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Machado Lessa CL, Branchini G, Moreira Delfino I, Ramos Voos MH, Teixeira C, Hoher JA, Nunes FB. Comparison of Sepsis-1, 2 and 3 for Predicting Mortality in Septic Patients of a Middle-Income Country: A Retrospective Observational Cohort Study. J Intensive Care Med 2024; 39:349-357. [PMID: 37899601 DOI: 10.1177/08850666231208368] [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: 10/31/2023]
Abstract
INTRODUCTION The diagnosis of sepsis is based on expert consensus and does not yet have a "gold standard." With the aim of improving and standardizing diagnostic methods, there have already been three major consensuses on the subject. However, there are still few studies in middle-income countries comparing the methods. This study describes the characteristics of patients diagnosed with sepsis and evaluates and compares the performance of Sepsis-1, 2, and 3 criteria in predicting 28 days, and in-hospital mortality. PATIENTS AND METHODS A retrospective observational cohort study was conducted in the intensive care unit of a tertiary hospital. All admissions between January 1, 2018, and December 31, 2019, were reviewed. Patients diagnosed with sepsis were included. RESULTS During the study period, 653 patients diagnosed with sepsis (by any of the studied criteria) were included in the study. The 28 days mortality rate was 45.8%, and the in-hospital mortality rate was 59.7%. We observed that 72.1% of patients met the minimum criteria for diagnosing sepsis according to the three protocols, and this group also had the highest mortality rate. Age and comorbidities such as cancer and liver cirrhosis were significantly associated with in-hospital mortality. The most common microorganisms were Escherichia coli, Klebsiella spp., and Staphylococcus spp. CONCLUSIONS The study found that most patients met the diagnostic criteria for sepsis using the three methods. Sepsis-2 showed greater sensitivity to predict mortality, while Sequential Organ Failure Assessment showed low accuracy, but was the only significant one. Furthermore, quick Sequential Organ Failure Assessment (qSOFA) had the highest specificity for mortality. Overall, these findings suggest that, although all three methods contribute to the diagnosis and prognosis of sepsis, Sepsis-2 is particularly sensitive in predicting mortality. Sepsis-3 shows some accuracy but requires improvement, and qSOFA exhibits the highest specificity. More research is needed to improve predictive capabilities and patient outcomes.
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Affiliation(s)
| | - Gisele Branchini
- Graduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil
| | - Isabela Moreira Delfino
- Graduate Program in Health Sciences, Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil
| | | | - Cassiano Teixeira
- Department of Clinical Medicine, Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil
| | - Jorge Amilton Hoher
- Department of Clinical Medicine, Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil
- Central-intensive Care Unit, Complexo Hospitalar Santa Casa de Misericórdia de Porto Alegre, Brazil
| | - Fernanda Bordignon Nunes
- Graduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil
- School of Health and Life Sciences, Pontifícia Universidade Católica do Rio Grande do Sul, Brazil
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2
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Mehta Y, Paul R, Rabbani R, Acharya SP, Withanaarachchi UK. Sepsis Management in Southeast Asia: A Review and Clinical Experience. J Clin Med 2022; 11:3635. [PMID: 35806919 PMCID: PMC9267826 DOI: 10.3390/jcm11133635] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 06/17/2022] [Accepted: 06/20/2022] [Indexed: 02/06/2023] Open
Abstract
Sepsis is a life-threatening condition that causes a global health burden associated with high mortality and morbidity. Often life-threatening, sepsis can be caused by bacteria, viruses, parasites or fungi. Sepsis management primarily focuses on source control and early broad-spectrum antibiotics, plus organ function support. Comprehensive changes in the way we manage sepsis patients include early identification, infective focus identification and immediate treatment with antimicrobial therapy, appropriate supportive care and hemodynamic optimization. Despite all efforts of clinical and experimental research over thirty years, the capacity to positively influence the outcome of the disease remains limited. This can be due to limited studies available on sepsis in developing countries, especially in Southeast Asia. This review summarizes the progress made in the diagnosis and time associated with sepsis, colistin resistance and chloramphenicol boon, antibiotic abuse, resource constraints and association of sepsis with COVID-19 in Southeast Asia. A personalized approach and innovative therapeutic alternatives such as CytoSorb® are highlighted as potential options for the treatment of patients with sepsis in Southeast Asia.
