in the emergency department (ED) is crucial to improve patient survival. Despite international promulgation, the uptake of the Surviving Sepsis Campaign (SSC) Hour-1 Bundle (lactate measurement, blood culture, broad-spectrum antibiotics, 30 mL/kg crystalloid for hypotension/lactate ≥4 mmol/L and vasopressors for hypotension during/after fluid resuscitation within 1 hour of sepsis recognition) is low across healthcare settings. Delays in sepsis recognition and a lack of high-quality evidence hinder its implementation. We propose a novel sepsis care model (National Early Warning Score, NEWS-1 care), in which the SSC Hour-1 Bundle is triggered objectively by a high NEWS-2 (≥5). This study aims to determine the feasibility of a full-scale type 1 hybrid effectiveness-implementation trial on the NEWS-1 care in multiple EDs. METHODS AND ANALYSIS We will conduct a pilot type 1 hybrid trial and prospectively recruit 200 patients from 4 public EDs in Hong Kong cluster randomised in a stepped wedge design over 10 months. All study sites will start with an initial period of standard care and switch in random order at 2-month intervals to the NEWS-1 care unidirectionally. The implementation evaluation will employ mixed methods guided by the Reach, Effectiveness, Adoption, Implementation and Maintenance framework, which includes qualitative and quantitative data from focus group interviews, staff survey and clinical record reviews. We will analyse the 14 feasibility outcomes as progression criteria to a full-scale trial, including trial acceptability to patients and staff, patient and staff recruitment rates, accuracy of sepsis screening, protocol adherence, accessibility to follow-up data, safety and preliminary clinical impacts of the NEWS1 care, using descriptive statistics. ETHICS AND DISSEMINATION The institutional review boards of all study sites approved this study. This study will establish the feasibility of a full-scale hybrid trial. We will disseminate the findings through peer-reviewed publications, conference presentations and educational activities. TRIAL REGISTRATION NUMBER NCT05731349.
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Affiliation(s)
- Rex Pui Kin Lam
- Department of Emergency Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Accident and Emergency Department, Queen Mary Hospital, Hospital Authority, Hong Kong, China
| | - Kevin Kei Ching Hung
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Hong Kong, China
- Accident and Emergency Department, Prince of Wales Hospital, Hospital Authority, Hong Kong, China
| | - Chun Tat Lui
- Accident and Emergency Department, Tuen Mun Hospital, Hospital Authority, Hong Kong, China
| | - Wai Shing Kwok
- Accident and Emergency Department, Pamela Youde Nethersole Eastern Hospital, Hospital Authority, Hong Kong, China
| | - Wendy Wing Tak Lam
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Eric Ho Yin Lau
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Siddharth Sridhar
- Department of Microbiology, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Peter Yau Tak Ng
- Accident and Emergency Department, Tuen Mun Hospital, Hospital Authority, Hong Kong, China
| | - Chi Hung Cheng
- Accident and Emergency Department, Prince of Wales Hospital, Hospital Authority, Hong Kong, China
| | - Tat Chi Tsang
- Accident and Emergency Department, Queen Mary Hospital, Hospital Authority, Hong Kong, China
| | - Matthew Sik Hon Tsui
- Accident and Emergency Department, Queen Mary Hospital, Hospital Authority, Hong Kong, China
| | - Colin Alexander Graham
- Accident and Emergency Medicine Academic Unit, The Chinese University of Hong Kong, Hong Kong, China
- Accident and Emergency Department, Prince of Wales Hospital, Hospital Authority, Hong Kong, China
| | - Timothy Hudson Rainer
- Department of Emergency Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Accident and Emergency Department, Queen Mary Hospital, Hospital Authority, Hong Kong, China
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García-Lamberechts EJ, Fuentes Ferrer M, Fernández-Alonso C, Burillo-Putze G, Aguiló S, Alquezar-Arbé A, Montero-Pérez FJ, Jacob J, Piñera Salmerón P, Salido Mota M, Marchena MJ, Martínez Alonso A, Chacón García A, Güemes de la Iglesia C, Troiano Ungerer OJ, Eiroa-Hernández P, Parra-Esquivel P, Lázaro Aragüés P, Gantes Nieto P, Cuerpo Cardeñosa S, Chacón García C, Serrano Lázaro L, Caballero Martínez M, Guillen L, Muñoz Martos R, González Del Castillo J, Miró Ò. Predictive usefulness of qSOFA, NEWS and GYM scores in the elderly patient: EDEN-5 study. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2024:S2529-993X(24)00008-X. [PMID: 38296669 DOI: 10.1016/j.eimce.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 07/18/2023] [Indexed: 02/02/2024]
Abstract
OBJECTIVE To analyze the prognostic accuracy of the scores NEWS, qSOFA, GYM used in hospital emergency department (ED) in the assessment of elderly patients who consult for an infectious disease. METHODS Data from the EDEN (Emergency Department and Elderly Need) cohort were used. This retrospective cohort included all patients aged ≥65 years seen in 52 Spanish EDs during two weeks (from 1-4-2019 to 7-4-2019 and 30/3/2020 to 5/4/2020) with an infectious disease diagnosis in the emergency department. Demographic variables, demographic variables, comorbidities, Charlson and Barthel index and needed scores parameters were recorded. The predictive capacity for 30-day mortality of each scale was estimated by calculating the area under the receiver operating characteristic (ROC) curve, and sensitivity and specificity were calculated for different cut-off points. The primary outcome variable was 30-day mortality. RESULTS 6054 patients were analyzed. Median age was 80 years (IQR 73-87) and 45.3% women. 993 (16,4%) patients died. NEWS score had better AUC than qSOFA (0.765, 95CI: 0.725-0.806, versus 0.700, 95%CI: 0.653-0.746; P < .001) and GYM (0.716, 95%CI: 0.675-0.758; P = .024), and there was no difference between qSOFA and GYM (P = .345). The highest sensitivity scores for 30-day mortality were GYM ≥ 1 point (85.4%) while the qSOFA score ≥2 points showed high specificity. In the case of the NEWS scale, the cut-off point ≥4 showed high sensitivity, while the cut-off point NEWS ≥ 8 showed high specificity. CONCLUSION NEWS score showed the highest predictive capacity for 30-day mortality. GYM score ≥1 showed a great sensitivity, while qSOFA ≥2 scores provide the highest specificity but lower sensitivity.
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Affiliation(s)
| | - Manuel Fuentes Ferrer
- Unidad de Investigación, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | - Cesáreo Fernández-Alonso
- Servicio de Urgencias, Hospital Clínico San Carlos, IDISSC, Universidad Complutense, Madrid, Spain
| | - Guillermo Burillo-Putze
- Facultad de Ciencias de la Salud, Universidad Europea de Canarias, La Orotava, Santa Cruz de Tenerife, Spain
| | - Sira Aguiló
- Área de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - Aitor Alquezar-Arbé
- Servicio de Urgencias, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Javier Jacob
- Servicio de Urgencias, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | | | | | | | | | | | | | | | - Patricia Eiroa-Hernández
- Servicio de Urgencias, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain
| | - Patricia Parra-Esquivel
- Servicio de Urgencias, Hospital Norte Tenerife, Icod de los Vinos, Santa Cruz de Tenerife, Spain
| | - Paula Lázaro Aragüés
- Servicio de Urgencias, Hospital General Universitario Reina Sofía, Murcia, Spain
| | | | | | | | | | | | - Lara Guillen
- Servicio de Urgencias, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Rocío Muñoz Martos
- Servicio de Urgencias, Hospital de la Axarquía, Velez-Málaga, Málaga, Spain
| | | | - Òscar Miró
- Área de Urgencias, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain
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Álvaro de la Parra JA, Del Olmo Rodríguez M, Caramés Sánchez C, Blanco Á, Pfang B, Mayoralas-Alises S, Fernandez-Ferro J, Calvo E, Gómez Martín Ó, Fernández Tabera J, Plaza Nohales C, Nieto C, Short Apellaniz J. Effect of an algorithm for automatic placing of standardised test order sets on low-value appointments and attendance rates at four Spanish teaching hospitals: an interrupted time series analysis. BMJ Open 2024; 14:e081158. [PMID: 38267242 PMCID: PMC10824031 DOI: 10.1136/bmjopen-2023-081158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 01/11/2024] [Indexed: 01/26/2024] Open
Abstract
OBJECTIVE Reducing backlogs for elective care is a priority for healthcare systems. We conducted an interrupted time series analysis demonstrating the effect of an algorithm for placing automatic test order sets prior to first specialist appointment on avoidable follow-up appointments and attendance rates. DESIGN Interrupted time series analysis. SETTING 4 academic hospitals from Madrid, Spain. PARTICIPANTS Patients referred from primary care attending 10 033 470 outpatient appointments from 16 clinical specialties during a 6-year period (1 January 2018 to 30 June 2023). INTERVENTION An algorithm using natural language processing was launched in May 2021. Test order sets developed for 257 presenting complaints from 16 clinical specialties were placed automatically before first specialist appointments to increase rates of diagnosis and initiation of treatment with discharge back to primary care. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcomes included rate of diagnosis and discharge to primary care and follow-up to first appointment index. The secondary outcome was trend in 'did not attend' rates. RESULTS Since May 2021, a total of 1 175 814 automatic test orders have been placed. Significant changes in trend of diagnosis and discharge to primary care at first appointment (p=0.005, 95% CI 0.5 to 2.9) and 'did not attend' rates (p=0.006, 95% CI -0.1 to -0.8) and an estimated attributable reduction of 11 306 avoidable follow-up appointments per month were observed. CONCLUSION An algorithm for placing automatic standardised test order sets can reduce low-value follow-up appointments by allowing specialists to confirm diagnoses and initiate treatment at first appointment, also leading to early discharge to primary care and a reduction in 'did not attend' rates. This initiative points to an improved process for outpatient diagnosis and treatment, delivering healthcare more effectively and efficiently.
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Affiliation(s)
| | - Marta Del Olmo Rodríguez
- Quirónsalud, Madrid, Spain
- Instituto de Investigacion Sanitaria de la Fundación Jiménez Díaz, Madrid, Spain
| | - Cristina Caramés Sánchez
- Quirónsalud, Madrid, Spain
- Instituto de Investigacion Sanitaria de la Fundación Jiménez Díaz, Madrid, Spain
| | | | - Bernadette Pfang
- Instituto de Investigacion Sanitaria de la Fundación Jiménez Díaz, Madrid, Spain
- Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | | | - Jose Fernandez-Ferro
- Instituto de Investigacion Sanitaria de la Fundación Jiménez Díaz, Madrid, Spain
- Neurology Department, Hospital Universitario Rey Juan Carlos, Mostoles, Spain
| | - Emilio Calvo
- Instituto de Investigacion Sanitaria de la Fundación Jiménez Díaz, Madrid, Spain
- Orthopaedic Surgery and Traumatology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Óscar Gómez Martín
- Instituto de Investigacion Sanitaria de la Fundación Jiménez Díaz, Madrid, Spain
- Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Jesús Fernández Tabera
- Instituto de Investigacion Sanitaria de la Fundación Jiménez Díaz, Madrid, Spain
- Villalba General University Hospital, Collado Villalba, Spain
| | - Carmen Plaza Nohales
- Instituto de Investigacion Sanitaria de la Fundación Jiménez Díaz, Madrid, Spain
- Hospital Universitario Rey Juan Carlos, Mostoles, Spain
| | - Carlota Nieto
- Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Jorge Short Apellaniz
- Instituto de Investigacion Sanitaria de la Fundación Jiménez Díaz, Madrid, Spain
- Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
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Algarni AM, Alfaifi MS, Al Bshabshe AA, Omair OM, Alsultan MA, Alzahrani HM, Alali HE, Alsabaani AA, Alqarni AM, Alghanem SA, Al Mufareh BS, Almemari AM, Sindi AA, Ozturan IU, Alhadhira AA, Shujaa AS, Alotaibi AH, Awladthani MM, Alsaad AA, Almarshed AA, AlQahtani AM, Harris TR, Alyahya BA, Assiri SA, Abuzeyad FH, Kazim SN, Al-Fares AA, Almazroua FY, Marzook NT, Basri AA, Elsafti AM, Alalshaikh AS, Özturan CA, Alawad YI, AlOmari A, Alkhateeb MA, Farooq MM, AlMutairi LA, Alasfour MM, Al Haber MI, Umar UKA, Bokhary NH, Alqahtani SF, Almutairi A, Alyahya HF, Alzahrani WS, Alsalmi F, Omair AM, Alasmari FM, Alfifi SY, Al-Nujimi MS, Foroutan F. Prognostic accuracy of qSOFA score, SIRS criteria, and EWSs for in-hospital mortality among adult patients presenting with suspected infection to the emergency department (PASSEM) Multicenter prospective external validation cohort study protocol. PLoS One 2024; 19:e0281208. [PMID: 38232095 PMCID: PMC10793907 DOI: 10.1371/journal.pone.0281208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 01/12/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Early identification of a patient with infection who may develop sepsis is of utmost importance. Unfortunately, this remains elusive because no single clinical measure or test can reflect complex pathophysiological changes in patients with sepsis. However, multiple clinical and laboratory parameters indicate impending sepsis and organ dysfunction. Screening tools using these parameters can help identify the condition, such as SIRS, quick SOFA (qSOFA), National Early Warning Score (NEWS), or Modified Early Warning Score (MEWS). We aim to externally validate qSOFA, SIRS, and NEWS/NEWS2/MEWS for in-hospital mortality among adult patients with suspected infection who presenting to the emergency department. METHODS AND ANALYSIS PASSEM study is an international prospective external validation cohort study. For 9 months, each participating center will recruit consecutive adult patients who visited the emergency departments with suspected infection and are planned for hospitalization. We will collect patients' demographics, vital signs measured in the triage, initial white blood cell count, and variables required to calculate Charlson Comorbidities Index; and follow patients for 90 days since their inclusion in the study. The primary outcome will be 30-days in-hospital mortality. The secondary outcome will be intensive care unit (ICU) admission, prolonged stay in the ICU (i.e., ≥72 hours), and 30- as well as 90-days all-cause mortality. The study started in December 2021 and planned to enroll 2851 patients to reach 200 in-hospital death. The sample size is adaptive and will be adjusted based on prespecified consecutive interim analyses. DISCUSSION PASSEM study will be the first international multicenter prospective cohort study that designated to externally validate qSOFA score, SIRS criteria, and EWSs for in-hospital mortality among adult patients with suspected infection presenting to the ED in the Middle East region. STUDY REGISTRATION The study is registered at ClinicalTrials.gov (NCT05172479).
