Evaluation of qSOFA score, and conjugated bilirubin and creatinine levels for predicting 28‑day mortality in patients with sepsis

Abstract

Sepsis is a dangerous disease that develops rapidly and has a high mortality rate. A timely and accurate assessment of the patient's condition is beneficial in improving prognosis and reducing mortality. Therefore, the present study was designed to investigate the potential association between quick sequential organ failure assessment (qSOFA) scores and biochemical indicators, such as conjugated bilirubin (CB) and creatinine levels, with the 28-day prognosis of patients with sepsis in a retrospective observational study. All cases were divided into survival and non-survival groups on the 28th day after diagnosis. The qSOFA scores, and CB and creatinine levels were significantly higher in the non-survival group than in the survival group (both P<0.01). Cox regression models identified CB [hazard ratio (HR), 1.006; P=0.002] and creatinine levels (HR, 1.002; P= 0.024) as independent factors affecting 28-day mortality. The area under the curve (AUC) for CB and creatinine levels plus qSOFA score was 0.792 (95% confidence interval, 0.745-0.834), which was larger than the values for CB level, creatinine level and qSOFA score alone (all P<0.01) in the prognosis of 28-day mortality. The cut-off value of CB and creatinine levels plus qSOFA score for the 28-day mortality was 0.275 (-2.466 + 0.012 x CB + 0.002 x creatinine + 1.289 x qSOFA). Patients with lower combined predictor values had a better prognosis as demonstrated by Kaplan-Meier survival curves (log-rank test, 10.060; P=0.002). In both the septic shock and sepsis groups, the combined predictor value was higher in the non-survival group than in the survival group (P<0.001). Therefore, an increase in the combined predictor value of CB and creatinine levels plus qSOFA score may be an important predictor of disease progression and prognosis in patients with sepsis and septic shock.

Development of a Nomogram for Predicting Mortality Risk in Sepsis Patients During Hospitalization: A Retrospective Study

“… 25 , 26 As a key indicator of a dysfunctional liver, hyper-bilirubin can also damage the bactericidal properties of neutrophils by antioxidation and stimulate the production of many inflammatory factors, leading to poor prognosis in sepsis patients. 27 This study also discovered that the increase in pro-BNP was closely associated with death risk for patients with sepsis, which could be explained by the close relationship between pro-BNP and heart failure. 28 Our study also observed that an increase in creatinine levels in the serum could help to predict the death risk of patients since sepsis causes acute renal injury.…”

Systemic immune-inflammation index combined with quick sequential organ failure assessment score for predicting mortality in sepsis patients

“…As a result of our finding, the combination of SII with qSOFA score manifested a distinguishing incremental effect on the prognostic ability in the sepsis, Furthermore, when compared to the qSOFA scoring system, there was a substantial enhancement in terms of sensitivity. Recently, researchers have explored the role of biochemical markers in the prognosis of sepsis [ 41 , 42 ], while some studies have attempted combining laboratory test biomarker and qSOFA score to improve the prognostic accuracy. Shetty et al found that combined with lactate ≥2 mmol/L and qSOFA performed a better identification ability for the suspected sepsis patients with an adverse outcome compared to qSOFA ≥2 [ 43 ].…”

“…Yu et al combined the procalcitonin with the qSOFA and found a great improvement in the mortality prediction capability of sepsis [ 44 ]. Xiao et al investigated the increasing predictor ability of conjugated bilirubin and creatinine levels combine with qSOFA score for sepsis progression and prognosis [ 42 ]. However, conflicting results were also raised by some other scholars.…”

Risk factors and incidence of sepsis-induced coagulopathy in patients with sepsis: a single- center retrospective cohort study

“…Patients with elevated bilirubin levels exhibit higher disease severity scores, as well as higher incidence of sepsis, shock, and organ failure. The combined predictive value of bilirubin and creatinine levels combined with an increase in qSOFA score may also be an important predictor of disease progression and prognosis in patients with sepsis and septic shock [34]. Serum bilirubin concentration has been used as one of the indicators for the assessment of liver function in critically ill patients.…”