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Affiliation(s)
- Yatin Mehta
- Institute of Critical Care and Anesthesiology, Medanta the Medicity, Sector-38, Gurugram 22001, India
| | - Rajib Paul
- Internal Medicine, Apollo Hospitals, Road Number 72, Jubilee Hills, Hyderabad 500033, India;
| | - Raihan Rabbani
- Critical Care & Internal Medicine, Square Hospitals Ltd., 18 Bir Uttam Qazi NuruzzamanSarak West, Panthapath, Dhaka 1205, Bangladesh;
| | - Subhash Prasad Acharya
- Critical Care Medicine, Institute of Medicine, Tribhuvan University, Maharajgunj, Kathmandu 44618, Nepal;
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3
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Hu T, Qiao Z, Mei Y. Urine Output Is Associated With In-hospital Mortality in Intensive Care Patients With Septic Shock: A Propensity Score Matching Analysis. Front Med (Lausanne) 2021; 8:737654. [PMID: 34869431 PMCID: PMC8637111 DOI: 10.3389/fmed.2021.737654] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 10/20/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The relationship between urine output (UO) and in-hospital mortality in intensive care patients with septic shock is currently inconclusive. Methods: The baseline data, UO, and in-hospital prognosis of intensive care patients with septic shock were retrieved from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. By drawing receiver operating characteristic (ROC) curves and comparing the areas under the ROC curves (AUC) to determine the predictive value of UO for in-hospital mortality, and by drawing the Kaplan-Meier curves to compare the difference in in-hospital mortality between different groups of UO. Results: Before and after the propensity score matching (PSM) analysis, UO was always a risk factor for in-hospital mortality in patients with septic shock. The AUC of UO was comparable to the Sequential Organ Failure Assessment (SOFA) scoring system, while the AUC of combining UO and SOFA was greater than that of SOFA. The median survival time of the high-UO group (UO > 0.39 ml/kg/h, before PSM; UO > 0.38 ml/kg/h, after PSM) was longer than that of the low-UO group. Compared with the high-UO group, the hazard ratios (HR) of the low-UO group were 2.6857 (before PSM) and 1.7879 (after PSM). Conclusions: UO is an independent risk factor for septic shock. Low levels of UO significantly increase the in-hospital mortality of intensive care patients with septic shock. The predictive value of UO is comparable to the SOFA scoring system, and the combined predictive value of the two surpasses SOFA alone.
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Affiliation(s)
- Tianyang Hu
- Department of Cardiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Zhao Qiao
- Department of Cardiology, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Ying Mei
- Health Management Center, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China
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Adegbite BR, Edoa JR, Ndzebe Ndoumba WF, Dimessa Mbadinga LB, Mombo-Ngoma G, Jacob ST, Rylance J, Hänscheid T, Adegnika AA, Grobusch MP. A comparison of different scores for diagnosis and mortality prediction of adults with sepsis in Low-and-Middle -Income Countries: a systematic review and meta-analysis. EClinicalMedicine 2021; 42:101184. [PMID: 34765956 PMCID: PMC8569629 DOI: 10.1016/j.eclinm.2021.101184] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 10/11/2021] [Accepted: 10/19/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Clinical scores for sepsis have been primarily developed for, and applied in High-Income Countries. This systematic review and meta-analysis examined the performance of the quick Sequential Organ Failure Assessment (qSOFA), Systemic Inflammatory Response Syndrome (SIRS), Modified Early Warning Score (MEWS), and Universal Vital Assessment (UVA) scores for diagnosis and prediction of mortality in patients with suspected infection in Low-and-Middle-Income Countries. METHODS PubMed, Science Direct, Web of Science, and the Cochrane Central Register of Controlled Trials databases were searched until May 18, 2021. Studies reporting the performance of at least one of the above-mentioned scores for predicting mortality in patients of 15 years of age and older with suspected infection or sepsis were eligible. The Quality Assessment of Diagnostic Accuracy Studies tool was used for risk-of-bias assessment. PRISMA guidelines were followed (PROSPERO registration: CRD42020153906). The bivariate random-effects regression model was used to pool the individual sensitivities, specificities and areas-under-the-curve (AUC). FINDINGS Twenty-four articles (of 5669 identified) with 27,237 patients were eligible for inclusion. qSOFA pooled sensitivity was 0·70 (95% confidence interval [CI] 0·60-0·78), specificity 0·73 (95% CI 0·67-0·79), and AUC 0·77 (95% CI 0·72-0·82). SIRS pooled sensitivity, specificity and AUC were 0·88 (95% CI 0·79 -0·93), 0·34 (95% CI 0·25-0·44), and 0·69 (95% CI 0·50-0·83), respectively. MEWS pooled sensitivity, specificity and AUC were 0·70 (95% CI 0·57 -0·81), 0·61 (95% CI 0·42-0·77), and 0·72 (95% CI 0·64-0·77), respectively. UVA pooled sensitivity, specificity and AUC were 0·49 (95% CI 0·33 -0·65), 0·91(95% CI 0·84-0·96), and 0·76 (95% CI 0·44-0·93), respectively. Significant heterogeneity was observed in the pooled analysis. INTERPRETATION Individual score performances ranged from poor to acceptable. Future studies should combine selected or modified elements of different scores. FUNDING Partially funded by the UK National Institute for Health Research (NIHR) (17/63/42).