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Affiliation(s)
| | - Musa S. Alfaifi
- Emergency Medicine Department, Armed Forces Hospital Southern Region, Khamis Mushait, Saudi Arabia
| | | | - Othman M. Omair
- Emergency Medicine Department, Aseer Central Hospital, Abha, Saudi Arabia
| | | | | | - Hadi E. Alali
- Emergency Medicine Department, Armed Forces Hospital Southern Region, Khamis Mushait, Saudi Arabia
| | | | - Ali M. Alqarni
- Radiology Department, Prince Mashary Bin Saud Hospital, Belgraishi, Saudi Arabia
| | - Salah A. Alghanem
- Emergency Medicine Department, Bahrain Defence Force Hospital, Al Riffa, Bahrain
| | - Bandar S. Al Mufareh
- Emergency Medicine Department, Royal Commission Hospital in Jubail, Jubail, Saudi Arabia
| | - Ayesha M. Almemari
- Emergency Medicine Department, Shaikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | | | - Ibrahim U. Ozturan
- Kocaeli University, Faculty of Medicine, Emergency Medicine Department, Kocaeli, Turkey
| | - Abdullah A. Alhadhira
- Emergency Medicine Department, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
| | - Asaad S. Shujaa
- Emergency Medicine Department, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
| | - Abdullah H. Alotaibi
- Emergency Medicine Department, King Abdullah University Hospital, Riyadh, Saudi Arabia
| | | | - Ahmed A. Alsaad
- Emergency Medicine Department, King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | | | | | - Tim R. Harris
- Emergency Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | | | - Saad A. Assiri
- Emergency Medicine Department, Sulaiman Al Habib Medical Group, Riyadh, Saudi Arabia
| | - Feras H. Abuzeyad
- Emergency Medicine Department, King Hamad University Hospital, Muharraq, Bahrain
| | - Sara N. Kazim
- Emergency Medicine Department, Rashid Hospital, Dubai, United Arab Emirates
| | | | | | - Naif T. Marzook
- Emergency Medicine Department, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Abdullah A. Basri
- Emergency Medicine Department, Bahrain Defence Force Hospital, Al Riffa, Bahrain
| | | | | | - Cansu A. Özturan
- Emergency Medicine Department, Gölcük Necati Çelik State Hospital, Gölcük, Kocaeli, Turkey
| | - Yousef I. Alawad
- Emergency Medicine Administration, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Awad AlOmari
- Critical Care Department, Sulaiman Al Habib Medical Group, Riyadh, Saudi Arabia
| | - Malek A. Alkhateeb
- Emergency Medicine Department, Sulaiman Al Habib Medical Group, Riyadh, Saudi Arabia
| | - Moonis M. Farooq
- Emergency Medicine Department, King Hamad University Hospital, Muharraq, Bahrain
| | | | | | - Mohammad I. Al Haber
- Emergency Medicine Department, Shaikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Umma-Kulthum A. Umar
- Emergency Medicine Department, Shaikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Nidal H. Bokhary
- College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Saeed F. Alqahtani
- Emergency Medicine Department, Aseer Central Hospital, Abha, Saudi Arabia
| | | | - Hisham F. Alyahya
- Emergency Medicine Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Wejdan S. Alzahrani
- Emergency Medicine Department, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Fawziah Alsalmi
- Emergency Medicine Department, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | | | | | | | | | - Farid Foroutan
- Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Ontario, Canada
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Lam RPK, Dai Z, Lau EHY, Ip CYT, Chan HC, Zhao L, Tsang TC, Tsui MSH, Rainer TH. Comparing 11 early warning scores and three shock indices in early sepsis prediction in the emergency department. World J Emerg Med 2024; 15:273-282. [PMID: 39050223 PMCID: PMC11265628 DOI: 10.5847/wjem.j.1920-8642.2024.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 01/10/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND This study aimed to evaluate the discriminatory performance of 11 vital sign-based early warning scores (EWSs) and three shock indices in early sepsis prediction in the emergency department (ED). METHODS We performed a retrospective study on consecutive adult patients with an infection over 3 months in a public ED in Hong Kong. The primary outcome was sepsis (Sepsis-3 definition) within 48 h of ED presentation. Using c-statistics and the DeLong test, we compared 11 EWSs, including the National Early Warning Score 2 (NEWS2), Modified Early Warning Score, and Worthing Physiological Scoring System (WPS), etc., and three shock indices (the shock index [SI], modified shock index [MSI], and diastolic shock index [DSI]), with Systemic Inflammatory Response Syndrome (SIRS) and quick Sequential Organ Failure Assessment (qSOFA) in predicting the primary outcome, intensive care unit admission, and mortality at different time points. RESULTS We analyzed 601 patients, of whom 166 (27.6%) developed sepsis. NEWS2 had the highest point estimate (area under the receiver operating characteristic curve [AUROC] 0.75, 95%CI 0.70-0.79) and was significantly better than SIRS, qSOFA, other EWSs and shock indices, except WPS, at predicting the primary outcome. However, the pooled sensitivity and specificity of NEWS2 ≥ 5 for the prediction of sepsis were 0.45 (95%CI 0.37-0.52) and 0.88 (95%CI 0.85-0.91), respectively. The discriminatory performance of all EWSs and shock indices declined when used to predict mortality at a more remote time point. CONCLUSION NEWS2 compared favorably with other EWSs and shock indices in early sepsis prediction but its low sensitivity at the usual cut-off point requires further modification for sepsis screening.
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Affiliation(s)
- Rex Pui Kin Lam
- Department of Emergency Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong, China
| | - Zonglin Dai
- School of Public Health, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong, China
| | - Eric Ho Yin Lau
- School of Public Health, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong, China
| | - Carrie Yuen Ting Ip
- Department of Emergency Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong, China
| | - Ho Ching Chan
- Department of Emergency Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong, China
| | - Lingyun Zhao
- Department of Emergency Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong, China
| | - Tat Chi Tsang
- Accident and Emergency Department, Queen Mary Hospital, Hong Kong, China
| | | | - Timothy Hudson Rainer
- Department of Emergency Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong, China
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Martin-Loeches I, Pereira JG, Teoh TK, Barlow G, Dortet L, Carrol ED, Olgemöller U, Boyd SE, Textoris J. Molecular antimicrobial susceptibility testing in sepsis. Future Microbiol 2024; 19:61-72. [PMID: 38180334 DOI: 10.2217/fmb-2023-0128] [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: 05/30/2023] [Accepted: 09/01/2023] [Indexed: 01/06/2024] Open
Abstract
Rapidly detecting and identifying pathogens is crucial for appropriate antimicrobial therapy in patients with sepsis. Conventional diagnostic methods have been a great asset to medicine, though they are time consuming and labor intensive. This work will enable healthcare professionals to understand the bacterial community better and enhance their diagnostic capacity by using novel molecular methods that make obtaining quicker, more precise results possible. The authors discuss and critically assess the merits and drawbacks of molecular testing and the added value of these tests, including the shift turnaround time, the implication for clinicians' decisions, gaps in knowledge, future research directions and novel insights or innovations. The field of antimicrobial molecular testing has seen several novel insights and innovations to improve the diagnosis and management of infectious diseases.
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Affiliation(s)
- Ignacio Martin-Loeches
- Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St James' Hospital, D08 NHY1, Dublin, Ireland
- Hospital Clinic, Institut D'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universidad de Barcelona, Ciberes, 08036 Barcelona, Spain
| | | | - Tee Keat Teoh
- Department of Clinical Microbiology, St James' Hospital, Dublin, Ireland
| | - Gavin Barlow
- York Biomedical Research Institute, University of York and Hull York Medical School, UK
- Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - Laurent Dortet
- Department of Bacteriology-Hygiene, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre, France
- INSERM UMR 1184, RESIST Unit, Paris-Saclay University, Le Kremlin-Bicêtre, France
- French National Reference Center for Antimicrobial Resistance, France
| | - Enitan D Carrol
- University of Liverpool, Institute of Infection, Veterinary and Ecological Sciences, Liverpool, UK
- Alder Hey Children's Hospital, Department of Infectious Diseases, Liverpool, UK
| | - Ulrike Olgemöller
- Department of Cardiology and Pneumology, University of Goettingen, Goettingen, Germany
| | - Sara E Boyd
- St George's University Hospital NHS Foundation Trust, London, UK
- Antimicrobial Pharmacodynamics and Therapeutics, Department of Molecular and Clinical Pharmacology, University of Liverpool, Liverpool, UK
- National Institute for Health Research, Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance, Imperial College London, London, UK
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Brunetti E, Presta R, Rinaldi G, Ronco G, De Vito D, Brambati T, Isaia G, Raspo S, Bracco C, Marabotto M, Fenoglio LM, Bo M. Predictors of In-Hospital Mortality in Older Inpatients with Suspected Infection. J Am Med Dir Assoc 2023; 24:1868-1873. [PMID: 37488028 DOI: 10.1016/j.jamda.2023.06.012] [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: 04/03/2023] [Revised: 06/05/2023] [Accepted: 06/12/2023] [Indexed: 07/26/2023]
Abstract
OBJECTIVES To determine the rate and predictors of death in older individuals with suspected infection at any time during hospital stay in a geriatric acute ward and the prognostic ability of different tools [quick Sequential (Sepsis-related) Organ Failure Assessment (qSOFA), Modified and National Early Warning Scores (MEWS) and (NEWS)] in such population. DESIGN Prospective observational single-center cohort study. SETTING AND PARTICIPANTS Among patients admitted to an acute geriatric unit of an Italian University Hospital with at least 1 sepsis risk factor, all subjects with suspected infection at admission or during hospital stay (defined as antibiotic prescription and associated culture test) were considered. METHODS A geriatric assessment including comorbidity and social, functional, and cognitive status was performed for each patient. Clinical parameters were evaluated at least twice daily throughout hospital stay; qSOFA, MEWS, and NEWS were derived, with positive cutoffs set at ≥2, ≥5, and ≥7, respectively. RESULTS Among 305 older inpatients (median age 86.0 years, 49.2% female), 21% died during hospital stay. Sepsis was diagnosed in 31.8% of the overall sample and in 64.1% of deceased patients. Deceased patients showed a significantly higher prevalence of prior institutionalization, functional dependence, cognitive impairment, and multimorbidity. The prognostic accuracy of the qSOFA score at infection onset was only fair (area under the receiver operating characteristic curve 0.72; 95% CI, 0.65-0.79, P < .001) and comparable with that of MEWS and NEWS. After multivariable analysis, in-hospital death was positively associated with male sex [odds ratio (OR), 2.11; 95% CI, 1.01-4.44; P = .048] and abnormal white blood cells count (OR, 4.93; 95% CI, 2.36-10.29; P < .001), platelet count (OR, 2.61; 95% CI, 1.10-6.16; P = .029) and serum creatinine (OR, 2.70; 95% CI, 1.30-5.61; P = .008), along with any of the score considered, and negatively associated with autonomy in instrumental activities (OR, 0.78; 95% CI, 0.68-0.90; P < .001). CONCLUSIONS Prognosis in older inpatients with infection or sepsis appears to be determined both by the geriatric characteristics and by the severity of the acute event, expressed by recommended tools and blood test results.
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Affiliation(s)
- Enrico Brunetti
- Section of Geriatrics, Department of Medical Sciences, AOU Città della Salute e della Scienza - Molinette, Turin, Italy; Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Roberto Presta
- Section of Geriatrics, Department of Medical Sciences, AOU Città della Salute e della Scienza - Molinette, Turin, Italy.
| | - Gianluca Rinaldi
- Section of Geriatrics, Department of Medical Sciences, AOU Città della Salute e della Scienza - Molinette, Turin, Italy; Section of Geriatrics, Department of Medical Specialties, AO Santa Croce e Carle, Cuneo, Italy
| | - Giuliano Ronco
- Section of Geriatrics, Department of Medical Sciences, AOU Città della Salute e della Scienza - Molinette, Turin, Italy
| | - Davide De Vito
- Section of Geriatrics, Department of Medical Sciences, AOU Città della Salute e della Scienza - Molinette, Turin, Italy
| | - Tiziana Brambati
- Section of Geriatrics, Department of Medical Sciences, AOU Città della Salute e della Scienza - Molinette, Turin, Italy
| | - Gianluca Isaia
- Section of Geriatrics, Department of Medical Sciences, AOU Città della Salute e della Scienza - Molinette, Turin, Italy
| | - Silvio Raspo
- Section of Geriatrics, Department of Medical Specialties, AO Santa Croce e Carle, Cuneo, Italy
| | - Christian Bracco
- Section of Internal Medicine, Department of Medical Specialties, AO Santa Croce e Carle, Cuneo, Italy
| | - Marco Marabotto
- Section of Geriatrics, Department of Medical Specialties, AO Santa Croce e Carle, Cuneo, Italy
| | - Luigi Maria Fenoglio
- Section of Internal Medicine, Department of Medical Specialties, AO Santa Croce e Carle, Cuneo, Italy
| | - Mario Bo
- Section of Geriatrics, Department of Medical Sciences, AOU Città della Salute e della Scienza - Molinette, Turin, Italy
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Kim T, Tae Y, Yeo HJ, Jang JH, Cho K, Yoo D, Lee Y, Ahn SH, Kim Y, Lee N, Cho WH. Development and Validation of Deep-Learning-Based Sepsis and Septic Shock Early Prediction System (DeepSEPS) Using Real-World ICU Data. J Clin Med 2023; 12:7156. [PMID: 38002768 PMCID: PMC10672000 DOI: 10.3390/jcm12227156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 11/14/2023] [Accepted: 11/15/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Successful sepsis treatment depends on early diagnosis. We aimed to develop and validate a system to predict sepsis and septic shock in real time using deep learning. METHODS Clinical data were retrospectively collected from electronic medical records (EMRs). Data from 2010 to 2019 were used as development data, and data from 2020 to 2021 were used as validation data. The collected EMRs consisted of eight vital signs, 13 laboratory data points, and three demographic information items. We validated the deep-learning-based sepsis and septic shock early prediction system (DeepSEPS) using the validation datasets and compared our system with other traditional early warning scoring systems, such as the national early warning score, sequential organ failure assessment (SOFA), and quick sequential organ failure assessment. RESULTS DeepSEPS achieved even higher area under receiver operating characteristic curve (AUROC) values (0.7888 and 0.8494 for sepsis and septic shock, respectively) than SOFA. The prediction performance of traditional scoring systems was enhanced because the early prediction time point was close to the onset time of sepsis; however, the DeepSEPS scoring system consistently outperformed all conventional scoring systems at all time points. Furthermore, at the time of onset of sepsis and septic shock, DeepSEPS showed the highest AUROC (0.9346). CONCLUSIONS The sepsis and septic shock early warning system developed in this study exhibited a performance that is worth considering when predicting sepsis and septic shock compared to other traditional early warning scoring systems. DeepSEPS showed better performance than existing sepsis prediction programs. This novel real-time system that simultaneously predicts sepsis and septic shock requires further validation.
