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Sherak RAG, Sajjadi H, Khimani N, Tolchin B, Jubanyik K, Taylor RA, Schulz W, Mortazavi BJ, Haimovich AD. SOFA score performs worse than age for predicting mortality in patients with COVID-19. PLoS One 2024; 19:e0301013. [PMID: 38758942 PMCID: PMC11101117 DOI: 10.1371/journal.pone.0301013] [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: 07/15/2022] [Accepted: 03/09/2024] [Indexed: 05/19/2024] Open
Abstract
The use of the Sequential Organ Failure Assessment (SOFA) score, originally developed to describe disease morbidity, is commonly used to predict in-hospital mortality. During the COVID-19 pandemic, many protocols for crisis standards of care used the SOFA score to select patients to be deprioritized due to a low likelihood of survival. A prior study found that age outperformed the SOFA score for mortality prediction in patients with COVID-19, but was limited to a small cohort of intensive care unit (ICU) patients and did not address whether their findings were unique to patients with COVID-19. Moreover, it is not known how well these measures perform across races. In this retrospective study, we compare the performance of age and SOFA score in predicting in-hospital mortality across two cohorts: a cohort of 2,648 consecutive adult patients diagnosed with COVID-19 who were admitted to a large academic health system in the northeastern United States over a 4-month period in 2020 and a cohort of 75,601 patients admitted to one of 335 ICUs in the eICU database between 2014 and 2015. We used age and the maximum SOFA score as predictor variables in separate univariate logistic regression models for in-hospital mortality and calculated area under the receiver operator characteristic curves (AU-ROCs) and area under precision-recall curves (AU-PRCs) for each predictor in both cohorts. Among the COVID-19 cohort, age (AU-ROC 0.795, 95% CI 0.762, 0.828) had a significantly better discrimination than SOFA score (AU-ROC 0.679, 95% CI 0.638, 0.721) for mortality prediction. Conversely, age (AU-ROC 0.628 95% CI 0.608, 0.628) underperformed compared to SOFA score (AU-ROC 0.735, 95% CI 0.726, 0.745) in non-COVID-19 ICU patients in the eICU database. There was no difference between Black and White COVID-19 patients in performance of either age or SOFA Score. Our findings bring into question the utility of SOFA score-based resource allocation in COVID-19 crisis standards of care.
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Affiliation(s)
- Raphael A. G. Sherak
- Yale Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, United States of America
| | - Hoomaan Sajjadi
- Department of Computer Science and Engineering, Center for Remote Health Technologies and Systems, Texas A&M Univ, College Station, TX, United States of America
| | - Naveed Khimani
- Department of Computer Science and Engineering, Center for Remote Health Technologies and Systems, Texas A&M Univ, College Station, TX, United States of America
| | - Benjamin Tolchin
- Department of Neurology, Yale School of Medicine, New Haven, CT, United States of America
- Yale New Haven Health Center for Clinical Ethics, New Haven, CT, United States of America
| | - Karen Jubanyik
- Yale Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, United States of America
| | - R. Andrew Taylor
- Yale Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, United States of America
| | - Wade Schulz
- Department of Laboratory Medicine, Yale School of Medicine, New Haven, CT, United States of America
- Biomedical Informatics and Data Science, Yale School of Medicine, New Haven, CT, United States of America
| | - Bobak J. Mortazavi
- Department of Computer Science and Engineering, Center for Remote Health Technologies and Systems, Texas A&M Univ, College Station, TX, United States of America
- Center for Outcomes Research and Evaluation, Yale University, New Haven, CT, United States of America
| | - Adrian D. Haimovich
- Yale Department of Emergency Medicine, Yale School of Medicine, New Haven, CT, United States of America
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
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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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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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Huang Y, Gao Y, Quan S, Pan H, Wang Y, Dong Y, Ye L, Wu M, Zhou A, Ruan X, Wang B, Chen J, Zheng C, Xu H, Lu Y, Pan J. DEVELOPMENT AND INTERNAL-EXTERNAL VALIDATION OF THE ACCI-SOFA MODEL FOR PREDICTING IN-HOSPITAL MORTALITY OF PATIENTS WITH SEPSIS-3 IN THE ICU: A MULTICENTER RETROSPECTIVE COHORT STUDY. Shock 2024; 61:367-374. [PMID: 38407987 DOI: 10.1097/shk.0000000000002311] [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: 02/28/2024]
Abstract
ABSTRACT Objective: To achieve a better prediction of in-hospital mortality, the Sequential Organ Failure Assessment (SOFA) score needs to be adjusted and combined with comorbidities. This study aims to enhance the prediction of SOFA score for in-hospital mortality in patients with Sepsis-3. Methods: This study adjusted the maximum SOFA score within the first 3 days (Max Day3 SOFA) in relation to in-hospital mortality using logistic regression and incorporated the age-adjusted Charlson Comorbidity Index (aCCI) as a continuous variable to build the age-adjusted Charlson Comorbidity Index-Sequential Organ Failure Assessment (aCCI-SOFA) model. The outcome was in-hospital mortality. We developed, internally validated, and externally validated the aCCI-SOFA model using cohorts of Sepsis-3 patients from the MIMIC-IV, MIMIC-III (CareVue), and the FAHWMU cohort. The predictive performance of the model was assessed through discrimination and calibration, which was assessed using the area under the receiver operating characteristic and calibration curves, respectively. The overall predictive effect was evaluated using the Brier score. Measurements and main results: Compared with the Max Day3 SOFA, the aCCI-SOFA model showed significant improvement in area under the receiver operating characteristic with all cohorts: development cohort (0.81 vs 0.75, P < 0.001), internal validation cohort (0.81 vs 0.76, P < 0.001), MIMIC-III (CareVue) cohort (0.75 vs 0.68, P < 0.001), and FAHWMU cohort (0.72 vs 0.67, P = 0.001). In sensitivity analysis, it was suggested that the application of aCCI-SOFA in early nonseptic shock patients had greater clinical value, with significant differences compared with the original SOFA scores in all cohorts ( P < 0.05). Conclusion: For septic patients in intensive care unit, the aCCI-SOFA model exhibited superior predictive performance. The application of aCCI-SOFA in early nonseptic shock patients had greater clinical value.
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Affiliation(s)
| | | | | | - Hao Pan
- Department of Orthopaedics, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, PR China
| | | | | | | | | | | | | | | | | | - Chenfei Zheng
- Department of Nephrology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, PR China
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Ko BS, Ryoo SM, Han E, Chang H, Yune CJ, Lee HJ, Suh GJ, Choi SH, Chung SP, Lim TH, Kim WY, Sohn JW, Jeong MA, Hwang SY, Shin TG, Kim K. Modified Cardiovascular Sequential Organ Failure Assessment Score in Sepsis: External Validation in Intensive Care Unit Patients. J Korean Med Sci 2023; 38:e418. [PMID: 38147839 PMCID: PMC10752749 DOI: 10.3346/jkms.2023.38.e418] [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: 07/10/2023] [Accepted: 09/24/2023] [Indexed: 12/28/2023] Open
Abstract
BACKGROUND There is a need to update the cardiovascular (CV) Sequential Organ Failure Assessment (SOFA) score to reflect the current practice in sepsis. We previously proposed the modified CV SOFA score from data on blood pressure, norepinephrine equivalent dose, and lactate as gathered from emergency departments. In this study, we externally validated the modified CV SOFA score in multicenter intensive care unit (ICU) patients. METHODS A multicenter retrospective observational study was conducted on ICU patients at six hospitals in Korea. We included adult patients with sepsis who were admitted to ICUs. We compared the prognostic performance of the modified CV/total SOFA score and the original CV/total SOFA score in predicting 28-day mortality. Discrimination and calibration were evaluated using the area under the receiver operating characteristic curve (AUROC) and the calibration curve, respectively. RESULTS We analyzed 1,015 ICU patients with sepsis. In overall patients, the 28-day mortality rate was 31.2%. The predictive validity of the modified CV SOFA (AUROC, 0.712; 95% confidence interval [CI], 0.677-0.746; P < 0.001) was significantly higher than that of the original CV SOFA (AUROC, 0.644; 95% CI, 0.611-0.677). The predictive validity of modified total SOFA score for 28-day mortality was significantly higher than that of the original total SOFA (AUROC, 0.747 vs. 0.730; 95% CI, 0.715-0.779; P = 0.002). The calibration curve of the original CV SOFA for 28-day mortality showed poor calibration. In contrast, the calibration curve of the modified CV SOFA for 28-day mortality showed good calibration. CONCLUSION In patients with sepsis in the ICU, the modified SOFA score performed better than the original SOFA score in predicting 28-day mortality.
