Critères de SEPSIS-3 aux urgences : étude prospective internationale de validation du qSOFA (the SCREEN study)

Freund, Yonathan; Lemachatti, N.; Krastinova, Evguenia; Laer, Marie Van; Claessens, Y.-E.; Avondo, A.; Feral-Pierssens, Anne Laure; Beaune, Sébastien

doi:10.1016/j.medmal.2017.03.022

Cited by 3 publications

(5 citation statements)

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“…The Sepsis-3 derivation analyses and most subsequent external validations of qSOFA have been conducted in patients already suspected to have infection. [6][7][8]27 There are few prior data detailing the prevalence of qSOFA criteria in undifferentiated patients. A retrospective analysis of 19,670 ED patients in a large academic hospital also found that qSOFA had a low positive predictive value (12%) for sepsis requiring ICU admission.…”

Section: Discussionmentioning

confidence: 99%

“…5 The qSOFA criteria were developed and validated in large datasets based on superior predictive validity and discrimination for mortality compared with SIRS. [6][7][8] Despite its prognostic value, the appropriate role of qSOFA in sepsis screening, diagnosis, and triggering of empiric antibiotics remains confusing and controversial. [9][10][11][12] One challenge is that qSOFA has been evaluated primarily in patients already suspected to have infection.…”

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confidence: 99%

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Epidemiology of Quick Sequential Organ Failure Assessment Criteria in Undifferentiated Patients and Association With Suspected Infection and Sepsis

Anand

Kadri

Rhee

2019

Chest

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BACKGROUND:The role of Quick Sequential Organ Failure Assessment (qSOFA) criteria in sepsis screening and management is controversial, particularly as they were derived only in patients with suspected infection. We examined the epidemiology and prognostic value of qSOFA in undifferentiated patients. METHODS:We identified patients with $ 2 qSOFA criteria within 1 day of admission among all adults admitted to 85 US hospitals from 2012 to 2015 and assessed for suspected infection (using clinical cultures and administration of antibiotics) and sepsis (as defined on the basis of Sepsis-3 criteria). We also examined the discrimination of qSOFA for in-hospital mortality among patients with and without suspected infection, using regression models.RESULTS: Of 1,004,347 hospitalized patients, 271,500 (27.0%) were qSOFA-positive on admission. Compared with qSOFA-negative patients, qSOFA-positive patients were older (median age, 65 vs 58 years), required ICU admission more often (28.5% vs 6.5%), and had higher mortality (6.7% vs 0.8%) (P < .001 for all comparisons). Sensitivities of qSOFA for suspected infection and sepsis were 41.3% (95% CI, 41.1%-41.5%) and 62.8% (95% CI, 62.4%-63.1%), respectively; positive predictive values were 31.0% (95% CI, 30.8%-31.1%) and 17.4% (95% CI, 17.2%-17.5%). The area under the receiver operating characteristic curve for mortality was lower for qSOFA in patients with suspected infection vs those without (0.814 vs 0.875; P < .001).CONCLUSIONS: Only one in three patients who are qSOFA-positive on admission has suspected infection, and one in six has sepsis. qSOFA also has low sensitivity for identifying suspected infection and sepsis, and its prognostic significance is not specific to infection. More sensitive and specific tools for sepsis screening and risk stratification are needed.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Epidemiology of Quick Sequential Organ Failure Assessment Criteria in Undifferentiated Patients and Association With Suspected Infection and Sepsis

Anand

Kadri

Rhee

2019

Chest

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“…Further significant disadvantages of the usual practice include the fact the combined use of SIRS criteria with suspect infection has given disappointing results in terms of sensitivity and specificity for the diagnosis of sepsis in ED setting (17). This approach, therefore, is neither accurate nor reproducible as it is subject to further level of adjudication by expert opinion before patients might be included in sepsis studies (18).…”

Section: Discussionmentioning

confidence: 99%

Derivation and Validation of a Biomarker-Based Clinical Algorithm to Rule Out Sepsis From Noninfectious Systemic Inflammatory Response Syndrome at Emergency Department Admission: A Multicenter Prospective Study*

Mearelli

Fiotti

Giansante

et al. 2018

Critical Care Medicine

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“…Esta superioridade se manteve na análise dos desfechos secundários, como risco de admissão na UTI e a combinação entre a admissão e a permanência superior a 72 horas. 18 A hiperlactatemia também foi analisada, num modelo secundário ajustado, para prever mortalidade intra- -hospitalar. Esta, quando associada ao qSOFA ≥ 2 e comparada às definições anteriores de sepse grave, pelo SRIS, não demonstrou superioridade, com áreas abaixo da curva similares: 0,80 (95% IC, 0,75-0,85) vs. 0,80 (95% IC, 0,74-0,85).…”

Section: Uso De Escores Preditores E Marcado-res De Desfechos Adverso...unclassified

“…Esta, quando associada ao qSOFA ≥ 2 e comparada às definições anteriores de sepse grave, pelo SRIS, não demonstrou superioridade, com áreas abaixo da curva similares: 0,80 (95% IC, 0,75-0,85) vs. 0,80 (95% IC, 0,74-0,85). 18 Tanto os critérios de SRIS quanto o SOFA vêm sendo estudados e comparados, em acurácia, às outras ferramentas de estratificação de risco, como o MEWS (Modified Early Warning Score) e o NEWS (National Early Warning Score). Este último corresponde ao MEWS modificado no Reino Unido.…”

Section: Uso De Escores Preditores E Marcado-res De Desfechos Adverso...unclassified

A Sepse como Estado Disfuncional do Hospedeiro: Novas Definições e Paradigmas Diagnósticos

Trindade¹,

Filho²,

Maciel³

2020

RCHSI

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A sepse, como condição clínica, vem sendo estudada desde os povos antigos, tendo sua terminologia derivada do grego “sepo”, que significa putrefação. Porém, relatos de sua descrição remotam mais de 2.500 anos na China. Anos depois, Roger Bone introduziu o conceito moderno para sepse, sendo uma condição que englobava a síndrome de resposta inflamatória sistêmica (SRIS). A sepse representa um importante problema de saúde pública no mundo, com 17 milhões de casos estimados anualmente, com elevada morbimortalidade. No Brasil, os dados disponíveis apontam para uma letalidade maior do que a dos países desenvolvidos, ultrapassando os 50% nas formas mais graves (choque séptico), além de desfechos piores nos pacientes atendidos pelo Sistema Único de Saúde (SUS).

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Critères de SEPSIS-3 aux urgences : étude prospective internationale de validation du qSOFA (the SCREEN study)

Cited by 3 publications

References 0 publications

Epidemiology of Quick Sequential Organ Failure Assessment Criteria in Undifferentiated Patients and Association With Suspected Infection and Sepsis

Epidemiology of Quick Sequential Organ Failure Assessment Criteria in Undifferentiated Patients and Association With Suspected Infection and Sepsis

Derivation and Validation of a Biomarker-Based Clinical Algorithm to Rule Out Sepsis From Noninfectious Systemic Inflammatory Response Syndrome at Emergency Department Admission: A Multicenter Prospective Study*

A Sepse como Estado Disfuncional do Hospedeiro: Novas Definições e Paradigmas Diagnósticos

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