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Affiliation(s)
- Taehwa Kim
- Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, School of Medicine, Pusan National University and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan 50612, Republic of Korea; (T.K.); (H.J.Y.); (J.H.J.)
| | - Yunwon Tae
- VUNO, Seoul 06541, Republic of Korea; (Y.T.); (K.C.); (D.Y.); (Y.L.)
| | - Hye Ju Yeo
- Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, School of Medicine, Pusan National University and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan 50612, Republic of Korea; (T.K.); (H.J.Y.); (J.H.J.)
- Department of Internal Medicine, School of Medicine, Pusan National University, Busan 46241, Republic of Korea
| | - Jin Ho Jang
- Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, School of Medicine, Pusan National University and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan 50612, Republic of Korea; (T.K.); (H.J.Y.); (J.H.J.)
| | - Kyungjae Cho
- VUNO, Seoul 06541, Republic of Korea; (Y.T.); (K.C.); (D.Y.); (Y.L.)
| | - Dongjoon Yoo
- VUNO, Seoul 06541, Republic of Korea; (Y.T.); (K.C.); (D.Y.); (Y.L.)
- Department of Critical Care Medicine and Emergency Medicine, Inha University College of Medicine, Incheon 22212, Republic of Korea
| | - Yeha Lee
- VUNO, Seoul 06541, Republic of Korea; (Y.T.); (K.C.); (D.Y.); (Y.L.)
| | - Sung-Ho Ahn
- Division of Biostatistics, Department of Neurology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan 50612, Republic of Korea;
| | - Younga Kim
- Department of Pediatrics, School of Medicine, Pusan National University, Yangsan 50612, Republic of Korea; (Y.K.); (N.L.)
| | - Narae Lee
- Department of Pediatrics, School of Medicine, Pusan National University, Yangsan 50612, Republic of Korea; (Y.K.); (N.L.)
| | - Woo Hyun Cho
- Division of Pulmonology, Allergy and Critical Care Medicine, Department of Internal Medicine, School of Medicine, Pusan National University and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan 50612, Republic of Korea; (T.K.); (H.J.Y.); (J.H.J.)
- Department of Internal Medicine, School of Medicine, Pusan National University, Busan 46241, Republic of Korea
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Kumar A, Abbenbroek B, Delaney A, Hammond N, Grattan S, Finfer S. Sepsis triggers and tools to support early identification in healthcare settings: An integrative review. Aust Crit Care 2023; 36:1117-1128. [PMID: 36813654 DOI: 10.1016/j.aucc.2023.01.001] [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: 06/21/2022] [Revised: 01/09/2023] [Accepted: 01/09/2023] [Indexed: 02/22/2023] Open
Abstract
BACKGROUND There is no universal trigger or tool to aid sepsis diagnosis. OBJECTIVES The objective of this study was to identify triggers and tools to assist the early detection of sepsis that can be readily implemented across various health care settings. METHODS A systematic integrative review was conducted using MEDLINE, CINAHL, EMBASE, Scopus, and the Cochrane Database of Systematic Reviews. Relevant grey literature and subject-matter expert consultation also informed the review. Study types included systematic reviews, randomised controlled trials, and cohort studies. All patient populations across prehospital, emergency department, and acute hospital inpatient settings, excluding the intensive care unit, were included. Sepsis triggers and tools were evaluated for efficacy in detecting sepsis and association with process measures and patient outcomes. Methodological quality was appraised using Joanna Briggs Institute tools. RESULTS Of the 124 included studies, most were retrospective cohort (49.2%) in adults (83.9%) within the emergency department (44.4%). The most commonly evaluated sepsis tools were qSOFA (12 studies) and SIRS (11 studies) with a median sensitivity of 28.0% versus 51.0% and a specificity of 98.0% versus 82.0%, respectively, for sepsis diagnosis. Lactate plus qSOFA (two studies) had a sensitivity between 57.0 and 65.5%, whereas the National Early Warning Score (four studies) demonstrated median sensitivity and specificity >80%, but the latter was considered difficult to implement. Amongst triggers, lactate (18 studies) at the threshold of ≥2.0 mmol/L showed higher sensitivity for predicting sepsis-related clinical deterioration than <2.0 mmol/L. Automated sepsis alerts and algorithms (35 studies) showed median sensitivity between 58.0 and 80.0% and specificity between 60.0 and 93.1%. There were limited data for other sepsis tools and maternal, paediatric, and neonatal populations. Overall methodological quality was high. CONCLUSION No single sepsis tool or trigger is applicable across various settings and populations, but considering efficacy and ease of implementation, there is evidence to use lactate plus qSOFA for adult patients. More research is needed in maternal, paediatric, and neonatal populations.
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Affiliation(s)
- Ashwani Kumar
- The George Institute for Global Health, University of New South Wales, Sydney, Australia.
| | - Brett Abbenbroek
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Anthony Delaney
- The George Institute for Global Health, University of New South Wales, Sydney, Australia; Royal North Shore Hospital, NSW, Australia
| | - Naomi Hammond
- The George Institute for Global Health, University of New South Wales, Sydney, Australia; Royal North Shore Hospital, NSW, Australia
| | - Sarah Grattan
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Simon Finfer
- The George Institute for Global Health, University of New South Wales, Sydney, Australia; Royal North Shore Hospital, NSW, Australia; School of Public Health, Imperial College London, London, England, UK
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21
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Xie W, Wu L, Yang M, Luo H, Li W, Li H. Association of preoperative electrocardiographic markers with sepsis in elderly patients after general surgery. BMC Cardiovasc Disord 2023; 23:485. [PMID: 37794366 PMCID: PMC10552407 DOI: 10.1186/s12872-023-03535-x] [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: 04/02/2023] [Accepted: 09/26/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Electrocardiographic markers, as surrogates for sympathetic excitotoxicity, are widely predictive of cardiovascular adverse events, but whether these markers can predict postsurgical sepsis (SS) is unclear. METHODS We retrospectively analyzed patients who underwent abdominal surgery from March 2013 to May 2023. We collected basic data, comorbidities, blood samples, echocardiology, electrocardiogram, and surgical data, as well as short-term outcome. The primary endpoints were postsurgical SS, in which logistic regression analyses can identify independent risk factors. The optimal cut-off value predictive postsurgical SS both P wave and PR interval were calculated in the receiver operating characteristic curve (ROC). RESULTS A total of 1988 subjects were analyzed, and the incidence of postsurgical SS was 3.8%. The mean age at enrollment was 68.6 ± 7.1 years, and 53.2% of the participants were men. In the ROC analysis, the areas under the curve (AUC) for P wave and PR interval predictive postsurgical SS were 0.615 (95%CI, 0.548-0.683; p = 0.001) and 0.618 (95%CI, 0.554-0.682; p = 0.001), respectively. The P wave and PR interval predicted postoperative sepsis with optimal discrimination of 103 and 157 ms, with a sensitivity of 0.744 and 0.419, and a specificity of 0.427 and 0.760. P-wave less than 103 ms or PR interval less than 157 ms associated with a 2.06 or 2.33 fold increase occurred risk postsurgical SS. CONCLUSIONS Shorter P-wave and PR intervals were both independently associated with postsurgical SS. These preoperative electrophysiological markers could have potential useful for early recognition of postoperative SS.
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Affiliation(s)
- WeiXian Xie
- Department of Anesthesiology, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People's Hospital, Area B24, Yinquan Road, Xincheng District, Qingyuan City, Guangdong Province, People's Republic of China
| | - LiXia Wu
- Department of Anesthesiology, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People's Hospital, Area B24, Yinquan Road, Xincheng District, Qingyuan City, Guangdong Province, People's Republic of China
| | - MeiXing Yang
- Department of Anesthesiology, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People's Hospital, Area B24, Yinquan Road, Xincheng District, Qingyuan City, Guangdong Province, People's Republic of China
| | - HongLi Luo
- Department of Anesthesiology, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People's Hospital, Area B24, Yinquan Road, Xincheng District, Qingyuan City, Guangdong Province, People's Republic of China
| | - Weichao Li
- Department of Anesthesiology, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People's Hospital, Area B24, Yinquan Road, Xincheng District, Qingyuan City, Guangdong Province, People's Republic of China.
| | - Heng Li
- Department of Anesthesiology, The Sixth Affiliated Hospital of Guangzhou Medical University, Qingyuan People's Hospital, Area B24, Yinquan Road, Xincheng District, Qingyuan City, Guangdong Province, People's Republic of China.
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22
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Anam AM, Shareef A, Shumy F, Gerardus King MR. Preventing unrecognized deterioration & improving outcomes of critically ill patients using the National Early Warning Score 2 in a high dependency unit in Bangladesh: A quality improvement project. Trop Doct 2023; 53:419-427. [PMID: 37309167 DOI: 10.1177/00494755231178124] [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] [Indexed: 06/14/2023]
Abstract
This Quality Improvement Project (QIP) aimed to assess the acceptability and utility of the National Early Warning Score 2 (NEWS2) in a Bangladeshi level-2 care setting. All nurses and physicians were trained on NEWS2 scores and a proper response before starting the QIP. Utilization of NEWS2 and patient outcome were documented and analyzed. Acceptability was acknowledged by increase in utilization, and utility by reduction in unrecognized deterioration of patients. The modified NEWS2 was well adopted and utilized by the nursing staff. There was a statistically significant reduction in unrecognized deterioration leading to cardiac arrest and the need for transfer to the Intensive Care Unit after implementation of NEWS2. With adequate training, motivation and appropriate modification, NEWS2 can become a well-accepted, widely adopted and realistic bedside monitoring tool in resource-limited settings like Bangladesh.
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Affiliation(s)
- Ahmad Mursel Anam
- Associate Consultant, Critical Care & Internal Medicine, Square Hospitals Ltd, Dhaka, Bangladesh
| | - Adnan Shareef
- Senior House Officer, HDU, Square Hospitals Ltd, Dhaka, Bangladesh
| | - Farzana Shumy
- Associate Consultant, Rheumatology & Internal Medicine, Square Hospitals Ltd, Dhaka, Bangladesh
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Zhao X, Wu X, Si Y, Xie J, Wang L, Liu S, Duan C, Wang Q, Wu D, Wang Y, Chen J, Yang J, Hu S, Yin W, Li J. D-DI/PLT can be a prognostic indicator for sepsis. PeerJ 2023; 11:e15910. [PMID: 37692119 PMCID: PMC10487589 DOI: 10.7717/peerj.15910] [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: 03/20/2023] [Accepted: 07/26/2023] [Indexed: 09/12/2023] Open
Abstract
Aims To investigate the indicators affecting the early outcome of patients with sepsis and to explore its prognostic efficacy for sepsis. Methods We collected clinical data from 201 patients with sepsis admitted to the emergency department of Xijing Hospital between June 2019 and June 2022. The patients were categorized into groups (survival or fatality) based on their 28-day prognosis. The clinical characteristics, biochemical indexes, organ function-related indicators, and disease scores of the patients were analyzed for both groups. Risk factor analysis was conducted for the indicators with significant differences. Results Among the indicators with significant differences between the deceased and survival groups, D-dimer (D-DI), Sequential Organ Failure Assessment (SOFA) score, platelet (PLT), international normalized ratio (INR), and D-DI/PLT were identified as independent risk factors affecting the prognosis of sepsis patients. Receiver operating characteristic (ROC) curves showed that D-DI/PLT (area under the curve (AUC) = 93.9), D-DI (AUC = 89.6), PLT (AUC = 81.3), and SOFA (AUC = 78.4) had good judgment efficacy. Further, Kaplan Meier (K-M) survival analysis indicated that the 28-day survival rates of sepsis patients were significantly decreased when they had high levels of D-DI/PLT, D-DI, and SOFA as well as low PLTs. The hazard ratio (HR) of D-DI/PLT between the two groups was the largest (HR = 16.19). Conclusions D-DI/PLT may be an independent risk factor for poor prognosis in sepsis as well as a clinical predictor of patient prognosis.