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Affiliation(s)
- Byuk Sung Ko
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul, Korea
| | - Seung Mok Ryoo
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Eunah Han
- Department of Emergency Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyunglan Chang
- Department of Emergency Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Chang June Yune
- Department of Critical Care Medicine, Anyang Sam Hospital, Anyang, Korea
| | - Hui Jai Lee
- Department of Emergency Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Gil Joon Suh
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sung-Hyuk Choi
- Department of Emergency Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Sung Phil Chung
- Department of Emergency Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Tae Ho Lim
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul, Korea
| | - Won Young Kim
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jang Won Sohn
- Division of Pulmonary Medicine and Allergy, Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Mi Ae Jeong
- Department of Anesthesiology and Pain Medicine, Hanyang University Medical Center, Hanyang University College of Medicine, Seoul, Korea
| | - Sung Yeon Hwang
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae Gun Shin
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Kyuseok Kim
- Department of Emergency Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea.
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Kusulja M, Trkulja V, Skočibušić E, Grgić B, Čulo M, Tambić Andrašević A, Santini M. Prediction of unfavorable outcomes in community-acquired bacteremia by SIRS, SOFA and qSOFA scores. Minerva Anestesiol 2023; 89:895-905. [PMID: 37307031 DOI: 10.23736/s0375-9393.23.17340-8] [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: 06/13/2023]
Abstract
BACKGROUND Sepsis diagnostic and prognostic scoring systems have changed over time. It remains uncertain which scoring system is the best predictor of unfavorable outcomes. We aimed to evaluate prediction of community-acquired bacteremia (CAB) outcomes using on-admission systemic inflammatory response syndrome (SIRS), sequential organ failure assessment (SOFA) and quick sequential organ failure assessment (qSOFA). METHODS We present a retrospective observational cohort study of consecutive adult patients hospitalized with CAB over ten years. SIRS, qSOFA and SOFA scores calculated on admission were dichotomized as ≥2 or 0-1. Raw and adjusted incidence of a composite unfavorable outcome (death, septic shock, invasive mechanical ventilation, extra-corporeal membrane oxygenation, renal replacement therapy) over 35 days were compared. RESULTS Among 1930 patients, 1221 (63.3%) had SIRS, 196 (10.2%) had qSOFA, and 1117 (57.9%) had SOFA≥2. Respective raw and adjusted probabilities of the outcome were similar. Incidence for qSOFA≥2 was high (41.3%) and still considerable for qSOFA 0-1 (5.4%). SOFA≥2 indicated higher risk than SIRS≥2 (14.7% vs. 12.4%), while SOFA 0-1 indicated lower risk than SIRS 0-1 (1.2% vs. 3.1%). This relationship between SOFA and SIRS was also observed in patients with qSOFA 0-1. CONCLUSIONS qSOFA≥2 was associated with highest probability of unfavorable outcome, but dichotomized SOFA was more precise at high vs. low-risk distinction. Consecutive use of dichotomized qSOFA and SOFA on admission of adults with CAB enables fast and reliable identification of patients at high (qSOFA≥2, risk ~≥35%), moderate (qSOFA 0-1, SOFA≥2, risk ~10%), and low risk (qSOFA 0-1, SOFA 0-1, risk 1-2%) of subsequent unfavorable events.
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Affiliation(s)
- Marija Kusulja
- Emergency Department, Dr Fran Mihaljević University Hospital for Infectious Diseases, Zagreb, Croatia -
| | - Vladimir Trkulja
- School of Medicine, Department of Pharmacology, Zagreb University, Zagreb, Croatia
| | - Elizabeta Skočibušić
- School of Medicine, Department for Infectious Diseases, Zagreb University, Zagreb, Croatia
| | - Borna Grgić
- Emergency Department, Dr Fran Mihaljević University Hospital for Infectious Diseases, Zagreb, Croatia
- School of Medicine, Department for Infectious Diseases, Zagreb University, Zagreb, Croatia
| | - Marija Čulo
- Department for Clinical Microbiology, Dr Fran Mihaljević University Hospital for Infectious Diseases, Zagreb, Croatia
| | - Arjana Tambić Andrašević
- Department for Clinical Microbiology, Dr Fran Mihaljević University Hospital for Infectious Diseases, Zagreb, Croatia
- School of Dental Medicine, Department for Microbiology, Zagreb University, Zagreb, Croatia
| | - Marija Santini
- School of Medicine, Department for Infectious Diseases, Zagreb University, Zagreb, Croatia
- Department for Infections in the Immunocompromised, Dr Fran Mihaljević University Hospital for Infectious Diseases, Zagreb, Croatia
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Kim TH, Jeong D, Park JE, Hwang SY, Suh GJ, Choi SH, Chung SP, Kim WY, Lee GT, Shin TG. Prognostic accuracy of initial and 24-h maximum SOFA scores of septic shock patients in the emergency department. Heliyon 2023; 9:e19480. [PMID: 37809700 PMCID: PMC10558605 DOI: 10.1016/j.heliyon.2023.e19480] [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: 02/08/2023] [Revised: 08/23/2023] [Accepted: 08/23/2023] [Indexed: 10/10/2023] Open
Abstract
Background We compared the prognostic accuracy of in-hospital mortality of the initial Sequential Organ Failure Assessment (SOFAini) score at the time of sepsis recognition and resuscitation and the maximum SOFA score (SOFAmax) using the worst variables in the 24 h after the initial score measurement in emergency department (ED) patients with septic shock. Methods This was a retrospective observational study using a multicenter prospective registry of septic shock patients in the ED between October 2015 and December 2019. The primary outcome was in-hospital mortality. The prognostic accuracies of SOFAini and SOFAmax were evaluated using the area under the receiver operating characteristic (AUC) curve. Results A total of 4860 patients was included, and the in-hospital mortality was 22.1%. In 59.7% of patients, SOFAmax increased compared with SOFAini, and the mean change of total SOFA score was 2.0 (standard deviation, 2.3). There was a significant difference in in-hospital mortality according to total SOFA score and the SOFA component scores, except cardiovascular SOFA score. The AUC of SOFAmax (0.71; 95% confidence interval [CI], 0.69-0.72) was significantly higher than that of SOFAini (AUC, 0.67; 95% CI, 0.66-0.69) in predicting in-hospital mortality. The AUCs of all scores of the six components were higher for the maximum values. Conclusion The prognostic accuracy of the initial SOFA score at the time of sepsis recognition was lower than the 24-h maximal SOFA score in ED patients with septic shock. Follow-up assessments of organ failure may improve discrimination of the SOFA score for predicting mortality.