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Affiliation(s)
- Bayode R Adegbite
- Centre de Recherches Médicales de Lambaréné and African Partner Institution, German Center for Infection Research (CERMEL), Lambaréné, Gabon
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, location AMC, Amsterdam Infection & Immunity, Amsterdam Public Health, University of Amsterdam, Amsterdam, The Netherlands
- Institut für Tropenmedizin, Universität Tübingen and German Center for Infection Research, Tübingen, Germany
| | - Jean R Edoa
- Centre de Recherches Médicales de Lambaréné and African Partner Institution, German Center for Infection Research (CERMEL), Lambaréné, Gabon
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, location AMC, Amsterdam Infection & Immunity, Amsterdam Public Health, University of Amsterdam, Amsterdam, The Netherlands
- Institut für Tropenmedizin, Universität Tübingen and German Center for Infection Research, Tübingen, Germany
| | - Wilfrid F Ndzebe Ndoumba
- Centre de Recherches Médicales de Lambaréné and African Partner Institution, German Center for Infection Research (CERMEL), Lambaréné, Gabon
| | - Lia B Dimessa Mbadinga
- Centre de Recherches Médicales de Lambaréné and African Partner Institution, German Center for Infection Research (CERMEL), Lambaréné, Gabon
| | - Ghyslain Mombo-Ngoma
- Centre de Recherches Médicales de Lambaréné and African Partner Institution, German Center for Infection Research (CERMEL), Lambaréné, Gabon
- Institut für Tropenmedizin, Universität Tübingen and German Center for Infection Research, Tübingen, Germany
- Department of Tropical Medicine, Bernhard Nocht Institute for Tropical Medicine & I Department of Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Shevin T Jacob
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool
- Walimu, Kampala, Uganda
| | - Jamie Rylance
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool
- Malawi-Liverpool-Wellcome Trust, Chichiri, Blantyre, Malawi
| | - Thomas Hänscheid
- Instituto de Microbiologica, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Ayola A Adegnika
- Centre de Recherches Médicales de Lambaréné and African Partner Institution, German Center for Infection Research (CERMEL), Lambaréné, Gabon
- Institut für Tropenmedizin, Universität Tübingen and German Center for Infection Research, Tübingen, Germany
- Department of Parasitology, Leiden University Medical Center, Leiden, The Netherlands
| | - Martin P Grobusch
- Centre de Recherches Médicales de Lambaréné and African Partner Institution, German Center for Infection Research (CERMEL), Lambaréné, Gabon
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, location AMC, Amsterdam Infection & Immunity, Amsterdam Public Health, University of Amsterdam, Amsterdam, The Netherlands
- Institut für Tropenmedizin, Universität Tübingen and German Center for Infection Research, Tübingen, Germany
- MasangaMedical Research Unit, Masanga, Sierra Leone
- Institute of Infectious Diseases and Molecular Medicine, University of Cape Town, Cape Town, South Africa
- Correspondence: Prof. Martin P. Grobusch, Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Amsterdam University Medical Centers, location AMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands, Phone: +31 6 566 4380
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5
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Ndong A, Diallo AC, Tendeng JN, Diallo AI, Diao ML, Sagna SA, Diop S, Dia DA, Diouf D, Racine BI, Nyemb PMM, Konaté I. QSIRS Can Improve Accuracy of QSOFA and SIRS in Prediction of Mortality in Surgical Emergencies. Surg J (N Y) 2021; 7:e199-e202. [PMID: 34395872 PMCID: PMC8354340 DOI: 10.1055/s-0041-1733831] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 04/08/2021] [Indexed: 11/06/2022] Open
Abstract
Background
The quick sequential organ failure assessment (QSOFA) score and the systemic inflammatory response syndrome (SIRS) criteria were developed to predict the risk of sepsis and death in patients received in emergency. To improve sensitivity in predicting death, the association of the two scores was proposed under the term QSIRS (QSOFA + SIRS). Our aim was to determine the accuracy of QSOFA, SIRS, and QSIRS in prediction of mortality in surgical emergencies, and to compare these scores.