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Affiliation(s)
- Xiaojun Zhao
- Department of Emergency, Xijing Hospital, Fourth Military Medical University, Xian, Shaanxi, China
| | - Xiuhua Wu
- Department of Respiratory and Clinical Care Medicine, Shanghai Sixth People’s Hospital, Shanghai, China
| | - Yi Si
- Department of Emergency, Xijing Hospital, Fourth Military Medical University, Xian, Shaanxi, China
| | - Jiangang Xie
- Department of Emergency, Xijing Hospital, Fourth Military Medical University, Xian, Shaanxi, China
| | - Linxiao Wang
- Department of Emergency, Xijing Hospital, Fourth Military Medical University, Xian, Shaanxi, China
- College of Life Sciences, Northwest University, Xi’an, Shaanxi, China
| | - Shanshou Liu
- Department of Emergency, Xijing Hospital, Fourth Military Medical University, Xian, Shaanxi, China
| | - Chujun Duan
- Department of Emergency, Xijing Hospital, Fourth Military Medical University, Xian, Shaanxi, China
| | - Qianmei Wang
- Department of Emergency, Xijing Hospital, Fourth Military Medical University, Xian, Shaanxi, China
| | - Dan Wu
- Department of Emergency, Xijing Hospital, Fourth Military Medical University, Xian, Shaanxi, China
| | - Yifan Wang
- Department of Emergency, Xijing Hospital, Fourth Military Medical University, Xian, Shaanxi, China
| | - Jijun Chen
- Department of Emergency, Xijing Hospital, Fourth Military Medical University, Xian, Shaanxi, China
| | - Jing Yang
- Department of Emergency, Xijing Hospital, Fourth Military Medical University, Xian, Shaanxi, China
| | - Shanbo Hu
- Department of Emergency, Xijing Hospital, Fourth Military Medical University, Xian, Shaanxi, China
| | - Wen Yin
- Department of Emergency, Xijing Hospital, Fourth Military Medical University, Xian, Shaanxi, China
| | - Junjie Li
- Department of Emergency, Xijing Hospital, Fourth Military Medical University, Xian, Shaanxi, China
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Liu C, Wu X, Deng R, Xu X, Chen C, Wu L, Zhang W, Yang H, Fei Y, Sun Y, Zhou S, Fang B. Systemic immune-inflammation index combined with quick sequential organ failure assessment score for predicting mortality in sepsis patients. Heliyon 2023; 9:e19526. [PMID: 37809490 PMCID: PMC10558729 DOI: 10.1016/j.heliyon.2023.e19526] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 08/03/2023] [Accepted: 08/25/2023] [Indexed: 10/10/2023] Open
Abstract
Objective To evaluate the prognostic ability of systemic immune-inflammation index (SII) combine with quick Sequential Organ Failure Assessment (qSOFA) criteria in predicting the 28-day mortality of sepsis. Methods A retrospective cohort study was conducted, with the population comprised in whom sepsis was confirmed. Clinical and laboratory data recorded were analyzed. The score of Sequential Organ Failure Assessment (SOFA), SII, qSOFA were calculated. Multivariable regression, receiver operating characteristic (ROC) analysis and Kaplan-Meier method were used to identify and compared the predictors of prognosis among SOFA, qSOFA, and the combination of SII with qSOFA. Results A total of 349 patients admitted from December 2020 and December 2022 were included in the cohort. 95 (27.2%) of whom had died by day 28. The SII, SOFA, and qSOFA scores were significant higher in the non-survivors than that of survivors (P < 0.05), and identified as independent predictors of sepsis mortality. The addition of SII to qSOFA shown an area under receiver operator characteristic (AUROC) of 0.840 (95% CI: 0.787-0.884), manifested an effective ability in predicting poor outcome than other scoring systems. The optimum cutoff for SII (>1.7668) and qSOFA (>1) represented a high risk level in 28-day mortality of sepsis, were performed and identified in Kaplan-Meier survival curves (log-rank test, HR: 6.942, 95% CI: 3.976-12.121; P < 0.0001). Conclusion The SII in addition to qSOFA provided an effective prognostic tool for predicting mortality in sepsis.
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Affiliation(s)
- Changya Liu
- Department of Emergency, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Xinxin Wu
- Shanghai Skin Disease Hospital, School of Medicine, Tongji University, 200443, Shanghai, China
| | - Rou Deng
- Department of Emergency, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Xiangru Xu
- Department of Emergency, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Caiyu Chen
- Department of Emergency, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Linguangjin Wu
- Department of Emergency, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Wen Zhang
- Department of Emergency, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Hongqiang Yang
- Department of Emergency, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Yuerong Fei
- Department of Emergency, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Yuting Sun
- Department of Emergency, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Shuang Zhou
- Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Bangjiang Fang
- Department of Emergency, LongHua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
- Institute of Emergency and Critical Care Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
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Bollinger M, Frère N, Shapeton AD, Schary W, Kohl M, Kill C, Riße J. Does Prehospital Suspicion of Sepsis Shorten Time to Administration of Antibiotics in the Emergency Department? A Retrospective Study in One University Hospital. J Clin Med 2023; 12:5639. [PMID: 37685707 PMCID: PMC10488377 DOI: 10.3390/jcm12175639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 08/25/2023] [Accepted: 08/26/2023] [Indexed: 09/10/2023] Open
Abstract
Early treatment is the mainstay of sepsis therapy. We suspected that early recognition of sepsis by prehospital healthcare providers may shorten the time for antibiotic administration in the emergency department. We retrospectively evaluated all patients above 18 years of age who were diagnosed with sepsis or severe infection in our emergency department between 2018 and 2020. We recorded the suspected diagnosis at the time of presentation, the type of referring healthcare provider, and the time until initiation of antibiotic treatment. Differences between groups were calculated using the Kruskal-Wallis rank sum test. Of the 277 patients who were diagnosed with severe infection or sepsis in the emergency department, an infection was suspected in 124 (44.8%) patients, and sepsis was suspected in 31 (11.2%) patients by referring healthcare providers. Time to initiation of antibiotic treatment was shorter in patients where sepsis or infection had been suspected prior to arrival for both patients with severe infections (p = 0.022) and sepsis (p = 0.004). Given the well-described outcome benefits of early sepsis therapy, recognition of sepsis needs to be improved. Appropriate scores should be used as part of routine patient assessment to reduce the time to antibiotic administration and improve patient outcomes.
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Affiliation(s)
- Matthias Bollinger
- Department of Anesthesiology, Intensive Care, Emergency Medicine and Pain Therapy, Schwarzwald-Baar Hospital, Klinikstrasse 11, 78052 Villingen-Schwenningen, Germany
- Department of Anesthesiology I, Faculty of Health, Witten/Herdecke University, 58455 Witten, Germany
| | - Nadja Frère
- Center of Emergency Medicine, University Hospital Essen, 45147 Essen, Germany
| | - Alexander Daniel Shapeton
- Department of Anesthesia, Critical Care and Pain Medicine, Boston Veterans Affairs Healthcare System, West Roxbury, MA 02132, USA
- Tufts University School of Medicine, Boston, MA 02111, USA
| | - Weronika Schary
- Institute of Precision Medicine, Faculty of Medical and Life Sciences, Furtwangen University, 78054 Villingen-Schwenningen, Germany
| | - Matthias Kohl
- Institute of Precision Medicine, Faculty of Medical and Life Sciences, Furtwangen University, 78054 Villingen-Schwenningen, Germany
| | - Clemens Kill
- Center of Emergency Medicine, University Hospital Essen, 45147 Essen, Germany
| | - Joachim Riße
- Center of Emergency Medicine, University Hospital Essen, 45147 Essen, Germany
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Schertz AR, Lenoir KM, Bertoni AG, Levine BJ, Mongraw-Chaffin M, Thomas KW. Sepsis Prediction Model for Determining Sepsis vs SIRS, qSOFA, and SOFA. JAMA Netw Open 2023; 6:e2329729. [PMID: 37624600 PMCID: PMC10457723 DOI: 10.1001/jamanetworkopen.2023.29729] [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: 02/28/2023] [Accepted: 07/07/2023] [Indexed: 08/26/2023] Open
Abstract
Importance The Sepsis Prediction Model (SPM) is a proprietary decision support tool created by Epic Systems; it generates a predicting sepsis score (PSS). The model has not undergone validation against existing sepsis prediction tools, such as Systemic Inflammatory Response Syndrome (SIRS), Sequential Organ Failure Assessment (SOFA), or quick Sepsis-Related Organ Failure Asessement (qSOFA). Objective To assess the validity and timeliness of the SPM compared with SIRS, qSOFA, and SOFA. Design, Setting, and Participants This retrospective cohort study included all adults admitted to 5 acute care hospitals in a single US health system between June 5, 2019, and December 31, 2020. Data analysis was conducted from March 2021 to February 2023. Main Outcomes and Measures A sepsis event was defined as receipt of 4 or more days of antimicrobials, blood cultures collected within ±48 hours of initial antimicrobial, and at least 1 organ dysfunction as defined by the organ dysfunction criteria optimized for the electronic health record (eSOFA). Time zero was defined as 15 minutes prior to qualifying antimicrobial or blood culture order. Results Of 60 507 total admissions, 1663 (2.7%) met sepsis criteria, with 1324 electronic health record-confirmed sepsis (699 [52.8%] male patients; 298 [22.5%] Black patients; 46 [3.5%] Hispanic/Latinx patients; 945 [71.4%] White patients), 339 COVID-19 sepsis (183 [54.0%] male patients; 98 [28.9%] Black patients; 36 [10.6%] Hispanic/Latinx patients; and 189 [55.8%] White patients), and 58 844 (97.3%; 26 632 [45.2%] male patients; 12 698 [21.6%] Black patients; 3367 [5.7%] Hispanic/Latinx patients; 40 491 White patients) did not meet sepsis criteria. The median (IQR) age was 63 (51 to 73) years for electronic health record-confirmed sepsis, 69 (60 to 77) years for COVID-19 sepsis, and 60 (42 to 72) years for nonsepsis admissions. Within the vendor recommended threshold PSS range of 5 to 8, PSS of 8 or greater had the highest balanced accuracy for classifying a sepsis admission at 0.79 (95% CI, 0.78 to 0.80). Change in SOFA score of 2 or more had the highest sensitivity, at 0.97 (95% CI, 0.97 to 0.98). At a PSS of 8 or greater, median (IQR) time to score positivity from time zero was 68.00 (6.75 to 605.75) minutes. For SIRS, qSOFA, and SOFA, median (IQR) time to score positivity was 7.00 (-105.00 to 08.00) minutes, 74.00 (-22.25 to 599.25) minutes, and 28.00 (-108.50 to 134.00) minutes, respectively. Conclusions and Relevance In this cohort study of hospital admissions, balanced accuracy of the SPM outperformed other models at higher threshold PSS; however, application of the SPM in a clinical setting was limited by poor timeliness as a sepsis screening tool as compared to SIRS and SOFA.
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Affiliation(s)
- Adam R. Schertz
- Department of Internal Medicine, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
- Section of Pulmonology, Critical Care, Allergy and Immunologic Diseases, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
| | - Kristin M. Lenoir
- Department of Biostatistics and Data Science, Division of Public Health Science, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
| | - Alain G. Bertoni
- Department of Internal Medicine, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
- Department of Biostatistics and Data Science, Division of Public Health Science, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
| | - Beverly J. Levine
- Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Morgana Mongraw-Chaffin
- Department of Epidemiology and Prevention, Atrium Health Wake Forest Baptist Winston-Salem, North Carolina
| | - Karl W. Thomas
- Department of Internal Medicine, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
- Section of Pulmonology, Critical Care, Allergy and Immunologic Diseases, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina
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Lai Q, Xia Y, Yang W, Zhou Y. Development and Validation of a Rapid and Efficient Prognostic Scoring System for Sepsis Based on Oxygenation Index, Lactate and Glasgow Coma Scale. J Inflamm Res 2023; 16:2955-2966. [PMID: 37484996 PMCID: PMC10362864 DOI: 10.2147/jir.s418531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 07/10/2023] [Indexed: 07/25/2023] Open
Abstract
Objective To develop a concise scoring system for efficient and rapid assessment of sepsis prognosis applicable to emergency departments. Methods This was a single-center retrospective cohort study of patients with sepsis. In this study, a new scoring system (oxygenation index, lactate, and Glasgow coma scale: GOL) was developed through a derivation group, and then the GOL was validated using a validation group. Multivariate logistic regression analysis was performed to investigate the relationship between GOL and 28-day adverse outcomes. The GOL was compared with the previous scoring system using receiver operating characteristic curves (ROC) and decision analysis curves. The endpoints of this study were mortality, mechanical ventilation (MV), and admission to the intensive care unit (AICU). Results 608 patients were included in the derivation group and 213 patients in the validation group, with 131 and 42 deaths, respectively. In the validation group, lactate (Lac), oxygenation index (PaO2/FiO2), and Glasgow coma scale score (GCS), the three best performers in predicting 28-day mortality from receiver operating characteristic curves, were used to construct the GOL. The higher the GOL score, the higher the incidence of death, MV and AICU within 28 days. Multifactorial logistic regression analysis showed that when the GOL was greater than 1, it was an independent risk factor for 28-day mortality, MV, and AICU. In predicting 28-day mortality, GOL was superior to the quick Sequential Organ Failure Assessment (qSOFA), Mortality in Emergency Department Sepsis Score (MEDS), Systemic Inflammatory Response Syndrome Score (SIRS), and Modified Early Warning Score (MEWS), and was comparable to the Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA). Conclusion The GOL is a simple, rapid, and accurate method for early identification of patients at increased risk of in-hospital death from sepsis.
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Affiliation(s)
- Qiang Lai
- Emergency Department, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
- Laboratory of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
- Disaster Medical Center, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Yiqin Xia
- Emergency Department, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
- Laboratory of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
- Disaster Medical Center, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Wentao Yang
- Emergency Department, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
- Laboratory of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
- Disaster Medical Center, Sichuan University, Chengdu, Sichuan, People’s Republic of China
| | - Yiwu Zhou
- Emergency Department, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
- Laboratory of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People’s Republic of China
- Disaster Medical Center, Sichuan University, Chengdu, Sichuan, People’s Republic of China
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Qiu X, Lei YP, Zhou RX. SIRS, SOFA, qSOFA, and NEWS in the diagnosis of sepsis and prediction of adverse outcomes: a systematic review and meta-analysis. Expert Rev Anti Infect Ther 2023; 21:891-900. [PMID: 37450490 DOI: 10.1080/14787210.2023.2237192] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 06/20/2023] [Accepted: 06/27/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND We compared Systemic Inflammatory Response Syndrome (SIRS), Sequential Organ Failure Assessment (SOFA), Quick Sepsis-related Organ Failure Assessment (qSOFA), and National Early Warning Score (NEWS) for sepsis diagnosis and adverse outcomes prediction. METHODS Clinical studies that used SIRS, SOFA, qSOFA, and NEWS for sepsis diagnosis and prognosis assessment were included. Data were extracted, and meta-analysis was performed for outcome measures, including sepsis diagnosis, in-hospital mortality, 7/10/14-day mortality, 28/30-day mortality, and ICU admission. RESULTS Fifty-seven included studies showed good overall quality. Regarding sepsis prediction, SIRS demonstrated high sensitivity (0.85) but low specificity (0.41), qSOFA showed low sensitivity (0.42) but high specificity (0.98), and NEWS exhibited high sensitivity (0.71) and specificity (0.85). For predicting in-hospital mortality, SOFA demonstrated the highest sensitivity (0.89) and specificity (0.69). In terms of predicting 7/10/14-day mortality, SIRS exhibited high sensitivity (0.87), while qSOFA had high specificity (0.75). For predicting 28/30-day mortality, SOFA showed high sensitivity (0.97) but low specificity (0.14), whereas qSOFA displayed low sensitivity (0.41) but high specificity (0.88). CONCLUSIONS NEWS independently demonstrates good diagnostic capability for sepsis, especially in high-income countries. SOFA emerges as the optimal choice for predicting in-hospital mortality and can be employed as a screening tool for 28/30-day mortality in low-income countries.
