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Lan L, Zhou M, Chen X, Dai M, Wang L, Li H. Prognostic accuracy of SOFA, MEWS, and SIRS criteria in predicting the mortality rate of patients with sepsis: A meta-analysis. Nurs Crit Care 2023. [PMID: 38129945 DOI: 10.1111/nicc.13016] [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: 07/07/2023] [Revised: 11/08/2023] [Accepted: 11/20/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND In recent years, some studies classified patients with sepsis and predicted their mortality by using some evaluation scales. Several studies reported significant differences in the predictive values of several tools, and the non-uniformity of the cut-off value. OBJECTIVE To determine and compare the prognostic accuracy of Sequential Organ Failure Assessment (SOFA) score, Modified Early Warning Score (MEWS), and Systemic Inflammatory Response Syndrome (SIRS) criteria in predicting the mortality of patients with sepsis. METHODS This study comprised of systematic literature review and meta-analysis according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. We searched PubMed, Embase, Web of Science and Cochrane Library databases from their establishment to July 31, 2022. The research articles published in the index journals provide sufficient data (true positive, false positive, true negative, and false negative results) for patients with sepsis. The combined sensitivity and specificity of the 95% confidence interval (CI) were calculated using the bivariate random effect model (BRM). The hierarchical overall subject working characteristics (HSROC) curve was drawn to evaluate the accuracy of the overall prognosis. RESULTS Data of 55 088 patients from 32 studies were included in this meta-analysis. SOFA had an intermediate sensitivity of 0.73 (95% CI: 0.67-0.78) and a specificity of 0.70 (0.63-0.76). SIRS criteria had the highest sensitivity of 0.75 (0.66-0.82) and the lowest specificity of 0.40 (0.29-0.52). MEWS had the lowest sensitivity of 0.49 (0.40-0.59) and the highest specificity of 0.82 (0.78-0.86). CONCLUSIONS Among SOFA, MEWS, and SIRS criteria, SOFA showed moderate sensitivity and specificity for predicting mortality in patients with sepsis, the highest sensitivity of SIRS and the strongest specificity of MEWS for predicting mortality in patients with sepsis. The future research direction is to combine the relevant indicators of MEWS and SIRS to develop a measurement tool with high reliability and validity. RELEVANCE TO CLINICAL PRACTICE The review provides useful insights into the prognostic accuracy of different assessment tools in predicting mortality in sepsis patients, which will help clinicians choose the most appropriate tool for early identification and treatment of sepsis. The findings may also contribute to the development of more accurate and reliable prognostic models for sepsis.
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Affiliation(s)
- Lin Lan
- Department of Emergency Medicine,West China Hospital, Sichuan University/West China School of Nursing,Sichuan University, Chengdu, China
- Institute of Disaster Medicine, Sichuan University, Chengdu, China
- Nursing Key Laboratory of Sichuan Province, Chengdu, China
| | - Meichi Zhou
- Nephrology and Urology Ward, West China Hospital,Sichuan University/ West China School of Nursing, Sichuan University Chengdu, Chengdu, China
| | - Xiaoli Chen
- Department of Emergency Medicine,West China Hospital, Sichuan University/West China School of Nursing,Sichuan University, Chengdu, China
- Institute of Disaster Medicine, Sichuan University, Chengdu, China
- Nursing Key Laboratory of Sichuan Province, Chengdu, China
| | - Min Dai
- Department of Emergency Medicine,West China Hospital, Sichuan University/West China School of Nursing,Sichuan University, Chengdu, China
- Institute of Disaster Medicine, Sichuan University, Chengdu, China
- Nursing Key Laboratory of Sichuan Province, Chengdu, China
| | - Ling Wang
- Department of Emergency Medicine,West China Hospital, Sichuan University/West China School of Nursing,Sichuan University, Chengdu, China
- Institute of Disaster Medicine, Sichuan University, Chengdu, China
- Nursing Key Laboratory of Sichuan Province, Chengdu, China
| | - Hong Li
- Department of Emergency Medicine,West China Hospital, Sichuan University/West China School of Nursing,Sichuan University, Chengdu, China
- Institute of Disaster Medicine, Sichuan University, Chengdu, China
- Nursing Key Laboratory of Sichuan Province, Chengdu, China
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Xie Y, Zhuang D, Chen H, Zou S, Chen W, Chen Y. 28-day sepsis mortality prediction model from combined serial interleukin-6, lactate, and procalcitonin measurements: a retrospective cohort study. Eur J Clin Microbiol Infect Dis 2023; 42:77-85. [PMID: 36383295 PMCID: PMC9816294 DOI: 10.1007/s10096-022-04517-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 10/24/2022] [Indexed: 11/17/2022]
Abstract