Patients and Methods
This is a prospective study over a period of 1 year. Patients older than 15 years who presented a digestive surgical emergency (bowel obstruction, peritonitis, appendicitis, strangulated hernia) were included. For each score, the specificity, the sensitivity, the positive predictive value, the negative predictive value, and areas under the receiver operating characteristic (ROC) curve (AUC) were compared.
Results
One hundred and eighteen patients were included and 11 deaths were recorded (9.3%). There was a statistically significant relationship between each score and death (QSOFA
p
= 0.01, SIRS
p
= 0.003, and QSIRS
p
= 0.004). The realization of the ROC curve found a higher AUC for QSIRS (0.845 [0.767–0.905]) compared with QSOFA (0.783 [0.698–0.854]) and SIRS (0.737 [0.648–0.813]). QSIRS (90.9%) had a higher sensitivity compared with the two other scores alone (SIRS = 81.9% and QSOFA = 36.3%).
Conclusion
Our study found that QSIRS improves the ability to predict death in digestive surgical emergencies.
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Affiliation(s)
| | | | | | - Amadou Ibra Diallo
- Department of Public Health and Preventive Medicine, Cheikh Anta Diop University, Dakar, Senegal
| | | | | | - Saer Diop
- Department of Surgery, Gaston Berger University, Saint-Louis, Senegal
| | - Diago Anta Dia
- Department of Surgery, Gaston Berger University, Saint-Louis, Senegal
| | - Daouda Diouf
- Department of Surgery, Gaston Berger University, Saint-Louis, Senegal
| | | | | | - Ibrahima Konaté
- Department of Surgery, Gaston Berger University, Saint-Louis, Senegal
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6
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Nunnally ME, Ferrer R, Martin GS, Martin-Loeches I, Machado FR, De Backer D, Coopersmith CM, Deutschman CS. The Surviving Sepsis Campaign: research priorities for the administration, epidemiology, scoring and identification of sepsis. Intensive Care Med Exp 2021; 9:34. [PMID: 34212256 PMCID: PMC8249046 DOI: 10.1186/s40635-021-00400-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 06/07/2021] [Indexed: 12/15/2022] Open
Abstract
Objective To identify priorities for administrative, epidemiologic and diagnostic research in sepsis. Design As a follow-up to a previous consensus statement about sepsis research, members of the Surviving Sepsis Campaign Research Committee, representing the European Society of Intensive Care Medicine and the Society of Critical Care Medicine addressed six questions regarding care delivery, epidemiology, organ dysfunction, screening, identification of septic shock, and information that can predict outcomes in sepsis. Methods Six questions from the Scoring/Identification and Administration sections of the original Research Priorities publication were explored in greater detail to better examine the knowledge gaps and rationales for questions that were previously identified through a consensus process. Results The document provides a framework for priorities in research to address the following questions: (1) What is the optimal model of delivering sepsis care?; (2) What is the epidemiology of sepsis susceptibility and response to treatment?; (3) What information identifies organ dysfunction?; (4) How can we screen for sepsis in various settings?; (5) How do we identify septic shock?; and (6) What in-hospital clinical information is associated with important outcomes in patients with sepsis? Conclusions There is substantial knowledge of sepsis epidemiology and ways to identify and treat sepsis patients, but many gaps remain. Areas of uncertainty identified in this manuscript can help prioritize initiatives to improve an understanding of individual patient and demographic heterogeneity with sepsis and septic shock, biomarkers and accurate patient identification, organ dysfunction, and ways to improve sepsis care.