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Affiliation(s)
- Tae Han Kim
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Daun Jeong
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jong Eun Park
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Emergency Medicine, College of Medicine, Kangwon National University, Chuncheon, Gangwon-do, Republic of Korea
| | - Sung Yeon Hwang
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Gil Joon Suh
- Department of Emergency Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Sung-Hyuk Choi
- Department of Emergency Medicine, College of Medicine, Korea University, Seoul, Republic of Korea
| | - Sung Phil Chung
- Department of Emergency Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Won Young Kim
- Department of Emergency Medicine, College of Medicine, Asan Medical Center, Seoul, Republic of Korea
| | - Gun Tak Lee
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Emergency Medicine, College of Medicine, Kangwon National University, Chuncheon, Gangwon-do, Republic of Korea
| | - Tae Gun Shin
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - On behalf of Korean Shock Society
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Emergency Medicine, College of Medicine, Kangwon National University, Chuncheon, Gangwon-do, Republic of Korea
- Department of Emergency Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea
- Department of Emergency Medicine, College of Medicine, Korea University, Seoul, Republic of Korea
- Department of Emergency Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
- Department of Emergency Medicine, College of Medicine, Asan Medical Center, Seoul, Republic of Korea
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Bateson M, Marwick CA, Staines HJ, Patton A, Stewart E, Rooney KD. Performance of bedside tools for predicting infection-related mortality and administrative data for sepsis surveillance: An observational cohort study. PLoS One 2023; 18:e0280228. [PMID: 36862700 PMCID: PMC9980760 DOI: 10.1371/journal.pone.0280228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 12/23/2022] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Measuring sepsis incidence and associated mortality at scale using administrative data is hampered by variation in diagnostic coding. This study aimed first to compare how well bedside severity scores predict 30-day mortality in hospitalised patients with infection, then to assess the ability of combinations of administrative data items to identify patients with sepsis. METHODS This retrospective case note review examined 958 adult hospital admissions between October 2015 and March 2016. Admissions with blood culture sampling were matched 1:1 to admissions without a blood culture. Case note review data were linked to discharge coding and mortality. For patients with infection the performance characteristics of Sequential Organ Failure Assessment (SOFA), National Early Warning System (NEWS), quick SOFA (qSOFA), and Systemic Inflammatory Response Syndrome (SIRS) were calculated for predicting 30-day mortality. Next, the performance characteristics of administrative data (blood cultures and discharge codes) for identifying patients with sepsis, defined as SOFA ≥2 because of infection, were calculated. RESULTS Infection was documented in 630 (65.8%) admissions and 347 (55.1%) patients with infection had sepsis. NEWS (Area Under the Receiver Operating Characteristic, AUROC 0.78 95%CI 0.72-0.83) and SOFA (AUROC 0.77, 95%CI 0.72-0.83), performed similarly well for prediction of 30-day mortality. Having an infection and/or sepsis International Classification of Diseases, Tenth Revision (ICD-10) code (AUROC 0.68, 95%CI 0.64-0.71) performed as well in identifying patients with sepsis as having at least one of: an infection code; sepsis code, or; blood culture (AUROC 0.68, 95%CI 0.65-0.71), Sepsis codes (AUROC 0.53, 95%CI 0.49-0.57) and positive blood cultures (AUROC 0.52, 95%CI 0.49-0.56) performed least well. CONCLUSIONS SOFA and NEWS best predicted 30-day mortality in patients with infection. Sepsis ICD-10 codes lack sensitivity. For health systems without suitable electronic health records, blood culture sampling has potential utility as a clinical component of a proxy marker for sepsis surveillance.
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Affiliation(s)
- Meghan Bateson
- ihub, Healthcare Improvement Scotland, Glasgow, United Kingdom
- * E-mail:
| | - Charis A. Marwick
- Population Health & Genomics Division, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Harry J. Staines
- Healthcare Biometrics, Sigma Statistical Services, Balmullo, United Kingdom
| | - Andrea Patton
- Usher Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Elaine Stewart
- School of Health and Life Sciences, University of the West of Scotland, Lanarkshire, United Kingdom
| | - Kevin D. Rooney
- Department of Anaesthetics and Intensive Care Medicine, Royal Alexandra Hospital, Paisley, United Kingdom
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Khan AM, Aslam SM. Comparison of qSOFA Score, SIRS Criteria, and SOFA Score as predictors of mortality in patients with sepsis. Ghana Med J 2022; 56:191-197. [PMID: 37448998 PMCID: PMC10336629 DOI: 10.4314/gmj.v56i3.9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023] Open
Abstract
Objectives Early diagnosis and treatment of sepsis are associated with a better outcome. With the change in the definition of sepsis, SOFA score and qSOFA score (heart rate, systolic blood pressure and Glasgow coma scale) were introduced and SIRS criteria were removed. This study compared the qSOFA score, SIRS criteria and SOFA score as predictors of mortality in patients with sepsis. Design Prospective observational study. Setting Department of General Medicine of a tertiary hospital. Participants The study included 116 patients. Interventions SOFA scores (range, 0 [best] to 24 [worst] points), SIRS status (range, 0 [best] to 4 [worst] criteria), and qSOFA scores (range, 0 [best] to 3 [worst] points) were calculated using physiological and laboratory parameters recorded within the first 24 hours of ICU admission. Main outcome measures SOFA, qSOFA, and SIRS scores were calculated and measured using physiological and laboratory parameters. Patients were followed till mortality (non-survivors) or discharge from the hospital (survivors). Data were analysed using software SPSS version 20. Results 54 (46.6%) of included patients died. Higher SOFA, qSOFA, and SIRS scores; tachycardia; hypotension; hypoxemia; basophilia; hypoproteinemia; hypoalbuminemia; and need for inotropic support and mechanical ventilation significantly associated with increased mortality. The area under the receiver operating curve for qSOFA ≥2 (0.678; p=0.001) and SOFA (0.74; p=0.000) were comparable and significant, whereas SIRS ≥2 (0.580, p=0.139) was not statistically significant. Conclusions A qSOFA score of greater than 2 is comparable to SOFA and is better than SIRS score greater than 2 for predicting mortality. Funding None indicated.
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Affiliation(s)
- A M Khan
- Department of General Medicine, M. S. Ramaiah Medical College, Bangalore, Karnataka, India
- Department of General Medicine, M. S. Ramaiah Medical College, Bangalore, Karnataka, India
| | - Shaikh M Aslam
- Department of General Medicine, M. S. Ramaiah Medical College, Bangalore, Karnataka, India
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10
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Lee HJ, Ko BS, Ryoo SM, Han E, Suh GJ, Choi SH, Chung SP, Lim TH, Kim WY, Kwon WY, Hwang SY, Jo YH, Shin J, Shin TG, Kim K, Chung TN, Lee JH, Kim KS, Park YS, Yoon YH, Choi HS, Han KS, Kang G, Kim YJ, Cho H. Modified cardiovascular SOFA score in sepsis: development and internal and external validation. BMC Med 2022; 20:263. [PMID: 35989336 PMCID: PMC9394016 DOI: 10.1186/s12916-022-02461-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 07/04/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The Sepsis-3 criteria introduced the system that uses the Sequential Organ-Failure Assessment (SOFA) score to define sepsis. The cardiovascular SOFA (CV SOFA) scoring system needs modification due to the change in guideline-recommended vasopressors. In this study, we aimed to develop and to validate the modified CV SOFA score. METHODS We developed, internally validated, and externally validated the modified CV SOFA score using the suspected infection cohort, sepsis cohort, and septic shock cohort. The primary outcome was 28-day mortality. The modified CV SOFA score system was constructed with consideration of the recently recommended use of the vasopressor norepinephrine with or without lactate level. The predictive validity of the modified SOFA score was evaluated by the discrimination for the primary outcome. Discrimination was assessed using the area under the receiver operating characteristics curve (AUC). Calibration was assessed using the calibration curve. We compared the prognostic performance of the original CV/total SOFA score and the modified CV/total SOFA score to detect mortality in patients with suspected infection, sepsis, or septic shock. RESULTS We identified 7,393 patients in the suspected cohort, 4038 patients in the sepsis cohort, and 3,107 patients in the septic shock cohort in seven Korean emergency departments (EDs). The 28-day mortality rates were 7.9%, 21.4%, and 20.5%, respectively, in the suspected infection, sepsis, and septic shock cohorts. The model performance is higher when vasopressor and lactate were used in combination than the vasopressor only used model. The modified CV/total SOFA score was well-developed and internally and externally validated in terms of discrimination and calibration. Predictive validity of the modified CV SOFA was significantly higher than that of the original CV SOFA in the development set (0.682 vs 0.624, p < 0.001), test set (0.716 vs 0.638), and all other cohorts (0.648 vs 0.557, 0.674 vs 0.589). Calibration was modest. In the suspected infection cohort, the modified model classified more patients to sepsis (66.0 vs 62.5%) and identified more patients at risk of septic mortality than the SOFA score (92.6 vs 89.5%). CONCLUSIONS Among ED patients with suspected infection, sepsis, and septic shock, the newly-developed modified CV/total SOFA score had higher predictive validity and identified more patients at risk of septic mortality.