Sepsis is a global medical issue owing to its unacceptably high mortality rate. Therefore, an effective approach to predicting patient outcomes is critically needed. We aimed to search for a novel 28-day sepsis mortality prediction model based on serial interleukin-6 (IL-6), lactate (LAC), and procalcitonin (PCT) measurements. We enrolled 367 septic patients based on Sepsis-3 (Third International Consensus Definitions for Sepsis and Septic Shock). Serum IL-6, LAC, and PCT levels were measured serially. Results collected within 24 and 48-72 h of admission were marked as D1 and D3 (e.g., IL-6D1/D3), respectively; the IL-6, LAC, and PCT clearance (IL-6c, LACc, PCTc) at D3 were calculated. Data were split into training and validation cohorts (7:3). Logistic regression analyses were used to select variables to develop models and choose the best one according to the Akaike information criterion (AIC). Receiver operating characteristic curves (ROC), calibration plots, and decision curve analysis (DCA) were used to test model performance. A nomogram was used to validate the model. There were 314 (85.56%) survivors and 53 (14.44%) non-survivors. Logistic regression analyses showed that IL-6D1, IL-6D3, PCTD1, PCTD3, and LACcD3 could be used to develop the best prediction model. The areas under the curves (AUC) of the training (0.849, 95% CI: 0.787-0.911) and validation cohorts (0.828, 95% CI: 0.727-0.929), calibration plot, and the DCA showed that the model performed well. Thus, the predictive value of the risk nomogram was verified. Combining IL-6D1, IL-6D3, PCTD1, PCTD3, and LACcD3 may create an accurate prediction model for 28-day sepsis mortality. Multiple-center research with a larger quantity of data is necessary to determine its clinical utility.
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Affiliation(s)
- Yinjing Xie
- Department of Medical Laboratory, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of South University of Science and Technology, Shenzhen, 518020, Guangdong, China
| | - Dehua Zhuang
- Department of Medical Laboratory, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of South University of Science and Technology, Shenzhen, 518020, Guangdong, China
| | - Huaisheng Chen
- Department of Critical Care Medicine, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of South University of Science and Technology, Shenzhen, 518020, Guangdong, China
| | - Shiqing Zou
- Department of Medical Laboratory, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of South University of Science and Technology, Shenzhen, 518020, Guangdong, China
| | - Weibu Chen
- Department of Medical Laboratory, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of South University of Science and Technology, Shenzhen, 518020, Guangdong, China.
| | - Yue Chen
- Department of Medical Laboratory, Shenzhen People's Hospital, The Second Clinical Medical College of Jinan University, The First Affiliated Hospital of South University of Science and Technology, Shenzhen, 518020, Guangdong, China.
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Feng J, Wang L, Feng Y, Yu G, Zhou D, Wang J. Serum levels of angiopoietin 2 mRNA in the mortality outcome prediction of septic shock. Exp Ther Med 2022; 23:362. [PMID: 35493434 DOI: 10.3892/etm.2022.11289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 01/19/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Jun Feng
- Emergency Department, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Lili Wang
- Emergency Department, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Yikuan Feng
- Emergency Department, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Gang Yu
- Emergency Department, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Daixing Zhou
- Emergency Department, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Junshuai Wang
- Emergency Department, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
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Li H, Chen J, Hu Y, Cai X, Tang D, Zhang P. Clinical value of serum calcium in elderly patients with sepsis. Am J Emerg Med 2021; 52:208-211. [PMID: 34959023 DOI: 10.1016/j.ajem.2021.12.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 12/03/2021] [Accepted: 12/10/2021] [Indexed: 12/29/2022] Open
Abstract
PURPOSE To explore the clinical value of serum calcium (Ca) in elderly patients with sepsis. MATERIALS AND METHODS The clinical data and laboratory data of elderly patients with sepsis (n = 165) and elderly population for physical examination (n = 67) in a tertiary hospital from January 2020 to November 2020 were collected. We analyzed serum Ca levels in sepsis and septic shock firstly, and then continued to investigate them in the survival group and the death group. Meanwhile, we also assessed the correlation between serum Ca and PCT. RESULTS The serum Ca levels of the elderly patients with sepsis were lower than that of the control group (median 1.98 vs 2.31 mmol/L, P < 0.001), and the more severe the sepsis, the lower the serum Ca levels. Sepsis patients with decreased serum Ca had higher shock rate and mortality. There was a negative correlation between serum Ca and PCT (r = -0.2957, P < 0.001). CONCLUSION Serum Ca has a certain value for the early recognition of elderly patients with sepsis and the judgment of the severity of the disease.