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Affiliation(s)
| | - Ricard Ferrer
- Intensive Care Department, Vall d'Hebron University Hospital, Barcelona, Spain.,Shock, Organ Dysfunction and Resuscitation (SODIR) Research Group, Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | - Greg S Martin
- Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Grady Memorial Hospital and Emory Critical Care Center, Emory University, Atlanta, GA, USA
| | - Ignacio Martin-Loeches
- Multidisciplinary Intensive Care Research Organization (MICRO), Department of Intensive Care Medicine, St. James's University Hospital, Trinity Centre for Health Sciences, Dublin, Ireland.,Hospital Clinic, IDIBAPS, Universidad de Barcelona, CIBERes, Barcelona, Spain
| | | | - Daniel De Backer
- Chirec Hospitals, Université Libre de Bruxelles, Brussels, Belgium
| | - Craig M Coopersmith
- Department of Surgery and Emory Critical Care Center, Emory University, Atlanta, GA, USA
| | - Clifford S Deutschman
- Department of Pediatrics, Cohen Children's Medical Center, Northwell Health, New Hyde Park, NY, USA.,The Feinstein Institute for Medical Research/ Elmezzi Graduate School of Molecular Medicine, Manhasset, NY, USA
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7
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Kilinc Toker A, Kose S, Turken M. Comparison of SOFA Score, SIRS, qSOFA, and qSOFA + L Criteria in the Diagnosis and Prognosis of Sepsis. Eurasian J Med 2021; 53:40-47. [PMID: 33716529 DOI: 10.5152/eurasianjmed.2021.20081] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Objective Sepsis has been defined as a life-threatening organ dysfunction that develops as a result of impaired host response to infection. This study aimed to investigate sequential organ failure assessment (SOFA) score, systemic inflammatory response syndrome (SIRS), quick SOFA (qSOFA), and qSOFA + lactate criteria (qSOFA+L) in the diagnosis and prognosis of sepsis. Materials and Methods A retrospective study was performed that included all patients diagnosed with sepsis between January 1, 2013 and December 31, 2017 in Izmir Tepecik Training and Research Hospital Infectious Diseases and Clinical Microbiology Clinic. Results A total of 976 patients diagnosed with sepsis (mean age 72.5±13.7 years, 52.7% women) over five years were included in this study. Of all patients admitted to the emergency department and diagnosed with sepsis, 37.4% (n=365) were hospitalized and 52.3% (n=191) of these patients died. Emergency department mortality was 12.5% (n=122). The mortality rate was higher in patients with qSOFA and qSOFA+L criteria ≥2 in the emergency department. There was no statistically significant difference in terms of SIRS, qSOFA, or qSOFA+L criteria among patients who died in the hospital. The SOFA score (area under receiver operator characteristic curve, AUC=0.89) was highly discriminative in predicting sepsis. When the SOFA score was>11, its sensitivity and negative predictive values were both 100%. The SOFA score (AUC=0.75 and 0.72, respectively) was also highly discriminative in predicting emergency and in-hospital mortality. When the SOFA score was>11, the sensitivity and specificity of predicting emergency department mortality were 63.5% and 78.8%, respectively. The sensitivity was 65.8% and the specificity was 75.5% when describing in-hospital mortality for SOFA scores>9. Conclusion The SOFA score was highly sensitive and predictive in the diagnosis of sepsis. The SOFA score had a high discriminative ability to predict emergency and in-hospital mortality.
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Affiliation(s)
- Aysin Kilinc Toker
- Department of Infectious Diseases and Clinical Microbiology, Kayseri City Hospital, Kayseri, Turkey
| | - Sukran Kose
- Department of Infectious Diseases and Clinical Microbiology, Tepecik Training and Education Hospital, Izmir, Turkey
| | - Melda Turken
- Department of Infectious Diseases and Clinical Microbiology, Tepecik Training and Education Hospital, Izmir, Turkey
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Klinger A, Mueller A, Sutherland T, Mpirimbanyi C, Nziyomaze E, Niyomugabo JP, Niyonsenga Z, Rickard J, Talmor DS, Riviello E. Predicting mortality in adults with suspected infection in a Rwandan hospital: an evaluation of the adapted MEWS, qSOFA and UVA scores. BMJ Open 2021; 11:e040361. [PMID: 33568365 PMCID: PMC7878147 DOI: 10.1136/bmjopen-2020-040361] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RATIONALE Mortality prediction scores are increasingly being evaluated in low and middle income countries (LMICs) for research comparisons, quality improvement and clinical decision-making. The modified early warning score (MEWS), quick Sequential (Sepsis-Related) Organ Failure Assessment (qSOFA), and Universal Vital Assessment (UVA) score use variables that are feasible to obtain, and have demonstrated potential to predict mortality in LMIC cohorts. OBJECTIVE To determine the predictive capacity of adapted MEWS, qSOFA and UVA in a Rwandan hospital. DESIGN, SETTING, PARTICIPANTS AND OUTCOME MEASURES We prospectively collected data on all adult patients admitted to a tertiary hospital in Rwanda with suspected infection over 7 months. We calculated an adapted MEWS, qSOFA and UVA score for each participant. The predictive capacity of each score was assessed including sensitivity, specificity, positive and negative predictive value, OR, area under the receiver operating curve (AUROC) and performance by underlying risk quartile. RESULTS We screened 19 178 patient days, and enrolled 647 unique patients. Median age was 35 years, and in-hospital mortality was 18.1%. The proportion of data missing for each variable ranged from 0% to 11.7%. The sensitivities and specificities of the scores were: adapted MEWS >4, 50.4% and 74.9%, respectively; qSOFA >2, 24.8% and 90.4%, respectively; and UVA >4, 28.2% and 91.1%, respectively. The scores as continuous variables demonstrated the following AUROCs: adapted MEWS 0.69 (95% CI 0.64 to 0.74), qSOFA 0.65 (95% CI 0.60 to 0.70), and UVA 0.71 (95% CI 0.66 to 0.76); there was no statistically significant difference between the discriminative capacities of the scores. CONCLUSION Three scores demonstrated a modest ability to predict mortality in a prospective study of inpatients with suspected infection at a Rwandan tertiary hospital. Careful consideration must be given to their adequacy before using them in research comparisons, quality improvement or clinical decision-making.