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Affiliation(s)
- Hui Jai Lee
- Department of Emergency Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Byuk Sung Ko
- Department of Emergency Medicine, Hanyang University College of Medicine, Seoul, South Korea
| | - Seung Mok Ryoo
- Department of Emergency Medicine, University of Ulsan College of Medicine Asan Medical Center, Seoul, South Korea
| | - Eunah Han
- Department of Emergency Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Gil Joon Suh
- Department of Emergency Medicine, College of Medicine, Seoul National University, Seoul, South Korea
| | - Sung-Hyuk Choi
- Department of Emergency Medicine, College of Medicine, Korea University, Seoul, South Korea
| | - Sung Phil Chung
- Department of Emergency Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Tae Ho Lim
- Department of Emergency Medicine, Hanyang University College of Medicine, Seoul, South Korea
| | - Won Young Kim
- Department of Emergency Medicine, University of Ulsan College of Medicine Asan Medical Center, Seoul, South Korea
| | - Woon Yong Kwon
- Department of Emergency Medicine, College of Medicine, Seoul National University, Seoul, South Korea
| | - Sung Yeon Hwang
- Department of Emergency Medicine, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - You Hwan Jo
- Department of Emergency Medicine, College of Medicine, Seoul National University, Seoul, South Korea
| | - Jonghwan Shin
- Department of Emergency Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Tae Gun Shin
- Department of Emergency Medicine, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, South Korea.
| | - Kyuseok Kim
- Department of Emergency Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Gyeonggi-Do, South Korea.
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11
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Moradi Moghaddam O, Niakan Lahiji M, Yazdan Panah L, Talebi-Taher M, Rajabi A, Mirhosseini SF. Relationship between Mini Nutritional Assessment Score and Infection in Critical Care Patients. Med J Islam Repub Iran 2022; 36:91. [PMID: 36408340 PMCID: PMC9586714 DOI: 10.47176/mjiri.36.91] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Indexed: 06/16/2023] Open
Abstract
Background: Nutrition and infectious diseases are 2 influential factors. Mini nutritional assessment (MNA) score is one of the indicators for assessing the nutritional status of the patients. The present study aimed to evaluate the relationship between MNA- short form (SF) and the infectious status of patients admitted to the intensive care unit (ICU) of Hazrat-e-Rasoul hospital in Tehran. Methods: This was a cross-sectional study performed at Hazrat-e-Rasoul hospital in Tehran from 2019 to 2020. Each patient completed the MNA-SF questionnaire. The questionnaire has 6 factors with a score range of 0 to 14, with 12 to 14 indicating "normal nutrition," 8 to 11 indicating "at risk of malnutrition," and 0 to 7 indicating "malnutrition." The patients were monitored for clinical and paraclinical signs and symptoms of infectious disease for the first 14 days after being admitted to the ICU. Then, the relationship between infection level and MNA-SF scores were recorded and the chi-square, independent samples t test, and Pearson correlation test were used. Results: In this study, 119 patients (60 men and 59 women), with a mean age of 53.82 ± 19.76 years were selected, and 71 (59.67%) of the patients had an infection. Women without infection were significantly more than men (p=0.021). In the assessment of the MNA-SF questionnaire, we found that 62 (52.1%) patients had "normal nutrition" status, 30 (25.2%), and 27 (22.7%) had "at risk for malnutrition" and "malnutrition" status, respectively. MNA-SF scores were significantly different in different age groups (p=0.040). There was a significant relationship between weight loss, mobility, and neuropsychological problems with age (p<0.001). Also, there was a meaningful relationship between nutritional status and infection (p=0.032). The results determined that noninfected cases among the patients with "normal nutrition" status were more than those "at risk for malnutrition" (p=0.007). The results of this study showed that clinical outcomes had a significant relationship with nutritional status (p=0.043). Conclusion: Based on the present study, good nutritional status can reduce infection and mortality in patients who are admitted to ICU, and the nutritional status assessed with MNA-SF can play an essential role in patients' susceptibility to infection.
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Affiliation(s)
- Omid Moradi Moghaddam
- Trauma and Injury Research Center, Critical Care Department, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Niakan Lahiji
- Trauma and Injury Research Center, Critical Care Department, Iran University of Medical Sciences, Tehran, Iran
| | - Leyla Yazdan Panah
- Department of Nutritional Sciences, School of Public Health, Hazrat-e Rasoul Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mahshid Talebi-Taher
- Department of Infectious Disease, School of Medicine, Antimicrobial Resistance Research Center, Institute of Immunology and Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Rajabi
- Critical Care Department, Hazrat-e Rasoul Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Seyedeh Farnaz Mirhosseini
- Clinical Nutrition Department, Hazrat-e Rasoul Hospital, Iran University of Medical Sciences, Tehran, Iran
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12
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Detecting Sepsis in Patients with Severe Subarachnoid Hemorrhage during Critical Care. J Clin Med 2022; 11:jcm11144229. [PMID: 35887994 PMCID: PMC9319068 DOI: 10.3390/jcm11144229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 07/15/2022] [Accepted: 07/20/2022] [Indexed: 01/27/2023] Open
Abstract
Introduction: Sepsis and septic shock continue to have a very high mortality rate. Therefore, the last consensus-based sepsis guideline introduced the sepsis related organ failure assessment (SOFA) score to ensure a rapid diagnosis and treatment of sepsis. In neurosurgical patients, especially those patients with subarachnoid hemorrhage (SAH), there are considerable difficulties in interpreting the SOFA score. Therefore, our study was designed to evaluate the applicability of the SOFA for critical care patients with subarachnoid hemorrhage. Methods: Our retrospective monocentric study was registered (NCT05246969) and approved by the local ethics committee (# 211/18). Patients admitted to the Department of Neurosurgery at the Frankfurt University Hospital were enrolled during the study period. Results: We included 57 patients with 85 sepsis episodes of which 141 patients had SOFA score-positive results and 243 SIRS positive detections. We failed to detect a correlation between the clinical diagnosis of sepsis and positive SOFA or SIRS scores. Moreover, a significant proportion of sepsis that was incorrectly detected via the SOFA score could be attributed to cerebral vasospasms (p < 0.01) or a decrease in Glasgow Coma Scale (p < 0.01). Similarly, a positive SIRS score was often not attributed to a septic episode (49.0%). Discussion: Regardless of the fact that SAH is a rare disease, the relevance of sepsis detection should be given special attention in light of the long duration of therapy and sepsis prevalence. Among the six modules represented by the SOFA score, two highly modules were practically eliminated. However, to enable early diagnosis of sepsis, the investigator’s clinical views and synopsis of various scores and laboratory parameters should be highlighted. Conclusions: In special patient populations, such as in critically ill SAH patients, the SOFA score can be limited regarding its applicability. In particular, it is very important to differentiate between CVS and sepsis.