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Affiliation(s)
- Xia Qiu
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yu-Peng Lei
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Rui-Xi Zhou
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Chengdu, Sichuan, China
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Russo A, Salini S, Gava G, Merra G, Piccioni A, De Matteis G, Tullo G, Novelli A, Petrucci M, Gasbarrini A, Landi F, Franceschi F, Covino M. Reduced Prognostic Role of Serum PCT Measurement in Very Frail Older Adults Admitted to the Emergency Department. Antibiotics (Basel) 2023; 12:1036. [PMID: 37370355 DOI: 10.3390/antibiotics12061036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/08/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND This study aims to evaluate the prognostic role of serum PCT in older patients with suspect sepsis or infective diagnosis in the Emergency Department (ED) with a particular focus on the clinical consequences and characteristics due to frailty status. METHODS This is a observational retrospective study conducted in the ED of a teaching hospital. We identified all consecutive patients aged ≥ 80 years admitted to the ED and subsequently hospitalized for clinical suspicion of infection. Inclusion criteria were: age ≥ 80 years and clinical suspicion of infection; availability of a PCT determination obtained < 24 h since ED access; and Clinical Frailty Scale (CFS) determination. Study endpoints were the diagnostic accuracy of PCT for all-cause in-hospital death, infective diagnosis at discharge, and bloodstream infection. Diagnostic accuracy was calculated via ROC analysis and compared in the patients with severe frailty, measured by CFS > 6, and patients with low or moderate frailty (CFS 1-6). A multivariate analysis was performed to calculate the adjusted odds of raised PCT values for the study endpoints. RESULTS In total, 1459 adults ≥ 80 years with a clinical suspicion of infection were included in the study cohort. The median age of the sample was 85 years (82-89), with 718 (49.2%) males. The multivariate models revealed that, after adjusting for significant covariates, the PCT values at ED admission were significantly associated with higher odds of infective diagnosis only in the fit/moderately frail group (Odds Ratio [95% CI] 1.04 [1.01-1.08], p 0.009) and not in very frail patients (Odds Ratio [95% CI] 1.02 [0.99-1.06], p 0.130). Similarly, PCT values were significantly associated with higher odds of in-hospital death in the fit/moderately frail group (Odds Ratio [95% CI] 1.01 [1.00-1.02], p 0.047), but not in the very frail ones (Odds Ratio [95% CI] 1.00 [0.98-1.02], p 0.948). Conversely, the PCT values were confirmed to be a good independent predictor of bloodstream infection in both the fit/moderately frail group (Odds Ratio [95% CI] 1.06 [1.04-1.08], p < 0.001) and the very frail group (Odds Ratio [95% CI] 1.05 [1.03-1.07], p < 0.001). CONCLUSIONS The PCT values at ED admission do not predict infective diagnosis, nor are associated with higher odds of in-hospital death. Still, in frail older adults, the PCT values in ED could be a useful predictor of bloodstream infection.
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Affiliation(s)
- Andrea Russo
- Department of Geriatrics, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Sara Salini
- Department of Geriatrics, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Giordana Gava
- Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Giuseppe Merra
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Andrea Piccioni
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Giuseppe De Matteis
- Department of Internal Medicina and Gastroenterology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Gianluca Tullo
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Angela Novelli
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Martina Petrucci
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Antonio Gasbarrini
- Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Department of Internal Medicina and Gastroenterology, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Francesco Landi
- Department of Geriatrics, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
- Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Francesco Franceschi
- Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
| | - Marcello Covino
- Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Emergency Department, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy
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Li Y, Wang Y. Temporal convolution attention model for sepsis clinical assistant diagnosis prediction. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2023; 20:13356-13378. [PMID: 37501491 DOI: 10.3934/mbe.2023595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Sepsis is an organ failure disease caused by an infection acquired in an intensive care unit (ICU), which leads to a high mortality rate. Developing intelligent monitoring and early warning systems for sepsis is a key research area in the field of smart healthcare. Early and accurate identification of patients at high risk of sepsis can help doctors make the best clinical decisions and reduce the mortality rate of patients with sepsis. However, the scientific understanding of sepsis remains inadequate, leading to slow progress in sepsis research. With the accumulation of electronic medical records (EMRs) in hospitals, data mining technologies that can identify patient risk patterns from the vast amount of sepsis-related EMRs and the development of smart surveillance and early warning models show promise in reducing mortality. Based on the Medical Information Mart for Intensive Care Ⅲ, a massive dataset of ICU EMRs published by MIT and Beth Israel Deaconess Medical Center, we propose a Temporal Convolution Attention Model for Sepsis Clinical Assistant Diagnosis Prediction (TCASP) to predict the incidence of sepsis infection in ICU patients. First, sepsis patient data is extracted from the EMRs. Then, the incidence of sepsis is predicted based on various physiological features of sepsis patients in the ICU. Finally, the TCASP model is utilized to predict the time of the first sepsis infection in ICU patients. The experiments show that the proposed model achieves an area under the receiver operating characteristic curve (AUROC) score of 86.9% (an improvement of 6.4% ) and an area under the precision-recall curve (AUPRC) score of 63.9% (an improvement of 3.9% ) compared to five state-of-the-art models.
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Affiliation(s)
- Yong Li
- College of Computer Science and Engineering, Northwest Normal University, 967 Anning East Road, Lanzhou 730070, China
| | - Yang Wang
- College of Computer Science and Engineering, Northwest Normal University, 967 Anning East Road, Lanzhou 730070, China
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Swami T, Shams A, Mittelstadt M, Guenther C, Tse T, Noor H, Shahid R. Implementation of early warning system in the clinical teaching unit to reduce unexpected deaths. BMJ Open Qual 2023; 12:bmjoq-2022-002194. [PMID: 37263736 DOI: 10.1136/bmjoq-2022-002194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 05/05/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Early detection of patients with clinical deterioration admitted to the hospital is critical. The early warning system (EWS) is developed to identify early clinical deterioration. Using individual patient's vital sign records, this bedside score can identify early clinical deterioration, triggering a communication algorithm between nurses and physicians, thereby facilitating early patient intervention. Although various models have been developed and implemented in emergency rooms and paediatric units, data remain sparse on the utility of the EWS in patients admitted to general internal medicine wards and the processes and challenges encountered during the implementation. LOCAL PROBLEM There is a lack of standardised tools to recognise early deterioration of patient condition. METHODS This was a quality improvement project piloted in the clinical teaching unit of a tertiary care hospital. Data were collected 24 weeks pre-EWS and 55 weeks post-EWS implementation. A series of Plan, Do, Study, Act cycles were conducted to identify the root cause, develop a driver diagram to understand the drivers of unexpected deaths, run a sham test trial run of the EWS, educate and obtained feedback of clinical care teams involved, assess adherence to the EWS during the pilot project (6 weeks pre-EWS and 6 weeks post-EWS implementation), evaluate outcomes by extending the duration to 24 weeks pre-EWS and 55 weeks post-EWS implementation, and retrospectively review the uptake of the EWS. INTERVENTIONS Implementation of a standardised protocol to detect deterioration in patient condition. RESULTS During the pre-EWS implementation phase (24 weeks), there were 4.4 events per week (1.2 septic workups, 1.9 observation unit transfers, 0.7 critical care transfers, 0.13 cardiac arrests and 0.46 per week unexpected deaths). In the post-EWS implementation phase (55 weeks), there were 4.2 events per week (1.0 septic workup, 1.9 observation unit transfers, 0.82 critical care transfers, 0.25 cardiac arrests and 0.25 unexpected deaths). CONCLUSION The EWS can improve patient care; however, more engagement of stakeholders and electronic vital sign documentation may improve the uptake of the system.
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Affiliation(s)
- Tara Swami
- University of Saskatchewan College of Medicine, Saskatoon, Saskatchewan, Canada
| | - Ali Shams
- University of Saskatchewan College of Medicine, Saskatoon, Saskatchewan, Canada
| | - Matthew Mittelstadt
- University of Saskatchewan College of Medicine, Saskatoon, Saskatchewan, Canada
| | - Catherine Guenther
- University of Saskatchewan College of Medicine, Saskatoon, Saskatchewan, Canada
| | - Tiffanie Tse
- University of Saskatchewan College of Medicine, Saskatoon, Saskatchewan, Canada
| | - Hifsa Noor
- University of Saskatchewan College of Medicine, Saskatoon, Saskatchewan, Canada
| | - Rabia Shahid
- Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Wang X, Guo Z, Chai Y, Wang Z, Liao H, Wang Z, Wang Z. Application Prospect of the SOFA Score and Related Modification Research Progress in Sepsis. J Clin Med 2023; 12:jcm12103493. [PMID: 37240599 DOI: 10.3390/jcm12103493] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/05/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023] Open
Abstract
In 2016, the SOFA score was proposed as the main evaluation system for diagnosis in the definition of sepsis 3.0, and the SOFA score has become a new research focus in sepsis. Some people are skeptical about diagnosing sepsis using the SOFA score. Experts and scholars from different regions have proposed different, modified versions of SOFA score to make up for the related problems with the use of the SOFA score in the diagnosis of sepsis. While synthesizing the different improved versions of SOFA proposed by experts and scholars in various regions, this paper also summarizes the relevant definitions of sepsis put forward in recent years to build a clear, improved application framework of SOFA score. In addition, the comparison between machine learning and SOFA scores related to sepsis is described and discussed in the article. Taken together, by summarizing the application of the improved SOFA score proposed in recent years in the related definition of sepsis, we believe that the SOFA score is still an effective means of diagnosing sepsis, but in the process of the continuous refinement and development of sepsis in the future, the SOFA score needs to be further refined and improved to provide more accurate coping strategies for different patient populations or application directions regarding sepsis. Against the big data background, machine learning has immeasurable value and significance, but its future applications should add more humanistic references and assistance.
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Affiliation(s)
- Xuesong Wang
- School of Clinical Medicine, Tsinghua University, Beijing 100190, China
| | - Zhe Guo
- School of Clinical Medicine, Tsinghua University, Beijing 100190, China
| | - Yan Chai
- School of Clinical Medicine, Tsinghua University, Beijing 100190, China
| | - Ziyi Wang
- School of Clinical Medicine, Tsinghua University, Beijing 100190, China
| | - Haiyan Liao
- School of Clinical Medicine, Tsinghua University, Beijing 100190, China
| | - Ziwen Wang
- School of Clinical Medicine, Tsinghua University, Beijing 100190, China
| | - Zhong Wang
- Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing 100084, China
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Kishore J, Kumar R, Nazli T, Ahmad A, Kumar P, Khan AA. Efficacy of the Unani Regimen as an Add-On to Standard Treatment in Hospitalised RT-PCR-Confirmed Mild to Moderate COVID-19 Patients: An Open-Label Randomized Controlled Trial. Cureus 2023; 15:e38574. [PMID: 37284399 PMCID: PMC10239565 DOI: 10.7759/cureus.38574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2023] [Indexed: 06/08/2023] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic resulted in mortality and morbidity worldwide. Many treatment modalities have been experimented with limited success. Therefore, the traditional system of medicine needs to be explored. Objective To evaluate the benefits of Unani regimensTiryaq-e-Arba and Unani Joshanda, as adjuvant therapy, were compared to standard treatment alone among reverse transcription polymerase chain reaction (RT-PCR)-confirmed mild to moderate COVID-19 cases. Materials and methods An open-label, double-arm, randomized, controlled interventional clinical study was conducted among 90 RT-PCR-confirmed mild to moderate COVID-19 inpatients admitted to a tertiary care hospital in New Delhi, India. Participants who fulfilled the criteria for inclusion were randomly assigned to two arms, with 43 subjects allocated to the Unani add-on arm and 47 subjects to the control arm receiving standard treatment alone. Results Clinical recovery was achieved in all patients of the Unani arm, while in the control arm, three (6.4%) patients deteriorated and had to be shifted to ICU following admission. In the intervention arm, a shorter duration of hospitalization was observed (mean 5.95 days {SD = 1.99}) than in the control arm (mean 7.62 days {SD, 4.06}); which was a statistically significant difference (p-value 0.017). The majority of the patients recovered within 10 days in the Unani add-on arm. The number of days taken for the reduction of symptoms was significantly less in the intervention arm (mean 5.14 days {SD, 2.39}) as compared with standard treatment (mean 6.53 days {SD, 3.06}) (p < 0.02). Renal and liver safety parameters were within the normal limits in both arms and no serious adverse event was reported. Conclusion Adding Unani formulations to standard treatment significantly reduced the duration of hospital stay and showed early recovery in COVID-19 patients compared with the control arm. It may be concluded that the synergistic effect of the Unani add-on with standard treatment gave more promising results in mild to moderate COVID-19 patients.