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Affiliation(s)
- Huan Li
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, China
| | - Juanjuan Chen
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, China
| | - Yuanhui Hu
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, China
| | - Xin Cai
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, China
| | - Dongling Tang
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, China
| | - Pingan Zhang
- Department of Clinical Laboratory, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, China.
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Bian Z, Zhu R, Chen S. The predict value of serum/urocystatin C on acute kidney injury in elderly patients with sepsis. Exp Gerontol 2021; 155:111576. [PMID: 34597711 DOI: 10.1016/j.exger.2021.111576] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 09/23/2021] [Accepted: 09/23/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To evaluate the predict value of serum/urocystatin C in acute kidney injury (AKI) in elderly patients with sepsis. METHODS A retrospective study was performed and 80 senile patients with sepsis in ** hospital of China was included. According to the diagnosis of AKI, all patients were divided into non-AKI group and AKI group. The clinical characteristics, laboratory and physiological indicators of the two groups were compared. The receiver operating characteristic curve (ROC) was used to analyze the accuracy of the variables, including serum cystatin C, urocystatin C, and serum creatinine, to predict the occurrence of AKI in patients with sepsis. RESULTS Of the 80 elderly patients with sepsis in China, 29 patients had AKI. Compared with the non-AKI group, patients in the AKI group had higher APACHE II scores, higher SOFA scores, higher procalcitonin, and lower mean arterial pressure (P < 0.05). The levels of serum cystatin C, urocystatin C, and serum creatinine in the AKI group were significantly higher than those in the non-AKI group (P < 0.05), while the difference in intensive care unit (ICU) mortality rate between the two groups was not significantly different (P > 0.05). The ROC curve showed that the area under the curve of serum cystatin C was 0.893, the area under the curve of urocystatin C was 0.898, and the area under the curve of serum creatinine was 0.652. CONCLUSION Serum cystatin and urocystatin could be used to predict the occurrence of AKI in elderly patients with sepsis.
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Affiliation(s)
- Zhixiang Bian
- Department of Nephrology, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai 200434, China
| | - Rui Zhu
- Department of Nephrology, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai 200434, China.
| | - Shunjie Chen
- Department of Nephrology, Shanghai Fourth People's Hospital, School of Medicine, Tongji University, Shanghai 200434, China.
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Madrazo M, López-Cruz I, Zaragoza R, Piles L, Eiros JM, Alberola J, Artero A. Prognostic accuracy of Quick SOFA in older adults hospitalised with community acquired urinary tract infection. Int J Clin Pract 2021; 75:e14620. [PMID: 34240521 DOI: 10.1111/ijcp.14620] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 07/01/2021] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Quick [Sepsis-related] Sequential Organ Failure Assessment (qSOFA) is a prognostic score based on sepsis-3 definition, easy to carry out, whose application has been studied in older adults with sepsis from different sources and respiratory sepsis. However, to date no study has analysed its prognostic accuracy in older adults admitted to hospital with community urinary tract infection. METHODS In a prospective study of 282 older adults admitted to hospital with community acquired urinary tract infection, the application of qSOFA to predict hospital mortality was analysed. The predictive capacity of qSOFA for in-hospital mortality was compared with Systemic Inflammatory Response Syndrome score (SIRS) and Sequential Organ Failure Assessment (SOFA), which require laboratory test in order to be calculated. RESULTS In a population with a median age of 81 years, where 51.8% were males and 10.6% had septic shock, qSOFA showed sensibility and specificity of 88.46 and 75.78% and area under the receiver operating characteristic curves (AUROC) of 0.810. AUROC for qSOFA was significantly higher than that of SIRS (AUROC 0.597, P = .005) and with no statistical differences with SOFA (AUROC 0.841, P = .635). CONCLUSION qSOFA showed a better predictive prognostic accuracy than SIRS and similar to SOFA in older adults admitted to hospital with community acquired urinary tract infection, having the advantage of not requiring laboratory tests.