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13
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Importance of Physical Therapy Interventions for Medically Complex Patient With Severe COVID-19: A Case Report. Cardiopulm Phys Ther J 2022. [DOI: 10.1097/cpt.0000000000000201] [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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14
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Risk factors for infection and mortality caused by carbapenem-resistant Klebsiella pneumoniae: a large multicentre case-control and cohort study. J Infect 2022; 84:637-647. [PMID: 35301013 DOI: 10.1016/j.jinf.2022.03.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 03/09/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVES To elucidate the predictors of carbapenem-resistant Klebsiella pneumoniae (CRKP) infection and help clinicians better identify CRKP infection at an early age. METHODS We conducted a multicentre case-control study of 422 patients with CRKP infection and 948 with carbapenem-susceptible K. pneumoniae (CSKP) infection from March to July 2017. Binary logistic regression was used to identify risk factors for CRKP infection. The subgroups of CRKP respiratory infection, intra-abdominal infection, and bloodstream infection were also evaluated. Patients were followed up for 28 days. Independent risk factors for 28-day crude mortality of CRKP infection were analysed using Cox proportional hazards regression models. RESULTS Longer stay of hospitalization, stay in the ICU, previous exposure to antibacterial agents (especially carbapenems, quinolones, aminoglycosides, and tigecycline), invasive procedures, intravascular catheter use, tracheotomy, or admission to ICU in the preceding 90 days were risk factors for CRKP infection. Carbapenem exposure was the only common predictor of different types of CRKP infection. The 28-day mortality of CRKP infection was 13.1% and was independently associated with sex, admitted unit, and types of infection. CONCLUSIONS Strict policies for antibiotic use, cautious decisions regarding the implementation of invasive procedures, and careful management of patients with catheters, especially intravascular catheters, are necessary to handle CRKP infection.
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15
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Schenck EJ, Hoffman KL, Oromendia C, Sanchez E, Finkelsztein EJ, Hong KS, Kabariti J, Torres LK, Harrington JS, Siempos II, Choi AMK, Campion TR. A Comparative Analysis of the Respiratory Subscore of the Sequential Organ Failure Assessment Scoring System. Ann Am Thorac Soc 2021; 18:1849-1860. [PMID: 33760709 PMCID: PMC8641830 DOI: 10.1513/annalsats.202004-399oc] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 03/23/2021] [Indexed: 11/20/2022] Open
Abstract
Rationale: The Sequential Organ Failure Assessment (SOFA) tool is a commonly used measure of illness severity. Calculation of the respiratory subscore of SOFA is frequently limited by missing arterial oxygen pressure (PaO2) data. Although missing PaO2 data are commonly replaced with normal values, the performance of different methods of substituting PaO2 for SOFA calculation is unclear. Objectives: The study objective was to compare the performance of different substitution strategies for missing PaO2 data for SOFA score calculation. Methods: This retrospective cohort study was performed using the Weill Cornell Critical Care Database for Advanced Research from a tertiary care hospital in the United States. All adult patients admitted to an intensive care unit (ICU) from 2011 to 2019 with an available respiratory SOFA score were included. We analyzed the availability of the PaO2/fraction of inspired oxygen (FiO2) ratio on the first day of ICU admission. In those without a PaO2/FiO2 ratio available, the ratio of oxygen saturation as measured by pulse oximetry to FiO2 was used to calculate a respiratory SOFA subscore according to four methods (linear substitution [Rice], nonlinear substitution [Severinghaus], modified respiratory SOFA, and multiple imputation by chained equations [MICE]) as well as the missing-as-normal technique. We then compared how well the different total SOFA scores discriminated in-hospital mortality. We performed several subgroup and sensitivity analyses. Results: We identified 35,260 unique visits, of which 9,172 included predominant respiratory failure. PaO2 data were available for 14,939 (47%). The area under the receiver operating characteristic curve for each substitution technique for discriminating in-hospital mortality was higher than that for the missing-as-normal technique (0.78 [0.77-0.79]) in all analyses (modified, 0.80 [0.79-0.81]; Rice, 0.80 [0.79-0.81]; Severinghaus, 0.80 [0.79-0.81]; and MICE, 0.80 [0.79-0.81]) (P < 0.01). Each substitution method had a higher accuracy for discriminating in-hospital mortality (MICE, 0.67; Rice, 0.67; modified, 0.66; and Severinghaus, 0.66) than the missing-as-normal technique. Model calibration for in-hospital mortality was less precise for the missing-as-normal technique than for the other substitution techniques at the lower range of SOFA and among the subgroups. Conclusions: Using physiologic and statistical substitution methods improved the total SOFA score's ability to discriminate mortality compared with the missing-as-normal technique. Treating missing data as normal may result in underreporting the severity of illness compared with using substitution. The simplicity of a direct oxygen saturation as measured by pulse oximetry/FiO2 ratio-modified SOFA technique makes it an attractive choice for electronic health record-based research. This knowledge can inform comparisons of severity of illness across studies that used different techniques.
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Affiliation(s)
- Edward J Schenck
- Division of Pulmonary and Critical Care Medicine, Joan and Sanford I. Weill Department of Medicine
- NewYork-Presbyterian Hospital, Weill Cornell Medicine, New York, New York; and
| | | | | | - Elizabeth Sanchez
- Division of Pulmonary and Critical Care Medicine, Joan and Sanford I. Weill Department of Medicine
| | - Eli J Finkelsztein
- Division of Pulmonary and Critical Care Medicine, Joan and Sanford I. Weill Department of Medicine
| | - Kyung Sook Hong
- Division of Pulmonary and Critical Care Medicine, Joan and Sanford I. Weill Department of Medicine
- Department of Surgery and Critical Care Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | | | - Lisa K Torres
- Division of Pulmonary and Critical Care Medicine, Joan and Sanford I. Weill Department of Medicine
- NewYork-Presbyterian Hospital, Weill Cornell Medicine, New York, New York; and
| | - John S Harrington
- Division of Pulmonary and Critical Care Medicine, Joan and Sanford I. Weill Department of Medicine
- NewYork-Presbyterian Hospital, Weill Cornell Medicine, New York, New York; and
| | - Ilias I Siempos
- Division of Pulmonary and Critical Care Medicine, Joan and Sanford I. Weill Department of Medicine
| | - Augustine M K Choi
- Division of Pulmonary and Critical Care Medicine, Joan and Sanford I. Weill Department of Medicine
- NewYork-Presbyterian Hospital, Weill Cornell Medicine, New York, New York; and
| | - Thomas R Campion
- Department of Population Health Sciences
- Information Technologies and Services, and
- Clinical and Translational Science Center, Weill Cornell Medicine, Cornell University, New York, New York
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16
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Abdullah SMOB, Sørensen RH, Nielsen FE. Prognostic Accuracy of SOFA, qSOFA, and SIRS for Mortality Among Emergency Department Patients with Infections. Infect Drug Resist 2021; 14:2763-2775. [PMID: 34321893 PMCID: PMC8313375 DOI: 10.2147/idr.s304952] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 05/20/2021] [Indexed: 12/16/2022] Open
Abstract
Objective This study aimed to determine the prognostic accuracy of SOFA in comparison to quick-SOFA (qSOFA) and systemic inflammatory response syndrome (SIRS) in predicting 28-day mortality in the emergency department (ED) patients with infections. Methods A secondary analysis of data from a prospective study of adult patients with documented or suspected infections admitted to an ED in Denmark from Oct-2017 to Mar-2018. The SOFA scores were calculated after adjustment for chronic diseases. The prognostic accuracy was assessed by analysis of sensitivity, specificity, predictive values, likelihood ratios, and area under the receiver operating characteristic curve (AUROC) with 95% confidence intervals (CI). Results A total of 2045 patients with a median age of 73.2 (IQR: 60.9-82.1) years were included. The overall 28-day mortality was 7.7%. In patients meeting a SOFA score ≥2, qSOFA score ≥2, and SIRS criteria ≥2 the 28-day mortality was 13.6% (11.2-16.3), 17.8% (12.4-24.3) and 8.3% (6.7-10.2), respectively. SOFA ≥2 had a sensitivity of 61.4% (53.3-69.0) and specificity of 67.3% (65.1-69.4), qSOFA ≥2 had a sensitivity of 19.6% (13.7-26.7) and specificity of 92.4% (91.1-93.6), and SIRS ≥2 had a sensitivity of 52.5% (44.4-60.5) and specificity of 51.5% (49.2-53.7). The AUROC for SOFA compared to SIRS was: 0.68 vs 0.52; p<0.001 and compared to qSOFA: 0.68 vs 0.63; p=0.018. Conclusion A SOFA score of at least two had better prognostic accuracy for 28-day mortality than SIRS and qSOFA. However, the overall accuracy of SOFA was poor for the prediction of 28-day mortality.