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Affiliation(s)
- Jugal Kishore
- Department of Community Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Rohit Kumar
- Department of Pulmonary Critical Care and Sleep Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Tamanna Nazli
- Department of Unani Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Aftab Ahmad
- Department of Community Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Pawan Kumar
- Department of Pathology, Central Council for Research in Unani Medicine, New Delhi, IND
| | - Asim A Khan
- Department of Unani Medicine, Central Council for Research in Unani Medicine, New Delhi, IND
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Sardidi H, Bawazeer D, Alhafi M, Alomran S, Sayed G. The Use of the Initial National Early Warning Score 2 at the Emergency Department as a Predictive Tool of In-Hospital Mortality in Hemodialysis Patients. Cureus 2023; 15:e39678. [PMID: 37398723 PMCID: PMC10308202 DOI: 10.7759/cureus.39678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2023] [Indexed: 07/04/2023] Open
Abstract
Background The diagnosis of sepsis in the emergency department (ED) is difficult due to the ambiguous nature of its expression and its non-specific symptoms. Multiple scoring tools have been utilized to detect the severity and prognosis of sepsis. This study aimed to evaluate the use of the initial National Early Warning Score 2 (NEWS-2) at the ED as a predictive tool of in-hospital mortality in hemodialysis patients. Methodology We performed a retrospective, observational study to review the records of hemodialysis patients admitted to King Abdulaziz Medical City in Riyadh with suspected sepsis from the 1st of January to the 31st of December 2019 using a convenient sampling technique. Results The results showed that NEWS-2 had a higher sensitivity in predicting sepsis compared to the Quick Sequential Organ Failure Assessment (qSOFA) (16.28% vs. 11.54%). However, qSOFA had a higher specificity in predicting sepsis compared to the NEWS-2 scoring system (81.16% vs. 74.14%). It was found that the NEWS-2 scoring system was more sensitive in predicting mortality compared to qSOFA (26% vs. 20%). However, qSOFA was more specific in predicting mortality compared to NEWS-2 (88.50% vs. 82.98%). Conclusions Our findings demonstrated that the initial NEWS-2 is a subpar screening tool for sepsis and in-hospital mortality in hemodialysis patients. The use of qSOFA at the time of ED presentation was found to have a relatively higher specificity in predicting sepsis and mortality when compared to NEWS-2. To assess the application of the initial NEWS-2 in the ED setting, additional research should be conducted.
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Affiliation(s)
- Habibah Sardidi
- Emergency Medicine, King Abdulaziz Medical City Riyadh, Riyadh, SAU
| | - Dalal Bawazeer
- Emergency Medicine, King Abdulaziz Medical City Riyadh, Riyadh, SAU
| | - Mohammed Alhafi
- Faculty of Medicine, King Saud Bin Abdulaziz University for Health Sciences College of Medicine, Riyadh, SAU
| | - Shadan Alomran
- Faculty of Medicine, King Saud Bin Abdulaziz University for Health Sciences College of Medicine, Riyadh, SAU
| | - Ghali Sayed
- Emergency Medicine, King Abdulaziz Medical City Riyadh, Riyadh, SAU
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Prasad PA, Correia J, Fang MC, Fisher A, Correll M, Oreper S, Auerbach A. Performance of point-of-care severity scores to predict prognosis in patients admitted through the emergency department with COVID-19. J Hosp Med 2023; 18:413-423. [PMID: 37057912 PMCID: PMC11344580 DOI: 10.1002/jhm.13106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 03/14/2023] [Accepted: 03/31/2023] [Indexed: 04/15/2023]
Abstract
BACKGROUND Identifying COVID-19 patients at the highest risk of poor outcomes is critical in emergency department (ED) presentation. Sepsis risk stratification scores can be calculated quickly for COVID-19 patients but have not been evaluated in a large cohort. OBJECTIVE To determine whether well-known risk scores can predict poor outcomes among hospitalized COVID-19 patients. DESIGNS, SETTINGS, AND PARTICIPANTS A retrospective cohort study of adults presenting with COVID-19 to 156 Hospital Corporation of America (HCA) Healthcare EDs, March 2, 2020, to February 11, 2021. INTERVENTION Quick Sequential Organ Failure Assessment (qSOFA), Shock Index, National Early Warning System-2 (NEWS2), and quick COVID-19 Severity Index (qCSI) at presentation. MAIN OUTCOME AND MEASURES The primary outcome was in-hospital mortality. Secondary outcomes included intensive care unit (ICU) admission, mechanical ventilation, and vasopressors receipt. Patients scored positive with qSOFA ≥ 2, Shock Index > 0.7, NEWS2 ≥ 5, and qCSI ≥ 4. Test characteristics and area under the receiver operating characteristics curves (AUROCs) were calculated. RESULTS We identified 90,376 patients with community-acquired COVID-19 (mean age 64.3 years, 46.8% female). 17.2% of patients died in-hospital, 28.6% went to the ICU, 13.7% received mechanical ventilation, and 13.6% received vasopressors. There were 3.8% qSOFA-positive, 45.1% Shock Index-positive, 49.8% NEWS2-positive, and 37.6% qCSI-positive at ED-triage. NEWS2 exhibited the highest AUROC for in-hospital mortality (0.593, confidence interval [CI]: 0.588-0.597), ICU admission (0.602, CI: 0.599-0.606), mechanical ventilation (0.614, CI: 0.610-0.619), and vasopressor receipt (0.600, CI: 0.595-0.604). CONCLUSIONS Sepsis severity scores at presentation have low discriminative power to predict outcomes in COVID-19 patients and are not reliable for clinical use. Severity scores should be developed using features that accurately predict poor outcomes among COVID-19 patients to develop more effective risk-based triage.
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Affiliation(s)
- Priya A. Prasad
- Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, CA, USA
| | - Jessica Correia
- HCA Healthcare, Sarah Cannon, USA, 1100 Dr. Martin L. King Jr. Blvd., Suite 800, Nashville, TN 37203
| | - Margaret C. Fang
- Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, CA, USA
| | - Arielle Fisher
- HCA Healthcare, Sarah Cannon, USA, 1100 Dr. Martin L. King Jr. Blvd., Suite 800, Nashville, TN 37203
| | - Mick Correll
- HCA Healthcare, Sarah Cannon, USA, 1100 Dr. Martin L. King Jr. Blvd., Suite 800, Nashville, TN 37203
| | - Sandra Oreper
- Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, CA, USA
| | - Andrew Auerbach
- Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, CA, USA
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Liao WH, Lee SY, Liao EC, Chang WH, Chen TH, Huang MK, Lin JP, Tsai W, Sun FJ, Chien DK. A pilot study of digital bedside cards in the emergency room of a medical centre in Taiwan. Sci Rep 2023; 13:6965. [PMID: 37117245 PMCID: PMC10147724 DOI: 10.1038/s41598-023-34234-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 04/26/2023] [Indexed: 04/30/2023] Open
Abstract
The emergency room (ER) digital bedside card is a simple and important invention. It can be directly connected to the hospital information system to display important patient information in real time, reduce the workload of ER staff, improve their satisfaction, and provide useful information for patients and their families. We conducted a prospective study of ER staff using questionnaires and conducted Wilcoxon signed-rank test to compare before and after ER digital bedside card implementation in the Tamsui MacKay Memorial Hospital. Sixty participants of the ER staff joined the study before and after digital card implementation. After the ER digital bedside card was set up, the number of round trips from the nursing station to the ER bedside and the number of common questions asked by patients and their family members were significantly reduced. The cards reduced the response time for frequently asked questions by patients and their family members and significantly improved the satisfaction of ER staff. Our study showed that ER digital bedside cards reduced the workload of ER staff, provided patients and their families with useful information, and greatly improved ER staff satisfaction. This marks an important milestone in the future development of smart ER.
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Affiliation(s)
- Wei-Hsiang Liao
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
- Department of Emergency Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Shih-Yi Lee
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
- MacKay Junior College of Medicine, Nursing, and Management, New Taipei City, Taiwan
| | - En-Chih Liao
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Wen-Han Chang
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
- Department of Emergency Medicine, MacKay Memorial Hospital, Taipei, Taiwan
- MacKay Junior College of Medicine, Nursing, and Management, New Taipei City, Taiwan
- Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan
- Institute of Mechatronic Engineering, National Taipei University of Technology, Taipei, Taiwan
- School of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Tse-Hao Chen
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
- Department of Emergency Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Ming-Kun Huang
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
- Department of Emergency Medicine, MacKay Memorial Hospital, Taipei, Taiwan
- MacKay Junior College of Medicine, Nursing, and Management, New Taipei City, Taiwan
| | - Jui-Ping Lin
- Department of Emergency Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Weide Tsai
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
- Department of Emergency Medicine, MacKay Memorial Hospital, Taipei, Taiwan
- MacKay Junior College of Medicine, Nursing, and Management, New Taipei City, Taiwan
| | - Fang-Ju Sun
- Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan
| | - Ding-Kuo Chien
- Department of Medicine, MacKay Medical College, New Taipei City, Taiwan.
- Department of Emergency Medicine, MacKay Memorial Hospital, Taipei, Taiwan.
- MacKay Junior College of Medicine, Nursing, and Management, New Taipei City, Taiwan.
- Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan.
- Institute of Mechatronic Engineering, National Taipei University of Technology, Taipei, Taiwan.
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Zacharakis A, Ackermann K, Hughes C, Lam V, Li L. Combining C-reactive protein and quick sequential organ failure assessment (qSOFA) to improve prognostic accuracy for sepsis and mortality in adult inpatients: A systematic review. Health Sci Rep 2023; 6:e1229. [PMID: 37091364 PMCID: PMC10119489 DOI: 10.1002/hsr2.1229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 03/21/2023] [Accepted: 04/04/2023] [Indexed: 04/25/2023] Open
Abstract
Background and Aims Infections are common in hospitals, and if mismanaged can develop into sepsis, a leading cause of death and disability worldwide. This study aimed to examine whether combining C-reactive protein (CRP) with the quick sequential organ failure assessment (qSOFA) improves its accuracy for predicting mortality and sepsis in adult inpatients. Methods PubMed, MEDLINE, EMBASE, Scopus, Web of Science, Science Direct, CINAHL, Open Grey, Grey Literature Report, and the Clinical Trials registry were searched using CRP and qSOFA search terms. Title, abstract, and full-text screening were performed by two independent reviewers using pre-determined eligibility criteria, followed by data extraction and a risk of bias assessment using the Quality Assessment tool for Diagnostic Accuracy Studies 2 (QUADAS-2). Disagreements were settled through discussion and consultation with a third reviewer. Results Four retrospective studies with a total of 2070 patients were included in this review. Adding CRP to qSOFA improved the Area Under the Receiver Operating Characteristic Curve up to 9.7% for predicting mortality and by 14.9% for identifying sepsis. The sensitivity and specificity of the combined score for mortality prediction were available in two studies. CRP improved the sensitivity of qSOFA by 43% and 71% while only decreasing the specificity by 12% and 7%, respectively. A meta-analysis was not performed due to study heterogeneity. Conclusion This comprehensive review provided initial evidence that combining CRP with qSOFA may improve the accuracy of qSOFA alone in identifying sepsis or patients at risk of dying in hospital. The combined tool demonstrated the potential to improve patient outcomes, with implications for low-resource settings given its simplicity and low-cost.
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Affiliation(s)
- Alexandra Zacharakis
- Macquarie Medical School, Faculty of Medicine, Health and Human SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - Khalia Ackermann
- Australian Institute of Health InnovationMacquarie UniversitySydneyNew South WalesAustralia
| | - Clifford Hughes
- Macquarie Medical School, Faculty of Medicine, Health and Human SciencesMacquarie UniversitySydneyNew South WalesAustralia
- Australian Institute of Health InnovationMacquarie UniversitySydneyNew South WalesAustralia
| | - Vincent Lam
- Macquarie Medical School, Faculty of Medicine, Health and Human SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - Ling Li
- Australian Institute of Health InnovationMacquarie UniversitySydneyNew South WalesAustralia
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Tullo G, Candelli M, Gasparrini I, Micci S, Franceschi F. Ultrasound in Sepsis and Septic Shock-From Diagnosis to Treatment. J Clin Med 2023; 12:jcm12031185. [PMID: 36769833 PMCID: PMC9918257 DOI: 10.3390/jcm12031185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 01/26/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
UNLABELLED Sepsis and septic shock are among the leading causes of in-hospital mortality worldwide, causing a considerable burden for healthcare. The early identification of sepsis as well as the individuation of the septic focus is pivotal, followed by the prompt initiation of antibiotic therapy, appropriate source control as well as adequate hemodynamic resuscitation. For years now, both emergency department (ED) doctors and intensivists have used ultrasound as an adjunctive tool for the correct diagnosis and treatment of these patients. Our aim was to better understand the state-of-the art role of ultrasound in the diagnosis and treatment of sepsis and septic shock. METHODS We conducted an extensive literature search about the topic and reported on the data from the most significant papers over the last 20 years. RESULTS We divided each article by topic and exposed the results accordingly, identifying four main aspects: sepsis diagnosis, source control and procedure, fluid resuscitation and hemodynamic optimization, and echocardiography in septic cardiomyopathy. CONCLUSION The use of ultrasound throughout the process of the diagnosis and treatment of sepsis and septic shock provides the clinician with an adjunctive tool to better characterize patients and ensure early, aggressive, as well as individualized therapy, when needed. More data are needed to conclude that the use of ultrasound might improve survival in this subset of patients.