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Affiliation(s)
- Manuel Madrazo
- Department of Internal Medicine, Doctor Peset University Hospital, Valencia, Spain
| | - Ian López-Cruz
- Department of Internal Medicine, Doctor Peset University Hospital, Valencia, Spain
| | - Rafael Zaragoza
- Intensive Medicine Unit, Doctor Peset University Hospital, Valencia, Spain
| | - Laura Piles
- Department of Internal Medicine, Doctor Peset University Hospital, Valencia, Spain
| | - José María Eiros
- Department of Microbiology and Parasitology, Rio Hortega University Hospital, University of Valladolid, Valladolid, Spain
| | - Juan Alberola
- Department of Microbiology, Doctor Peset University Hospital, University of Valencia, Valencia, Spain
| | - Arturo Artero
- Department of Internal Medicine, Doctor Peset University Hospital, University of Valencia, Valencia, Spain
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Remelli F, Castellucci F, Vitali A, Mattioli I, Zurlo A, Spadaro S, Volpato S. Predictive value of geriatric-quickSOFA in hospitalized older people with sepsis. BMC Geriatr 2021; 21:241. [PMID: 33849471 PMCID: PMC8045242 DOI: 10.1186/s12877-021-02182-1] [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: 02/08/2021] [Accepted: 03/26/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND QuickSOFA, a prognostic score proposed for patients with infection, has shown a poor predictive value in the geriatric population, probably because of the inappropriateness of the Glasgow Coma Scale (GCS) in assessing acute alteration of mental status in older patients. Indeed, the GCS might result chronically low in older patient with pre-existing cognitive disorders. The aim of this study was to develop an alternative quickSOFA (geriatric-quickSOFA), using the presence of delirium, assessed according to DSM-5 criteria, instead of GCS assessment, to predict mortality in hospitalized older patients with sepsis. METHODS Retrospective observational study in Acute Geriatrics Unit of St. Anna Hospital of Ferrara (Italy). The study enrolled 165 patients hospitalized between 2017 and 2018 with diagnosis of sepsis or septic shock. Demographic, clinical data and 30-day survival were collected for each patient. Based on arterial blood pressure, respiratory rate, and the presence of delirium, geriatric-quickSOFA was calculated at admission. Primary outcome was 30-day mortality. RESULTS One hundred sixty-five patients were enrolled with a median age of 88 years; 60.6% were men. High quickSOFA score was not significantly correlated neither with in-hospital nor 30-day mortality. High geriatric-qSOFA score was significantly related to both in-hospital (13.3%vs 51.5%, p = 0.0003) and 30-day mortality (30.0%vs 84.3%, p < 0.00001). CONCLUSION Geriatric-quickSOFA is significantly associate with short-term mortality risk in older patients with sepsis. Geriatric quickSOFA seems to represent a more suitable and useful predictive tool than the traditional quickSOFA in the geriatric population.
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Affiliation(s)
- Francesca Remelli
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy.,Geriatrics Unit, Azienda Ospedaliero- universitaria di Ferrara, Ferrara, Italy
| | | | - Aurora Vitali
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy.,Geriatrics Unit, Azienda Ospedaliero- universitaria di Ferrara, Ferrara, Italy
| | - Irene Mattioli
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy.,Geriatrics Unit, Azienda Ospedaliero- universitaria di Ferrara, Ferrara, Italy
| | - Amedeo Zurlo
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy.,Geriatrics Unit, Azienda Ospedaliero- universitaria di Ferrara, Ferrara, Italy
| | - Savino Spadaro
- Anestesiology and Resuscitation Unit, Department of Morfology, Surgery and Sperimental Medicine, University of Ferrara, Ferrara, Italy
| | - Stefano Volpato
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy. .,Orthogeriatrics Unit, Azienda Ospedaliero-Universitaria di Ferrara, Via Aldo Moro, 8, 44124, Ferrara, Italy.