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Affiliation(s)
| | | | - Finn Erland Nielsen
- Department of Emergency Medicine, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Slagelse, Denmark.,Copenhagen Center for Translational Research, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Slagelse, Denmark
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Raschke RA, Agarwal S, Rangan P, Heise CW, Curry SC. Discriminant Accuracy of the SOFA Score for Determining the Probable Mortality of Patients With COVID-19 Pneumonia Requiring Mechanical Ventilation. JAMA 2021; 325:1469-1470. [PMID: 33595630 PMCID: PMC7890534 DOI: 10.1001/jama.2021.1545] [Citation(s) in RCA: 107] [Impact Index Per Article: 35.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
This cohort study characterizes the accuracy of the Sequential Organ Failure Assessment (SOFA) score to discriminate death from survival in patients with COVID-19 pneumonia receiving oxygen therapy for 4 hours or longer before undergoing endotracheal intubation.
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Affiliation(s)
- Robert A. Raschke
- Division of Clinical Data Analytics and Decision Support, University of Arizona College of Medicine, Phoenix
| | | | - Pooja Rangan
- Department of Internal Medicine, Banner–University Medical Center Phoenix, Phoenix, Arizona
| | - C. William Heise
- Division of Clinical Data Analytics and Decision Support, University of Arizona College of Medicine, Phoenix
| | - Steven C. Curry
- Division of Clinical Data Analytics and Decision Support, University of Arizona College of Medicine, Phoenix
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Ramdeen S, Ferrell B, Bonk C, Schubel L, Littlejohn R, Capan M, Arnold R, Miller K. The Available Criteria for Different Sepsis Scoring Systems in the Emergency Department-A Retrospective Assessment. Open Access Emerg Med 2021; 13:91-96. [PMID: 33688278 PMCID: PMC7936926 DOI: 10.2147/oaem.s280279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 12/14/2020] [Indexed: 01/26/2023] Open
Abstract
Objective The goal of the study was to assess the criteria availability of eight sepsis scoring methods within 6 hours of triage in the emergency department (ED). Design Retrospective data analysis study. Setting ED of MedStar Washington Hospital Center (MWHC), a 912-bed urban, tertiary hospital. Patients Adult (age ≥ 18 years) patients presenting to the MWHC ED between June 1, 2017 and May 31, 2018 and admitted with a diagnosis of severe sepsis with or without shock. Main Outcomes Measured Availability of sepsis scoring criteria of eight different sepsis scoring methods at three time points—0 Hours (T0), 3 Hours (T1) and 6 Hours (T2) after arrival to the ED. Results A total of 50 charts were reviewed, which included 23 (46%) males and 27 (54%) females. Forty-eight patients (96%) were Black or African American. Glasgow Coma Scale was available for all 50 patients at T0. Vital signs, except for temperature, were readily available (>90%) at T0. The majority of laboratory values relevant for sepsis scoring criteria were available (>90%) at T1, with exception to bilirubin (66%) and creatinine (80%). NEWS, PRESEP and qSOFA had greater than 90% criteria availability at triage. SOFA and SIRS consistently had the least percent of available criteria at all time points in the ED. Conclusion The availability of patient data at different time points in a patient’s ED visit suggests that different scoring methods could be utilized to assess for sepsis as more patient information becomes available.
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Affiliation(s)
- Sanjhai Ramdeen
- Georgetown University School of Medicine, Washington, DC, USA
| | - Brandon Ferrell
- Georgetown University School of Medicine, Washington, DC, USA
| | - Christopher Bonk
- National Center for Human Factors in Healthcare, MedStar Health Research Institute, Washington, DC, USA
| | - Laura Schubel
- National Center for Human Factors in Healthcare, MedStar Health Research Institute, Washington, DC, USA
| | - Robin Littlejohn
- National Center for Human Factors in Healthcare, MedStar Health Research Institute, Washington, DC, USA
| | - Muge Capan
- Decision Sciences & MIS Department, LeBow College of Business, Drexel University, Philadelphia, PA, USA
| | - Ryan Arnold
- Department of Emergency Medicine, Drexel University School of Medicine, Philadelphia, PA, USA
| | - Kristen Miller
- Georgetown University School of Medicine, Washington, DC, USA.,National Center for Human Factors in Healthcare, MedStar Health Research Institute, Washington, DC, USA
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Hargovan S, Gunnarsson R, Carter A, De Costa A, Brooks J, Groch T, Sivalingam S. The 4-Hour Cairns Sepsis Model: A novel approach to predicting sepsis mortality at intensive care unit admission. Aust Crit Care 2021; 34:552-560. [PMID: 33563513 DOI: 10.1016/j.aucc.2020.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 12/15/2020] [Accepted: 12/19/2020] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Sepsis commonly causes intensive care unit (ICU) mortality, yet early identification of adults with sepsis at risk of dying in the ICU remains a challenge. OBJECTIVE The aim of the study was to derive a mortality prediction model (MPM) to assist ICU clinicians and researchers as a clinical decision support tool for adults with sepsis within 4 h of ICU admission. METHODS A cohort study was performed using 500 consecutive admissions between 2014 and 2018 to an Australian tertiary ICU, who were aged ≥18 years and had sepsis. A total of 106 independent variables were assessed against ICU episode-of-care mortality. Multivariable backward stepwise logistic regression derived an MPM, which was assessed on discrimination, calibration, fit, sensitivity, specificity, and predictive values and bootstrapped. RESULTS The average cohort age was 58 years, the Acute Physiology and Chronic Health Evaluation III-j severity score was 72, and the case fatality rate was 12%. The 4-Hour Cairns Sepsis Model (CSM-4) consists of age, history of renal disease, number of vasopressors, Glasgow Coma Scale, lactate, bicarbonate, aspartate aminotransferase, lactate dehydrogenase, albumin, and magnesium with an area under the receiver operating characteristic curve of 0.90 (95% confidence interval = 0.84-0.95, p < 0.00001), a Nagelkerke R2 of 0.51, specificity of 0.94, a negative predictive value of 0.98, and almost identical odds ratios during bootstrapping. The CSM-4 outperformed existing MPMs tested on our data set. The CSM-4 also performed similar to existing MPMs in their derivation papers whilst using fewer, routinely collected, and inexpensive variables. CONCLUSIONS The CSM-4 is a newly derived MPM for adults with sepsis at ICU admission. It displays excellent discrimination, calibration, fit, specificity, negative predictive value, and bootstrapping values whilst being easy to use and inexpensive. External validation is required.