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Noparatkailas N, Inchai J, Deesomchok A. Blood Lactate Level and the Predictor of Death in Non-shock Septic Patients. Indian J Crit Care Med 2023; 27:93-100. [PMID: 36865504 PMCID: PMC9973057 DOI: 10.5005/jp-journals-10071-24404] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 12/30/2022] [Indexed: 02/04/2023] Open
Abstract
Objective To evaluate the association of initial blood lactate with mortality and subsequent septic shock in non-shock septic patients. Materials and methods A retrospective cohort study was conducted at Maharaj Nakorn Chiang Mai Hospital, Chiang Mai University, Muang, Chiang Mai, Thailand. Inclusion criteria included septic patients admitted to a non-critical medical ward and had initial serum lactate at the emergency department (ED). Shock and other causes of hyperlactatemia were excluded. Results A total of 448 admissions were included with median age [interquartile range (IQR)] of 71 (59, 87) years and 200 males (44.6%). Pneumonia was the most common cause of sepsis (47.5%). The median systemic inflammatory response syndrome (SIRS) and quick sequential organ failure assessment (qSOFA) scores were 3 (2, 3) and 1 (1, 2), respectively. The median initial blood lactate was 2.19 (1.45, 3.23) mmol/L. The high blood lactate (≥2 mmol/L) group; N = 248, had higher qSOFA and other predictive scores and had significantly higher 28 days mortality (31.9% vs 10.0%; p < 0.001) and subsequent 3 days septic shock (18.1% vs 5.0%; p < 0.001) than the normal blood lactate group; N = 200. A combination of blood lactate above or equal to 2 mmol/L plus the national early warning score (NEWS) above or equal to 7 showed the highest prediction of 28 days mortality with the area under receiver-operating characteristic curve (AUROC) of 0.70 [95% confidence interval (CI): 0.65-0.75]. Conclusions An initial blood lactate level above or equal to 2 mmol/L is associated with high mortality and subsequent septic shock among non-shock septic patients. The composite of blood lactate levels and other predictive scores yields better accuracy to predict mortality. How to cite this article Noparatkailas N, Inchai J, Deesomchok A. Blood Lactate Level and the Predictor of Death in Non-shock Septic Patients. Indian J Crit Care Med 2023;27(2):93-100.
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Affiliation(s)
- Nabhat Noparatkailas
- Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Muang, Chiang Mai, Thailand
| | - Juthamas Inchai
- Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Muang, Chiang Mai, Thailand
| | - Athavudh Deesomchok
- Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Muang, Chiang Mai, Thailand,Athavudh Deesomchok, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Muang, Chiang Mai, Thailand, Phone: +66 53936396, e-mail:
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Lin SF, Lin HA, Pan YH, Hou SK. A novel scoring system combining Modified Early Warning Score with biomarkers of monocyte distribution width, white blood cell counts, and neutrophil-to-lymphocyte ratio to improve early sepsis prediction in older adults. Clin Chem Lab Med 2023; 61:162-172. [PMID: 36103663 DOI: 10.1515/cclm-2022-0656] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 09/08/2022] [Indexed: 01/08/2023]
Abstract
OBJECTIVES This study aims to investigate whether combining scoring systems with monocyte distribution width (MDW) improves early sepsis detection in older adults in the emergency department (ED). METHODS In this prospective observational study, we enrolled older adults aged ≥60 years who presented with confirmed infectious diseases to the ED. Three scoring systems-namely quick sepsis-related organ failure assessment (qSOFA), Modified Early Warning Score (MEWS), and National Early Warning Score (NEWS), and biomarkers including MDW, neutrophil-to-lymphocyte ratio (NLR), and C-reactive protein (CRP), were assessed in the ED. Logistic regression models were used to construct sepsis prediction models. RESULTS After propensity score matching, we included 522 and 2088 patients with and without sepsis in our analysis from January 1, 2020, to September 30, 2021. NEWS ≥5 and MEWS ≥3 exhibited a moderate-to-high sensitivity and a low specificity for sepsis, whereas qSOFA score ≥2 demonstrated a low sensitivity and a high specificity. When combined with biomarkers, the NEWS-based, the MEWS-based, and the qSOFA-based models exhibited improved diagnostic accuracy for sepsis detection without CRP inclusion (c-statistics=0.842, 0.842, and 0.826, respectively). Of the three models, MEWS ≥3 with white blood cell (WBC) count ≥11 × 109/L, NLR ≥8, and MDW ≥20 demonstrated the highest diagnostic accuracy in all age subgroups (c-statistics=0.886, 0.825, and 0.822 in patients aged 60-74, 75-89, and 90-109 years, respectively). CONCLUSIONS Our novel scoring system combining MEWS with WBC, NLR, and MDW effectively detected sepsis in older adults.
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Affiliation(s)
- Sheng-Feng Lin
- Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan.,Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Hui-An Lin
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan.,Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Yi-Hsiang Pan
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Sen-Kuang Hou
- Department of Emergency Medicine, Taipei Medical University Hospital, Taipei, Taiwan.,Department of Emergency Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Vanichkulbodee A, Romposra M, Inboriboon PC, Trongtrakul K. Effects of vitamin D insufficiency on sepsis severity and risk of hospitalisation in emergency department patients: a cross-sectional study. BMJ Open 2023; 13:e064985. [PMID: 36653058 PMCID: PMC9853214 DOI: 10.1136/bmjopen-2022-064985] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To evaluate the association of 25-hydroxyvitamin D (25(OH)D) level on sepsis severity and risk of hospitalisation in emergency department (ED) septic patients when categorised as vitamin D insufficiency according to the level of 25(OH)D<30 ng/mL. DESIGN Cross-sectional observational study. SETTING A 900-bed academic tertiary hospital with an ED residency training programme in Bangkok, Thailand. PARTICIPANTS An observational study of 101 ED septic patients aged ≥18 years was conducted between March 2015 and September 2015. OUTCOME MEASURES The level of 25(OH)D was analysed and correlated with sepsis severity assessed by Acute Physiology Age Chronic Health Evaluation-II (APACHE-II) and Mortality in ED Sepsis (MEDS) scores, and the risk of hospitalisation. RESULTS One hundred and one patients were enrolled, with an average age of 68±18 years, 56% female, APACHE-II score of 14±6, MEDS score of 8±5 and 25(OH)D level was 19±11 ng/mL. The prevalence of vitamin D insufficiency in our ED septic patients was 87% and the admission rate was 88%. A significant association between 25(OH)D level and sepsis severity scores was found, which was measured by APACHE-II and MEDS scores (-0.29; 95% CI -0.41 to -0.17, p<0.001 and -0.15; 95% CI -0.25 to -0.06, p=0.002, respectively). However, vitamin D insufficiency could not determine hospitalisation (OR=1.42; 95% CI 0.27 to 7.34; p=0.68 and OR=1.65; 95% CI 0.07 to 41.7; p=0.76 when adjusted by baseline covariates). CONCLUSIONS The vitamin D insufficiency of septic patients in our ED was high and had a significant negative association with sepsis severity. However, vitamin D insufficiency status cannot predict the hospitalisation of septic patients who were admitted to the ED. Further research is needed to investigate the role of vitamin D supplementation in the ED in affecting sepsis severity. TRIAL REGISTRATION NUMBER TCTR20151127001.
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Affiliation(s)
- Alissara Vanichkulbodee
- Department of Emergency Medicine, Navamindradhiraj University, Faculty of Medicine Vajira Hospital, Bangkok, Thailand
| | - Muditha Romposra
- Department of Emergency Medicine, Navamindradhiraj University, Faculty of Medicine Vajira Hospital, Bangkok, Thailand
- Emergency Room, Sukhumvit Hospital, Bangkok, Thailand
| | | | - Konlawij Trongtrakul
- Department of Internal Medicine, Division of Critical Care, Navamindradhiraj University, Faculty of Medicine Vajira Hospital, Bangkok, Thailand
- Department of Internal Medicine, Division of Pulmonary, Critical Care, and Allergy, Chiang Mai University, Faculty of Medicine, Chiang Mai, Thailand
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Abuzer Ö. Evaluation of Short-Term Mortality Prediction Using Initial Lactate and NEWS+L at Admission in COVID-19 Patients. Disaster Med Public Health Prep 2023; 17:e333. [PMID: 36594175 DOI: 10.1017/dmp.2022.299] [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] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To predict the short-term mortality of the serum lactate level and the National Early Warning Score + lactate (NEWS+L) at the time of first admission to the emergency department in COVID-19 patients. MATERIALS AND METHODS This retrospective analysis was performed by screening the data of COVID-19 patients over a 6-month period (from January 15, 2021, to June 15, 2021). The demographic, comorbidities, vital parameters, and lactate values, as well as C- reactive protein (CRP), blood urea nitrogen (BUN), and 28-day mortality data were recorded. RESULTS A total of 70 patients were included in our study. The median (25th - 75th percentile) age was 58 (47.3 - 73.5) years, and 33 (47.1%) patients were female. The mean lactate value was 1.6 (1.2 - 1.98) mmol/L, the mean NEWS was 6 (4-7.75), and the mean NEWS+L was 7.24 ± 2.54. Mortality occurred in 13 (18.2%) of the 70 patients at 28 days. Lactate, NEWS, and NEWS+L had no significant relationship with mortality. None of these parameters was able to predict mortality (P = 0.132, 0.670, and 0.994, respectively). CONCLUSION Our findings showed that the NEWS+L, NEWS, and lactate level could not predict short-term mortality in COVID-19 patients at the time of first admission.
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Affiliation(s)
- Özkan Abuzer
- Department of Emergency Medicine, University of Health Sciences Umraniye Training and Research Hospital, Istanbul, Turkey
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Validation of Sepsis-3 using survival analysis and clinical evaluation of quick SOFA, SIRS, and burn-specific SIRS for sepsis in burn patients with suspected infection. PLoS One 2023; 18:e0276597. [PMID: 36595535 PMCID: PMC9810178 DOI: 10.1371/journal.pone.0276597] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 10/10/2022] [Indexed: 01/04/2023] Open
Abstract
PURPOSE Sepsis-3 is a life-threatening organ dysfunction caused by dysregulated host responses to infection; and defined using the Sepsis-3 criteria, introduced in 2016, however, the criteria need to be validated in specific clinical fields. We investigated mortality prediction and compared the diagnostic performance of quick Sequential Organ Failure Assessment (qSOFA), systemic inflammatory response syndrome (SIRS), and burn-specific SIRS (bSIRS) in burn patients. METHODS This single-center retrospective cohort study examined burn patients in Seoul, Korea during January 2010-December 2020. Overall, 1,391 patients with suspected infection were divided into four sepsis groups using SOFA, qSOFA, SIRS, and burn-specific SIRS. RESULTS Hazard ratios (HRs) of all unadjusted models were statistically significant; however, the HR (0.726, p = 0.0080.001) in the SIRS ≥2 group is below 1. In the adjusted model, HRs of the SOFA ≥2 (2.426, <0.001), qSOFA ≥2 (7.198, p<0.001), and SIRS ≥2 (0.575, p<0.001) groups were significant. The diagnostic performance of dichotomized qSOFA, SIRS, and bSIRS for sepsis was defined by the Sepsis-3 criteria. The mean onset day was 4.13±2.97 according to Sepsis-3. The sensitivity of SIRS (0.989, 95% confidence interval [CI]: 0.982-0.994) was higher than that of qSOFA (0.841, 95% CI: 0.819-0.861) and bSIRS (0.803, 95% CI: 0.779-0.825). Specificities of qSOFA (0.929, 95% CI: 0.876-0.964) and bSIRS (0.922, 95% CI: 0.868-0.959) were higher than those of SIRS (0.461, 95% CI: 0.381-0.543). CONCLUSION Sepsis-3 is a good alternative diagnostic tool because it reflects sepsis severity without delaying diagnosis. SIRS showed higher sensitivity than qSOFA and bSIRS and may therefore more adequately diagnose sepsis.
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Melero-Guijarro L, Sanz-García A, Martín-Rodríguez F, Lipari V, Mazas Perez Oleaga C, Carvajal Altamiranda S, Martínez López NM, Domínguez Azpíroz I, Castro Villamor MA, Sánchez Soberón I, López-Izquierdo R. Prehospital qSOFA, mSOFA, and NEWS2 performance for sepsis prediction: A prospective, multi-center, cohort study. Front Med (Lausanne) 2023; 10:1149736. [PMID: 37144037 PMCID: PMC10151818 DOI: 10.3389/fmed.2023.1149736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 03/27/2023] [Indexed: 05/06/2023] Open
Abstract
Background Nowadays, there is no gold standard score for prehospital sepsis and sepsis-related mortality identification. The aim of the present study was to analyze the performance of qSOFA, NEWS2 and mSOFA as sepsis predictors in patients with infection-suspected in prehospital care. The second objective is to study the predictive ability of the aforementioned scores in septic-shock and in-hospital mortality. Methods Prospective, ambulance-based, and multicenter cohort study, developed by the emergency medical services, among patients (n = 535) with suspected infection transferred by ambulance with high-priority to the emergency department (ED). The study enrolled 40 ambulances and 4 ED in Spain between 1 January 2020, and 30 September 2021. All the variables used in the scores, in addition to socio-demographic data, standard vital signs, prehospital analytical parameters (glucose, lactate, and creatinine) were collected. For the evaluation of the scores, the discriminative power, calibration curve and decision curve analysis (DCA) were used. Results The mSOFA outperformed the other two scores for mortality, presenting the following AUCs: 0.877 (95%CI 0.841-0.913), 0.761 (95%CI 0.706-0.816), 0.731 (95%CI 0.674-0.788), for mSOFA, NEWS, and qSOFA, respectively. No differences were found for sepsis nor septic shock, but mSOFA's AUCs was higher than the one of the other two scores. The calibration curve and DCA presented similar results. Conclusion The use of mSOFA could provide and extra insight regarding the short-term mortality and sepsis diagnostic, backing its recommendation in the prehospital scenario.