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Affiliation(s)
- Amanda Klinger
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Ariel Mueller
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Tori Sutherland
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Christophe Mpirimbanyi
- Department of Surgery, Kigali University Teaching Hospital, Kigali, Rwanda
- University of Rwanda College of Medicine and Health Sciences, School of Medicine and Pharmacy, Kigali, Rwanda
| | - Elie Nziyomaze
- Department of Surgery, Kigali University Teaching Hospital, Kigali, Rwanda
- University of Rwanda College of Medicine and Health Sciences, School of Medicine and Pharmacy, Kigali, Rwanda
| | - Jean-Paul Niyomugabo
- University of Rwanda College of Medicine and Health Sciences, School of Medicine and Pharmacy, Kigali, Rwanda
| | - Zack Niyonsenga
- University of Rwanda College of Medicine and Health Sciences, School of Medicine and Pharmacy, Kigali, Rwanda
| | - Jennifer Rickard
- Department of Surgery, Kigali University Teaching Hospital, Kigali, Rwanda
- Division of Critical Care/Acute Care Surgery, Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Daniel S Talmor
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Elisabeth Riviello
- Harvard Medical School, Boston, Massachusetts, USA
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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9
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Guarino M, Gambuti E, Alfano F, De Giorgi A, Maietti E, Strada A, Ursini F, Volpato S, Caio G, Contini C, De Giorgio R. Predicting in-hospital mortality for sepsis: a comparison between qSOFA and modified qSOFA in a 2-year single-centre retrospective analysis. Eur J Clin Microbiol Infect Dis 2020; 40:825-831. [PMID: 33118057 PMCID: PMC7979592 DOI: 10.1007/s10096-020-04086-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 10/23/2020] [Indexed: 12/27/2022]
Abstract
Sepsis is a life-threating organ dysfunction caused by a dysregulated host response to infection. This study proposed a new tool, i.e. modified qSOFA, for the early prognostic assessment of septic patients. All cases of sepsis/septic shock consecutively observed in 2 years (January 2017–December 2018), at St. Anna University Hospital of Ferrara, Italy, were included. Each patient was evaluated with qSOFA and a modified qSOFA (MqSOFA), i.e. adding a SpO2/FiO2 ratio to qSOFA. Logistic regression and survival analyses were applied to compare the two scores. A total number of 1137 consecutive cases of sepsis and septic shock were considered. Among them 136 were excluded for incomplete report of vital parameters. A total number of 668 patients (66.7%) were discharged, whereas 333 (33.3%) died because of sepsis-related complications. Data analysis showed that MqSOFA (AUC 0.805, 95% C.I. 0.776–0.833) had a greater ability to detect in-hospital mortality than qSOFA (AUC 0.712, 95% C.I. 0.678–0.746) (p < 0.001). Eighty-five patients (8.5%) were reclassified as high-risk (qSOFA< 2 and MqSOFA≥ 2) resulting in an improvement of sensitivity with a minor reduction in specificity. A significant difference of in-hospital mortality was observed between low-risk and reclassified high-risk (p < 0.001) and low-risk vs. high-risk groups (p < 0.001). We demonstrated that MqSOFA provided a better predictive score than qSOFA regarding patient’s outcome. Since sepsis is an underhanded and time-dependent disease, physicians may rely upon the herein proposed simple score, i.e. MqSOFA, to establish patients’ severity and outcome.