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Affiliation(s)
- Satyen Hargovan
- Cairns and Hinterland Hospital and Health Service, Australia; College of Medicine and Dentistry, James Cook University, Queensland, Australia.
| | - Ronny Gunnarsson
- Research and Development Unit, Primary Health Care and Dental Care, Regionhalsan, Southern Alvsborg County, Region Vastra Gotaland, Sweden; School of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Sweden; Centre for Antibiotic Resistance Research (CARe) at University of Gothenburg, Gothenburg, Sweden
| | - Angus Carter
- College of Medicine and Dentistry, James Cook University, Queensland, Australia; Intensivist and Medical Donation Specialist, Cairns and Hinterland Health Service, Australia
| | - Alan De Costa
- College of Medicine and Dentistry, James Cook University, Queensland, Australia; Department of Surgery, Cairns and Hinterland Hospital and Health Service, Australia
| | - James Brooks
- Cairns and Hinterland Hospital and Health Service, Australia
| | - Taissa Groch
- Cairns and Hinterland Hospital and Health Service, Australia
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Pairattanakorn P, Angkasekwinai N, Sirijatuphat R, Wangchinda W, Tancharoen L, Thamlikitkul V. Diagnostic and Prognostic Utility Compared Among Different Sepsis Scoring Systems in Adult Patients With Sepsis in Thailand: A Prospective Cohort Study. Open Forum Infect Dis 2020; 8:ofaa573. [PMID: 33447637 PMCID: PMC7781453 DOI: 10.1093/ofid/ofaa573] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 11/21/2020] [Indexed: 12/25/2022] Open
Abstract
Background The diagnostic and prognostic utility of various sepsis scores varied among different cohorts and settings. Methods A prospective cohort study in adult patients with sepsis at Siriraj Hospital (Bangkok, Thailand) was conducted during January to July 2019. The performance of sepsis assessments, including systemic inflammatory response syndrome (SIRS) score, sequential organ failure assessment (SOFA) score, quick sepsis-related organ failure assessment (qSOFA) score, modified early warning score (MEWS), and national early warning score (NEWS), for sepsis detection and mortality prediction were compared with agreement between 2 infectious disease (ID) specialists to determine their sepsis and septic shock status as the reference standard. Results Among the 470 subjects included in this study, 206 patients (43.8%) were determined by 2 ID specialists to have sepsis. Systemic inflammatory response syndrome ≥2, qSOFA ≥2, and NEWS ≥5 yielded the highest sensitivity (93.2%), specificity (81.3%), and accuracy (72.6%), respectively, for detecting sepsis. The SIRS ≥2 had the highest sensitivity (97.8%), whereas qSOFA ≥2 had the highest specificity (61%) and accuracy (69.7%) for predicting mortality among sepsis patients. Receiver operating characteristic (ROC) curve showed MEWS to have the highest discriminatory power for sepsis detection (area under the ROC curve [AUROC], 0.79; 95% confidence interval [CI], 0.74–0.83), whereas SOFA had the highest discriminatory power for predicting hospital mortality (AUROC, 0.76; 95% CI, 0.69–0.79). Conclusions The NEWS ≥5 and qSOFA ≥2 were the most accurate scoring systems for sepsis detection and mortality prediction, respectively. Each scoring system is useful for different specific purposes relative to early detection and mortality prediction in sepsis patients.
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Affiliation(s)
- Prat Pairattanakorn
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.,Internal Medicine Department, Bangkok Metropolitan Administration General Hospital, Bangkok, Thailand
| | - Nasikarn Angkasekwinai
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Rujipas Sirijatuphat
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Walaiporn Wangchinda
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Lalita Tancharoen
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Visanu Thamlikitkul
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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21
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Koch C, Edinger F, Fischer T, Brenck F, Hecker A, Katzer C, Markmann M, Sander M, Schneck E. Comparison of qSOFA score, SOFA score, and SIRS criteria for the prediction of infection and mortality among surgical intermediate and intensive care patients. World J Emerg Surg 2020; 15:63. [PMID: 33239088 PMCID: PMC7687806 DOI: 10.1186/s13017-020-00343-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 11/05/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND It is crucial to rapidly identify sepsis so that adequate treatment may be initiated. Accordingly, the Sequential Organ Failure Assessment (SOFA) and the quick SOFA (qSOFA) scores are used to evaluate intensive care unit (ICU) and non-ICU patients, respectively. As demand for ICU beds rises, the intermediate care unit (IMCU) carries greater importance as a bridge between the ICU and the regular ward. This study aimed to examine the ability of SOFA and qSOFA scores to predict suspected infection and mortality in IMCU patients. METHODS Retrospective data analysis included 13,780 surgical patients treated at the IMCU, ICU, or both between January 01, 2012, and September 30, 2018. Patients were screened for suspected infection (i.e., the commencement of broad-spectrum antibiotics) and then evaluated for the SOFA score, qSOFA score, and the 1992 defined systemic inflammatory response syndrome (SIRS) criteria. RESULTS Suspected infection was detected in 1306 (18.3%) of IMCU, 1365 (35.5%) of ICU, and 1734 (62.0%) of IMCU/ICU encounters. Overall, 458 (3.3%) patients died (IMCU 45 [0.6%]; ICU 250 [6.5%]; IMCU/ICU 163 [5.8%]). All investigated scores failed to predict suspected infection independently of the analyzed subgroup. Regarding mortality prediction, the qSOFA score performed sufficiently within the IMCU cohort (AUCROC SIRS 0.72 [0.71-0.72]; SOFA 0.52 [0.51-0.53]; qSOFA 0.82 [0.79-0.84]), while the SOFA score was predictive in patients of the IMCU/ICU cohort (AUCROC SIRS 0.54 [0.53-0.54]; SOFA 0.73 [0.70-0.77]; qSOFA 0.59 [0.58-0.59]). CONCLUSIONS None of the assessed scores was sufficiently able to predict suspected infection in surgical ICU or IMCU patients. While the qSOFA score is appropriate for mortality prediction in IMCU patients, SOFA score prediction quality is increased in critically ill patients.