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SOFA and qSOFA usefulness for in-hospital death prediction of elderly patients admitted for suspected infection in internal medicine. Infection 2020; 48:879-887. [PMID: 32767020 DOI: 10.1007/s15010-020-01494-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 07/29/2020] [Indexed: 01/31/2023]
Abstract
PURPOSE To reduce intensive care unit overcrowding and optimize resources, elderly patients affected by suspected infection with declining clinical conditions could be managed in internal medicine departments with stepdown beds. However, commonly used prognostic scores, as Sequential Organ Failure Assessment (SOFA) or quick SOFA (qSOFA) have never been studied in this specific setting. The aim of this study was to evaluate the role and the accuracy of SOFA and qSOFA as prognostic scores in a population of elderly patients with suspected infection admitted to stepdown beds of two internal medicine departments. METHODS Elderly patients admitted from the emergency department in the stepdown beds of two different internal medicine departments for suspected infection were assessed with SOFA and qSOFA scores at the admission. All patients were treated according to current guidelines. Age, sex, comorbidities, Charlson comorbidity index, SOFA and qSOFA were assessed. In-hospital death and length of hospital admission were also recorded. RESULTS 390 subjects were enrolled. In-hospital death occurred in 144 (36.9%) patients; we observed that both SOFA (HR 1.189; 95% CI 1.128-1.253; p < 0.0001) and qSOFA (HR 1.803; 95% CI 1.503-2.164; p < 0.0001) scores were independently associated with an increased risk of in-hospital death. However, the accuracy of both SOFA (AUC: 0.686; 95% CI 0.637-0.732; p < 0.0001) and qSOFA (AUC: 0.680; 95% CI 0.641-0.735; p < 0.0001) in predicting in-hospital death was low in this population. CONCLUSION Elderly patients admitted to stepdown beds for suspected infection experience a high rate of in-hospital death; both SOFA and qSOFA scores can be useful to identify a group of patients who can benefit from admission to an intermediate care environment, however their accuracy is low.
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Demirtas E, Bakir M, Buyuktuna SA, Oksuz C, Oz M, Cebecioglu K, Unlusavuran M. Comparison of the Predictive Performances of qSOFA, APACHE II, and SGS for Evaluation of the Disease Prognosis of CCHF Patients at the Emergency Department. Jpn J Infect Dis 2020; 73:323-329. [PMID: 32350220 DOI: 10.7883/yoken.jjid.2019.507] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In this study, we compared the predictive performances of quick sequential organ failure assessment (qSOFA), the acute physiology and chronic health evaluation (APACHE II) scores, and the severity grading score (SGS) for evaluation of the disease prognosis of patients with Crimean-Congo hemorrhagic fever (CCHF) at the emergency department. We recorded the qSOFA, SGS, and APACHE II scores at admission and at the 72nd and 120th hour in 97 patients admitted to the emergency department and diagnosed with CCHF. In our study, the area under a receiver operating characteristic curve values of qSOFA, SGS, and APACHE II at admission were found to be 0.640, 0.824, and 0.576, respectively. No statistical significance was found for a qSOFA score ≥ 2 at admission as a predictor of mortality. The use of qSOFA score for diseases with a mortal prognosis such as CCHF is insufficient in predicting the prognosis.
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Affiliation(s)
- Erdal Demirtas
- Department of Emergency Medicine, Faculty of Medicine, University of Sivas Cumhuriyet, Turkey
| | - Mehmet Bakir
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, University of Sivas Cumhuriyet, Turkey
| | - Seyit Ali Buyuktuna
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, University of Sivas Cumhuriyet, Turkey
| | - Caner Oksuz
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, University of Sivas Cumhuriyet, Turkey
| | - Murtaza Oz
- Department of Infectious Disease and Clinical Microbiology, Faculty of Medicine, University of Sivas Cumhuriyet, Turkey
| | - Kıvanc Cebecioglu
- Department of Emergency Medicine, Faculty of Medicine, University of Sivas Cumhuriyet, Turkey
| | - Meltem Unlusavuran
- Department of Biostatistics, Faculty of Medicine, University of Erciyes, Turkey
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