Validation of National Early Warning Score and Quick Sequential (sepsis-related) Organ Failure Assessment in acute myeloid leukaemia patients treated with intensive chemotherapy

OBJECTIVES

Chemotherapy-induced neutropenia in acute myeloid leukaemia (AML) is a risk factor for life-threatening infections. Early diagnosis and prompt interventions are associated with better outcomes, but the prediction of infection severity remains an open question. Recently, National Early Warning Score (NEWS) and quick sequential organ failure assessment (qSOFA) scores were proposed as warning clinical instruments predicting in-hospital mortality, but their role in the haematological context is still unknown.

METHODS

We retrospectively assess the predictive role of NEWS and qSOFA in a large and homogeneous cohort of adult AML patients treated with intensive chemotherapy. In a total of 1048 neutropenic episodes recorded in 334 consecutive patients, the scores were applied to predict outcomes on the same day of fever onset, and after 24 and 48 h from score calculation.

RESULTS

Both NEWS and qSOFA significantly predicted death, with more accuracy on the same day (NEWS AUROC 0.984 and qSOFA AUROC 0.969) and after 24 h (NEWS AUROC 0.928 and qSOFA AUROC 0.887), while remained moderately accurate after 48 h. Furthermore, also ICU admission was accurately predicted at fever onset and after 24 h.

CONCLUSIONS

Both scores were useful tools in the management of post chemotherapy neutropenic febrile AML patients.

Clinical observation and analysis on the significance of quick sequential organ failure assessment in 74 non-ICU patients with sepsis

BACKGROUND

Sepsis is an important disease that endangers human health and is the main cause of death in ICU patients, which has been a focus of clinical treatment. This study aims to evaluate the significance of the readily available quick sequential organ failure assessment (qSOFA) score in clinical cases of sepsis.

METHODS

A retrospective cross-sectional study of patients with sepsis treated in the Department of Infectious Diseases, the Affiliated Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology from January 2015 to December 2016 was conducted, and the patients were divided into a high-score group (≥2 points) and the low-score group (<2 points) according to the diagnostic criteria for sepsis (Sepsis 3.0). The differences in disease outcome and inflammatory indicators were compared between groups.

RESULTS

A total of 74 patients with sepsis were included in this study. When the cutoff qSOFA score was 2 points, the patients in the high-score group showed a higher mortality rate (71.43%), and the patients in the low-score group showed a higher improvement rate (87.76%). The inflammatory indicators did not show statistically significant differences between the two groups.

CONCLUSIONS

The qSOFA score can better predict the prognoses of non-ICU patients with sepsis compared with traditional inflammatory indicators. Clinicians should raise their awareness about qSOFA and improving its accuracy.