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Affiliation(s)
- Christian Koch
- Department of Anesthesiology, Operative Intensive Care Medicine and Pain Therapy, University Hospital of Giessen, Rudolf-Buchheim-Street 7, 35392, Giessen, Germany. .,German Center of Infection Research (DZIF), Partner Site Giessen/Marburg/Langen, Giessen, Germany.
| | - Fabian Edinger
- Department of Anesthesiology, Operative Intensive Care Medicine and Pain Therapy, University Hospital of Giessen, Rudolf-Buchheim-Street 7, 35392, Giessen, Germany.,German Center of Infection Research (DZIF), Partner Site Giessen/Marburg/Langen, Giessen, Germany
| | - Tobias Fischer
- Department of Anesthesiology, Operative Intensive Care Medicine and Pain Therapy, University Hospital of Giessen, Rudolf-Buchheim-Street 7, 35392, Giessen, Germany
| | - Florian Brenck
- Department of Anesthesiology, Operative Intensive Care Medicine and Pain Therapy, University Hospital of Giessen, Rudolf-Buchheim-Street 7, 35392, Giessen, Germany
| | - Andreas Hecker
- Department of General and Thoracic Surgery, University Hospital of Giessen, Giessen, Germany
| | - Christian Katzer
- Department of Anesthesiology, Operative Intensive Care Medicine and Pain Therapy, University Hospital of Giessen, Rudolf-Buchheim-Street 7, 35392, Giessen, Germany
| | - Melanie Markmann
- Department of Anesthesiology, Operative Intensive Care Medicine and Pain Therapy, University Hospital of Giessen, Rudolf-Buchheim-Street 7, 35392, Giessen, Germany
| | - Michael Sander
- Department of Anesthesiology, Operative Intensive Care Medicine and Pain Therapy, University Hospital of Giessen, Rudolf-Buchheim-Street 7, 35392, Giessen, Germany.,German Center of Infection Research (DZIF), Partner Site Giessen/Marburg/Langen, Giessen, Germany
| | - Emmanuel Schneck
- Department of Anesthesiology, Operative Intensive Care Medicine and Pain Therapy, University Hospital of Giessen, Rudolf-Buchheim-Street 7, 35392, Giessen, Germany.,German Center of Infection Research (DZIF), Partner Site Giessen/Marburg/Langen, Giessen, Germany
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Administrative Database and Empiric Therapy Are Always Useful for Appropriate Treatment of Pediatric Patients? Crit Care Med 2020; 48:438-440. [PMID: 32058384 DOI: 10.1097/ccm.0000000000004175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Supplemental Digital Content is available in the text. The Sepsis-3 taskforce defined sepsis as suspicion of infection and an acute rise in the Sequential Organ Failure Assessment score by 2 points over the preinfection baseline. Sepsis-3 studies, though, have not distinguished between acute and chronic organ failure, and may not accurately reflect the epidemiology, natural history, or impact of sepsis. Our objective was to determine the extent to which the predictive validity of Sepsis-3 is attributable to chronic rather than acute organ failure.
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Sepsis, a 2020 review for the internist. ROMANIAN JOURNAL OF INTERNAL MEDICINE = REVUE ROUMAINE DE MEDECINE INTERNE 2020; 58:129-137. [PMID: 32396142 DOI: 10.2478/rjim-2020-0012] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Indexed: 12/29/2022]
Abstract
Sepsis is an overwhelming reaction to infection that comes with high morbidity and mortality, which requires urgent interventions in order to improve outcomes. Surviving Sepsis is an international campaign that aims to improve sepsis outcomes. The 2016 guideline modifies the previous definition of sepsis and proposes some specific diagnostic and therapeutic measures, such as the protocolized use of fluid resuscitation and antibiotics. We aim to summarize the main recommendations of the 2016 guideline that are relevant to the internist and evidence-base update them to the year 2020. In the current context, this review doesn't address patients affected by SARS-COV2 induced disease.
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Haas LEM, Termorshuizen F, Lange DW, Dijk D, Keizer NF. Performance of the quick SOFA in very old ICU patients admitted with sepsis. Acta Anaesthesiol Scand 2020; 64:508-516. [PMID: 31885070 DOI: 10.1111/aas.13536] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 11/07/2019] [Accepted: 12/21/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND The number of very elderly ICU patients (abbreviated to VOPs; ≥80 years) with sepsis increases. Sepsis was redefined in 2016 (sepsis 3.0) using the quick SOFA (qSOFA) score. Since then, multiple studies have validated qSOFA for prognostication in different patient categories, but the prognostic value in VOPs with sepsis is still unknown. METHODS Retrospective cohort study including patients admitted to Dutch ICUs with sepsis, in the period 2012 to 2016, evaluating the outcome and the performance of qSOFA, an extended qSOFA model, SOFA, SAPS II, and APACHE IV for hospital mortality. RESULTS 5969 patients were included, of which 935 VOPs. Crude hospital mortality rates were 19%, 28%, and 39% for patients aged 18-65, 65-80, and ≥80 years respectively. Discriminative performance of qSOFA for in-hospital mortality in VOPs was poor (AUC 0.596) and lower than that of SOFA, APACHE IV, and SAPS II (0.704, 0.722, and 0.780 respectively). A qSOFA model extended with several other characteristics (AUC 0.643) was non-inferior to the full SOFA, but still inferior to APACHE IV and SAPS II, for all age groups. The Hosmer-Lemeshow goodness-of-fit test showed non-significant p-values for all models. Accuracy for both qSOFA and the extended qSOFA was lower compared to APACHE IV and SAPS II (Brier scores 0.227, 0.223, 0.184, and 0.183 respectively). CONCLUSION The qSOFA showed worse discriminative performance to predict mortality than SOFA, APACHE IV, and SAPS II in both VOPs and younger patients admitted with sepsis.
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Affiliation(s)
- Lenneke E. M. Haas
- Department of Intensive Care Diakonessenhuis Utrecht Utrecht the Netherlands
| | - Fabian Termorshuizen
- Department of Medical Informatics Amsterdam Public Health Research Institute Amsterdam UMC University of Amsterdam Amsterdam the Netherlands
- National Intensive Care Evaluation (NICE) Foundation Amsterdam the Netherlands
| | - Dylan W. Lange
- Department of Intensive Care University Medical Center University Utrecht Utrecht the Netherlands
| | - Diederik Dijk
- Department of Intensive Care University Medical Center University Utrecht Utrecht the Netherlands
| | - Nicolette F. Keizer
- Department of Medical Informatics Amsterdam Public Health Research Institute Amsterdam UMC University of Amsterdam Amsterdam the Netherlands
- National Intensive Care Evaluation (NICE) Foundation Amsterdam the Netherlands
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Mitchell E, Pearce MS, Roberts A. Gram-negative bloodstream infections and sepsis: risk factors, screening tools and surveillance. Br Med Bull 2019; 132:5-15. [PMID: 31815280 DOI: 10.1093/bmb/ldz033] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 10/03/2019] [Accepted: 10/09/2019] [Indexed: 12/12/2022]
Abstract
INTRODUCTION AND BACKGROUND Incidence of gram-negative bloodstream infections (GNBSIs) and sepsis are rising in the UK. Healthcare-associated risk factors have been identified that increase the risk of infection and associated mortality. Current research is focused on identifying high-risk patients and improving the methods used for surveillance. SOURCES OF DATA Comprehensive literature search of the topic area using PubMed (Medline). Government, professional and societal publications were also reviewed. AREAS OF AGREEMENT A range of healthcare-associated risk factors independently associate with the risk of GNBSIs and sepsis. AREAS OF CONTROVERSY There are calls to move away from using simple comorbidity scores to predict the risk of sepsis-associated mortality, instead more advanced multimorbidity models should be considered. GROWING POINTS AND AREAS FOR DEVELOPING RESEARCH Advanced risk models should be created and evaluated for their ability to predict sepsis-associated mortality. Investigations into the accuracy of NEWS2 to predict sepsis-associated mortality are required.
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Affiliation(s)
| | - Mark S Pearce
- Population Health Sciences Institute, Newcastle University, UK
| | - Anthony Roberts
- Population Health Sciences Institute, Newcastle University, UK.,Academic Health Science Network - North East & North Cumbria.,South Tees Hospital Foundation Trust, UK.,North East Quality Observatory Service (NEQOS)
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Correction: Comparative prognostic accuracy of sepsis scores for hospital mortality in adults with suspected infection in non-ICU and ICU at an academic public hospital. PLoS One 2019; 14:e0224780. [PMID: 31665190 PMCID: PMC6821051 DOI: 10.1371/journal.pone.0224780] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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