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Affiliation(s)
- Laura Melero-Guijarro
- Emergency Department, Complejo Asistencial Universitario de Palencia, Palencia, Spain
| | - Ancor Sanz-García
- Faculty of Health Sciences, Universidad de Castilla la Mancha, Talavera de la Reina, Spain
- Prehospital Early Warning Scoring-System Investigation Group, Valladolid, Spain
- *Correspondence: Ancor Sanz-García,
| | - Francisco Martín-Rodríguez
- Prehospital Early Warning Scoring-System Investigation Group, Valladolid, Spain
- Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain
- Advanced Life Support, Emergency Medical Services (SACYL), Valladolid, Spain
| | - Vivian Lipari
- Universidad Europea del Atlántico, Santader, Spain
- Universidad Internacional Iberoamericana, Campeche, Mexico
| | - Cristina Mazas Perez Oleaga
- Universidad Europea del Atlántico, Santader, Spain
- Universidad Internacional Iberoamericana, Arecibo, PR, United States
- Universidade Internacional do Cuanza, Cuito, Bié, Angola
| | - Stefanía Carvajal Altamiranda
- Universidad Europea del Atlántico, Santader, Spain
- Universidade Internacional do Cuanza, Cuito, Bié, Angola
- Fundación Universitaria Internacional de Colombia, Bogotá, Colombia
| | - Nohora Milena Martínez López
- Universidad Europea del Atlántico, Santader, Spain
- Universidad Internacional Iberoamericana, Campeche, Mexico
- Fundación Universitaria Internacional de Colombia, Bogotá, Colombia
| | - Irma Domínguez Azpíroz
- Universidad Europea del Atlántico, Santader, Spain
- Universidad Internacional Iberoamericana, Campeche, Mexico
- Universidad de La Romana, La Romana, Dominican Republic
| | - Miguel A. Castro Villamor
- Emergency Department, Complejo Asistencial Universitario de Palencia, Palencia, Spain
- Faculty of Health Sciences, Universidad de Castilla la Mancha, Talavera de la Reina, Spain
- Prehospital Early Warning Scoring-System Investigation Group, Valladolid, Spain
| | | | - Raúl López-Izquierdo
- Prehospital Early Warning Scoring-System Investigation Group, Valladolid, Spain
- Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain
- Emergency Department, Hospital Universitario Rio Hortega, Valladolid, Spain
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Emergency Evaluation and Management of Sepsis and Septic Shock. PHYSICIAN ASSISTANT CLINICS 2023. [DOI: 10.1016/j.cpha.2022.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Julienne J, Douillet D, Mozziconacci MS, Callahan JC. Prognostic accuracy of using lactate in addition to the quick Sequential Organ Failure Assessment score and the National Early Warning Score for emergency department patients with suspected infection. J Accid Emerg Med 2023; 40:28-35. [PMID: 35396249 DOI: 10.1136/emermed-2021-211271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 02/22/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND The aim of this study was to determine whether: (1) the quick Sequential (Sepsis-related) Organ Failure Assessment (qSOFA) and National Early Warning Score (NEWS) clinical prediction tools alone, (2) modified versions of these prediction tools that integrate lactate into their scores, or (3) use of the two tools in tandem with lactate better predicts in-hospital 28-day mortality among adult EDpatients with suspected infection. METHODS From 1 January through 31 December 2018, this retrospective cohort study enrolled consecutive adult patients with suspected infection evaluated at two EDs in France. Patients were included if blood cultures were obtained and non-prophylactic antibiotics were administered in the ED. qSOFA, NEWS criteria and lactate measurements were recorded when patients were clinically suspected of having an infection. Two composite scores (lactate qSOFA (LqSOFA) and lactate NEWS (LNEWS)) integrating lactate were created. Diagnostic test performances for predicting in-hospital mortality within 28days were assessed for qSOFA≥2, LqSOFA≥2, qSOFA≥2 or lactate≥2 mmol/L, and for NEWS≥7, LNEWS≥7, and NEWS≥7 or lactate≥2 mmol/L. RESULTS 1003 patients were included, 130 (13%) of whom had died by day 28. Sensitivities for 28-day mortality were 50% (95%CI41% to 59%) for qSOFA≥2,69% (95% CI60% to 77%) for LqSOFA≥2,77% (95% CI69% to 84%) for qSOFA or lactate≥2 mmol/L; and 69% (95% CI60% to 77%) for NEWS≥7, 80% (95% CI72% to 86%) for LNEWS≥7, 87% (95% CI80% to 92%) for NEWS≥7 or lactate≥2 mmol/L. CONCLUSION Lactate used in tandem with qSOFA or NEWS yielded higher sensitivities in predicting in-hospital 28-day mortality, as compared with integration of lactate into these prediction tools or usage of the tools independently.
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Affiliation(s)
| | - Delphine Douillet
- Emergency Department, CHU d'Angers, Angers, France.,UMR MitoVasc CNRS 6015 - INSERM 1083, University of Angers, Angers, France
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Dewitte K, Scheurwegs E, Van Ierssel S, Jansens H, Dams K, Roelant E. Audit of a computerized version of the Manchester triage system and a SIRS-based system for the detection of sepsis at triage in the emergency department. Int J Emerg Med 2022; 15:67. [PMID: 36513965 PMCID: PMC9745734 DOI: 10.1186/s12245-022-00472-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 12/04/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND AND IMPORTANCE Different triage systems can be used to screen for sepsis and are often incorporated into local electronic health records. Often the design and interface of these digitalizations are not audited, possibly leading to deleterious effects on screening test performance. OBJECTIVE To audit a digital version of the MTS for detection of sepsis during triage in the ED. DESIGN A single-center retrospective study SETTINGS AND PARTICIPANTS: Patients (n=29766) presenting to an ED of a tertiary-care center who received formal triage were included. OUTCOME MEASURES AND ANALYSIS Calculated performance measures included sensitivity, specificity, likelihood ratios, and AUC for the detection of sepsis. Errors in the application of the specific sepsis discriminator of the MTS were recorded. MAIN RESULTS A total of 189 (0.7%) subjects met the Sepsis-3 criteria, with 47 cases meeting the criteria for septic shock. The MTS had a low sensitivity of 47.6% (95% CI 40.3 to 55.0) for allocating sepsis patients to the correct triage category. However, specificity was high at 99.4% (95% CI 99.3 to 99.5).
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Affiliation(s)
- Ken Dewitte
- grid.411414.50000 0004 0626 3418Emergency Department, Antwerp University Hospital, Edegem, Belgium
| | - Elyne Scheurwegs
- grid.5284.b0000 0001 0790 3681ADREM (Advanced Database Research and Modelling), Biomedical Informatics Research Center Antwerp (Biomina), University of Antwerp, Antwerpen, Belgium
| | - Sabrina Van Ierssel
- grid.411414.50000 0004 0626 3418Department of General Internal Medicine, infectious diseases and tropical medicine, Antwerp University Hospital, Edegem, Belgium
| | - Hilde Jansens
- grid.411414.50000 0004 0626 3418Department of Infection Control and Microbiology, Antwerp University Hospital, Edegem, Belgium
| | - Karolien Dams
- grid.411414.50000 0004 0626 3418Department of Intensive Care Medicine, Antwerp University Hospital, Edegem, Belgium
| | - Ella Roelant
- grid.411414.50000 0004 0626 3418Clinical Trial Center (CTC), Clinical Research Center Antwerp, Antwerp University Hospital, Edegem, Belgium
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Jeppesen KN, Dalsgaard ML, Ovesen SH, Rønsbo MT, Kirkegaard H, Jessen MK. Bacteremia Prediction With Prognostic Scores and a Causal Probabilistic Network - A Cohort Study of Emergency Department Patients. J Emerg Med 2022; 63:738-746. [PMID: 36522812 DOI: 10.1016/j.jemermed.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 07/02/2022] [Accepted: 09/04/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Physicians tend to overestimate patients' pretest probability of having bacteremia. The low yield of blood cultures and contaminants is associated with significant financial cost, as well as increased length of stay and unnecessary antibiotic treatment. OBJECTIVE This study examined the abilities of the National Early Warning Score (NEWS), the Quick Sequential Organ Failure Assessment (qSOFA), the Modified Sequential Organ Failure Assessment (mSOFA), and two versions of the causal probabilistic network, SepsisFinder™ (SF) to predict bacteremia in adult emergency department (ED) patients. METHODS This cohort study included adult ED patients from a large urban, academic tertiary hospital, with blood cultures obtained within 24 h of admission between 2016 and 2017. The outcome measure was true bacteremia. NEWS, qSOFA, mSOFA, and the two versions of SF score were calculated for all patients based on the first available full set of vital signs within 2 h and laboratory values within 6 h after drawing the blood cultures. Area under the receiver operating characteristic curve (AUROC) was calculated for each scoring system. RESULTS The study included 3106 ED patients, of which 199 (6.4%) patients had true bacteremia. The AUROCs for prediction of bacteremia were: NEWS = 0.65, qSOFA = 0.60, SF I = 0.65, mSOFA = 0.71, and SF II = 0.80. CONCLUSIONS Scoring systems using only vital signs, NEWS, and SF I showed moderate abilities in predicting bacteremia, whereas qSOFA performed poorly. Scoring systems using both vital signs and laboratory values, mSOFA and especially SF II, showed good abilities in predicting bacteremia.
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Affiliation(s)
- Klaus N Jeppesen
- Emergency Department, Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Michael L Dalsgaard
- Emergency Department, Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Stig H Ovesen
- Emergency Department, Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark; Emergency Department, Regional Hospital Horsens, Horsens, Denmark
| | - Mette T Rønsbo
- Department of Clinical Microbiology, Aarhus University Hospital, Aarhus, Denmark
| | - Hans Kirkegaard
- Emergency Department, Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Marie K Jessen
- Emergency Department, Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark
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Sauer CM, Chen LC, Hyland SL, Girbes A, Elbers P, Celi LA. Leveraging electronic health records for data science: common pitfalls and how to avoid them. Lancet Digit Health 2022; 4:e893-e898. [PMID: 36154811 DOI: 10.1016/s2589-7500(22)00154-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/29/2022] [Accepted: 07/28/2022] [Indexed: 12/29/2022]
Abstract
Analysis of electronic health records (EHRs) is an increasingly common approach for studying real-world patient data. Use of routinely collected data offers several advantages compared with other study designs, including reduced administrative costs, the ability to update analysis as practice patterns evolve, and larger sample sizes. Methodologically, EHR analysis is subject to distinct challenges because data are not collected for research purposes. In this Viewpoint, we elaborate on the importance of in-depth knowledge of clinical workflows and describe six potential pitfalls to be avoided when working with EHR data, drawing on examples from the literature and our experience. We propose solutions for prevention or mitigation of factors associated with each of these six pitfalls-sample selection bias, imprecise variable definitions, limitations to deployment, variable measurement frequency, subjective treatment allocation, and model overfitting. Ultimately, we hope that this Viewpoint will guide researchers to further improve the methodological robustness of EHR analysis.
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Affiliation(s)
- Christopher M Sauer
- Laboratory for Critical Care Computational Intelligence, Department of Intensive Care Medicine, Amsterdam Medical Data Science, Amsterdam Cardiovascular Science, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, Location VUmc, Amsterdam, Netherlands; Laboratory for Computational Physiology, Institute for Medical Engineering & Science, Massachusetts Institute of Technology, Cambridge, MA, USA.
| | - Li-Ching Chen
- Department of Computer Science, National Tsing Hua University, Hsinchu, Taiwan
| | | | - Armand Girbes
- Laboratory for Critical Care Computational Intelligence, Department of Intensive Care Medicine, Amsterdam Medical Data Science, Amsterdam Cardiovascular Science, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, Location VUmc, Amsterdam, Netherlands
| | - Paul Elbers
- Laboratory for Critical Care Computational Intelligence, Department of Intensive Care Medicine, Amsterdam Medical Data Science, Amsterdam Cardiovascular Science, Amsterdam Institute for Infection and Immunity, Amsterdam UMC, Location VUmc, Amsterdam, Netherlands
| | - Leo A Celi
- Laboratory for Computational Physiology, Institute for Medical Engineering & Science, Massachusetts Institute of Technology, Cambridge, MA, USA; Department of Biostatistics, Harvard T H Chan School of Public Health, Boston, MA, USA; Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Polilli E, Di Iorio G, Silveri C, Angelini G, Anelli MC, Esposito JE, D’Amato M, Parruti G, Carinci F. Monocyte Distribution Width as a predictor of community acquired sepsis in patients prospectively enrolled at the Emergency Department. BMC Infect Dis 2022; 22:849. [PMCID: PMC9661454 DOI: 10.1186/s12879-022-07803-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 10/25/2022] [Indexed: 11/16/2022] Open
Abstract
Background Monocyte Distribution Width (MDW), a simple cellular marker of innate monocyte activation, can be used for the early recognition of sepsis. We performed an observational prospective monocentric study to assess the predictive role of MDW in detecting sepsis in a sample of consecutive patients presenting at the Emergency Department.
Methods Prospective observational study using demographic and clinical characteristics, past medical history and other laboratory measurements to predict confirmed sepsis using multivariate logistic regression.
Results A total of 2724 patients were included in the study, of which 272 (10%) had sepsis or septic shock. After adjusting for known and potential risk factors, logistic regression found the following independent predictors of sepsis: SIRS equal to 1 (OR: 2.32, 1.16–4.89) and 2 or more (OR: 27.8, 14.8–56.4), MDW > 22 (OR: 3.73, 2.46–5.70), smoking (OR: 3.0, 1.22–7.31), end stage renal function (OR: 2.3, 1.25–4.22), neurodegenerative disease (OR: 2.2, 1.31–3.68), Neutrophils ≥ 8.9 × 103/µL (OR: 2.73, 1.82–4.11), Lymphocytes < 1.3 × 103/µL (OR: 1.72, 1.17–2.53) and CRP ≥ 19.1 mg/L (OR: 2.57, 1.63–4.08). A risk score derived from predictive models achieved high accuracy by using an optimal threshold (AUC: 95%; 93–97%). Conclusions The study suggests that incorporating MDW in the clinical decision process may improve the early identification of sepsis, with minimal additional effort on the standard procedures adopted during emergency care.
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Affiliation(s)
- Ennio Polilli
- grid.461844.bClinical Pathology Unit, Pescara General Hospital, Pescara, Italy
| | - Giancarlo Di Iorio
- grid.461844.bClinical Pathology Unit, Pescara General Hospital, Pescara, Italy
| | - Claudio Silveri
- grid.461844.bEmergency Department, Pescara General Hospital, Pescara, Italy
| | - Gilda Angelini
- grid.461844.bClinical Pathology Unit, Pescara General Hospital, Pescara, Italy
| | | | - Jessica Elisabetta Esposito
- grid.461844.bClinical Pathology Unit, Pescara General Hospital, Pescara, Italy ,grid.158820.60000 0004 1757 2611Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
| | - Milena D’Amato
- grid.461844.bClinical Pathology Unit, Pescara General Hospital, Pescara, Italy
| | - Giustino Parruti
- grid.461844.bInfectious Diseases Unit, Pescara General Hospital, Pescara, Italy
| | - Fabrizio Carinci
- grid.6292.f0000 0004 1757 1758Department of Statistical Sciences, Bologna University, Bologna, Italy
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