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Affiliation(s)
- Matteo Guarino
- Department of Morphology, Surgery and Experimental Medicine, St. Anna University Hospital, University of Ferrara, Via A. Moro, 844124, Cona, Ferrara, Italy
| | - Edoardo Gambuti
- Department of Morphology, Surgery and Experimental Medicine, St. Anna University Hospital, University of Ferrara, Via A. Moro, 844124, Cona, Ferrara, Italy
| | - Franco Alfano
- Department of Morphology, Surgery and Experimental Medicine, St. Anna University Hospital, University of Ferrara, Via A. Moro, 844124, Cona, Ferrara, Italy
| | - Alfredo De Giorgi
- Department of Internal Medicine, St. Anna University Hospital, University of Ferrara, Cona, Ferrara, Italy
| | - Elisa Maietti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
- Centre of Clinical Epidemiology, Department of Medical Science, University of Ferrara, Ferrara, Italy
| | - Andrea Strada
- Department of Emergency Medicine, St. Anna University Hospital, University of Ferrara, Cona, Ferrara, Italy
| | - Francesco Ursini
- Department of Morphology, Surgery and Experimental Medicine, St. Anna University Hospital, University of Ferrara, Via A. Moro, 844124, Cona, Ferrara, Italy
| | - Stefano Volpato
- Department of Morphology, Surgery and Experimental Medicine, St. Anna University Hospital, University of Ferrara, Via A. Moro, 844124, Cona, Ferrara, Italy
| | - Giacomo Caio
- Department of Morphology, Surgery and Experimental Medicine, St. Anna University Hospital, University of Ferrara, Via A. Moro, 844124, Cona, Ferrara, Italy
| | - Carlo Contini
- Department of Infectious and Dermatology Diseases, St. Anna University Hospital, University of Ferrara, Cona, Ferrara, Italy
| | - Roberto De Giorgio
- Department of Morphology, Surgery and Experimental Medicine, St. Anna University Hospital, University of Ferrara, Via A. Moro, 844124, Cona, Ferrara, Italy.
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10
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Basham MA, Ghumro HA, Syed MUS, Saeed S, Pervez SA, Farooque U, Kumar N, Imtiaz Z, Sajjad M, Jamal A, Aslam Siddiqui I, Idris F. Validity of Sequential Organ Failure Assessment and Quick Sequential Organ Failure Assessment in Assessing Mortality Rate in the Intensive Care Unit With or Without Sepsis. Cureus 2020; 12:e11071. [PMID: 33224665 PMCID: PMC7676951 DOI: 10.7759/cureus.11071] [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] [Indexed: 11/30/2022] Open
Abstract
Introduction Sepsis and septic shock (sepsis-induced hypotension not improved by adequate fluid resuscitation) are among the most common reasons for admission to an intensive care unit (ICU) and display high mortality rates. Different scoring systems are used to diagnose and predict the mortality of patients having sepsis. This study aims to validate the prognostic accuracy of Sequential Organ Failure Assessment (SOFA) and Quick Sequential Organ Failure Assessment (qSOFA) in determining the mortality of both septic and non-septic patients. Materials and methods This retrospective cohort study was conducted in May 2018 in the Surgical Intensive Care Unit (SICU) of a tertiary care hospital in Karachi, Pakistan. Past 200 patient records, from January 2018 to April 2018, were examined, and 20 records were discarded due to insufficient data. Sufficient observational data were collected, which was used to assess the validity of the SOFA and qSOFA in determining the mortality rate of sepsis. A comparison of the two modalities was made. Results Out of the 200 patients, 180 were enrolled. Data from their entire ICU stay were used to calculate their initial, highest, and mean SOFA and qSOFA. Mean SOFA score up to nine correlated with a mortality rate of up to <79%, while scores 10 and above predicted a 100% mortality rate. A mean qSOFA score of three predicted a 67% mortality rate. Univariate logistic analysis performed with odds ratio showed that the mean qSOFA score was in comparison more closely able to predict mortality, followed by mean SOFA score (p values < 0.01). Conclusions This study concluded that both SOFA and qSOFA scores are good predictors of mortality. However, qSOFA is more closely accurate in predicting mortality than SOFA. But further analysis with larger sample size for a longer duration as well as the application of these scores in the emergency departments and general wards can prove the precision of this study.
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Affiliation(s)
| | | | | | - Sumayyah Saeed
- Internal Medicine, Civil Hospital Karachi, Dow University of Health Sciences, Karachi, PAK
| | | | - Umar Farooque
- Neurology, Dow University of Health Sciences, Karachi, PAK
| | - Naresh Kumar
- Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Zainab Imtiaz
- Internal Medicine, Lahore Medical and Dental College, Lahore, PAK
| | - Muhsana Sajjad
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Aisha Jamal
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | | | - Farha Idris
- Surgery, Civil Hospital Karachi, Dow University of Health Sciences, Karachi, PAK
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11
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Shahsavarinia K, Moharramzadeh P, Arvanagi RJ, Mahmoodpoor A. qSOFA score for prediction of sepsis outcome in emergency department. Pak J Med Sci 2020; 36:668-672. [PMID: 32494253 PMCID: PMC7260919 DOI: 10.12669/pjms.36.4.2031] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Objective: The third international consensus definition for sepsis and septic shock (sepsis 3) task force recently introduced qSOFA (quick sequential organ failure assessment) as a score for detection of patients at risk of sepsis outside of intensive care units. We performed this study to evaluate the validity of qSOFA for early detection and risk stratification of septic patients in emergency department. Methods: We conducted this study in an emergency department of the largest university affiliated hospital in northwest of Iran from Sept 2015 to Sept 2016. One hundred and forty patients who were SIRS positive with a suspected infection without alternative diagnosis and a microbiological proven infection were enrolled in this study. qSOFA was calculated for each patient and correlated with sepsis grades and mortality. Results: From 140 patients 84 (60%) had positive qSOFA score and 56 (40%) patients had negative qSOFA score. Our results showed that near half of patients with positive qSOFA expired during their stay in hospital while this was about 5% for patients with negative qSOFA. ROC curve of study regarding prediction of outcome with qSOFA showed an area under curve of 0.59. (P value: 0.04). Time spent to sepsis detection was 16 minutes shorter with qSOFA score compared to SIRS criteria in this study. Conclusion: In patients with suspected sepsis, qSOFA has acceptable value for risk stratification of severity, multi organ failure and mortality. It seems that education of medical staff and frequent screening of patients for warning signs can help to increase the value of qSOFA in prediction of mortality in critically ill septic patients.
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Affiliation(s)
- Kavous Shahsavarinia
- Kavous Shahsavarinia, Associate Professor, Road Traffic Injury Research Center, Department of Emergency Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Payman Moharramzadeh
- Payman Moharramzadeh, Associate Professor, Department of Emergency Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Reza Jamal Arvanagi
- Reza Jamal Arvanagi, Emergency Medicine Specialist, Department of Emergency Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ata Mahmoodpoor
- Prof. Dr. Ata Mahmoodpoor, Department of Anesthesiology and intensive care, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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12
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Yu JY, Jeong GY, Jeong OS, Chang DK, Cha WC. Machine Learning and Initial Nursing Assessment-Based Triage System for Emergency Department. Healthc Inform Res 2020; 26:13-19. [PMID: 32082696 PMCID: PMC7010940 DOI: 10.4258/hir.2020.26.1.13] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 10/15/2019] [Accepted: 10/17/2019] [Indexed: 12/05/2022] Open
Abstract
Objectives The aim of this study was to develop machine learning (ML) and initial nursing assessment (INA)-based emergency department (ED) triage to predict adverse clinical outcome. Methods The retrospective study included ED visits between January 2016 and December 2017 that resulted in either intensive care unit admission or emergency room death. We trained four classifiers using logistic regression and a deep learning model on INA and low dimensional (LD) INA, logistic regression on the Korea Triage and acuity scale (KTAS) and Sequential Related Organ Failure Assessment (SOFA). We varied the outcome ratio for external validation. Finally, variables of importance were identified using the random forest model's information gain. The four most influential variables were used for LD modeling for efficiency. Results A total of 86,304 patient visits were included, with an overall outcome rate of 3.5%. The area under the curve (AUC) values for the KTAS model were 76.8 (74.9–78.6) with logistic regression and 74.0 (72.1–75.9) for the SOFA model, while the AUC values of the INA model were 87.2 (85.9–88.6) and 87.6 (86.3–88.9) with logistic regression and deep learning, suggesting that the ML and INA-based triage system result more accurately predicted the outcomes. The AUC values for the LD model were 81.2 (79.4–82.9) and 80.7 (78.9–82.5) for logistic regression and deep learning, respectively. Conclusions We developed an ML and INA-based triage system for EDs. The novel system was able to predict clinical outcomes more accurately than existing triage systems, KTAS and SOFA.
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Affiliation(s)
- Jae Yong Yu
- Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, Korea
| | - Gab Yong Jeong
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ok Soon Jeong
- Department of IT Planning, Samsung Medical Center, Seoul, Korea
| | - Dong Kyung Chang
- Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, Korea.,Department of IT Planning, Samsung Medical Center, Seoul, Korea.,Department of Gastroenterology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Chul Cha
- Department of Digital Health, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, Korea.,Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of IT Planning, Samsung Medical Center, Seoul, Korea
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