Low Accuracy of Positive qSOFA Criteria for Predicting 28-Day Mortality in Critically Ill Septic Patients During the Early Period After Emergency Department Presentation

Hwang, Sung Yeon; Jo, Ik Joon; Lee, Se Uk; Lee, Tae Rim; Yoon, Hee; Chul, Won; Sim, Min Seob; Shin, Tae Gun

doi:10.1016/j.annemergmed.2017.05.022

Cited by 88 publications

(71 citation statements)

References 28 publications

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“…The results of studies examining the ability of qSOFA and SOFA scores in predicting outcome of patients with sepsis have been conflicting. Although qSOFA has been suggested to be superior in predicting mortality compared with SIRS, sepsis, and severe sepsis criteria [86], its ability to predict mortality remains questionable [87,88]. A recent study by Raith et al [89] showed the significant superiority of SOFA to qSOFA in predicting the outcome of septic patients.…”

Section: Predicting the Outcome Of Sepsismentioning

confidence: 99%

Sepsis 2019: What Surgeons Need to Know

Kaafarani

Rattan

et al. 2020

Surgical Infections

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The definition of sepsis continues to be as dynamic as the management strategies used to treat this. Sepsis-3 has replaced the earlier systemic inflammatory response syndrome (SIRS)-based diagnoses with the rapid Sequential Organ Failure Assessment (SOFA) score assisting in predicting overall prognosis with regards to mortality. Surgeons have an important role in ensuring adequate source control while recognizing the threat of carbapenem-resistance in gram-negative organisms. Rapid diagnostic tests are being used increasingly for the early identification of multi-drug-resistant organisms (MDROs), with a key emphasis on the multidisciplinary alert of results. Novel, higher generation antibiotic agents have been developed for resistance in ESKCAPE (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species) organisms while surgeons have an important role in the prevention of spread. The Study to Optimize Peritoneal Infection Therapy (STOP-IT) trial has challenged the previous paradigm of length of antibiotic treatment whereas biomarkers such as procalcitonin are playing a prominent role in individualizing therapy. Several novel therapies for refractory septic shock, while still investigational, are gaining prominence rapidly (such as vitamin C) whereas others await further clinical trials. Management strategies presented as care bundles continue to be updated by the Surviving Sepsis Campaign, yet still remain controversial in its global adoption. We have broadened our temporal and epidemiologic perspective of sepsis by understanding it both as an acute, time-sensitive, life-threatening illness to a chronic condition that increases the risk of mortality up to five years post-discharge. Artificial intelligence, machine learning, and bedside scoring systems can assist the clinician in predicting post-operative sepsis. The public health role of the surgeon is key. This includes collaboration and multidisciplinary antibiotic stewardship at a hospital level. It also requires controlling pharmaceutical sales and the unregulated dispensing of antibiotic agents globally through policy initiatives to control emerging resistance through prevention.

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Section: Predicting the Outcome Of Sepsismentioning

confidence: 99%

Sepsis 2019: What Surgeons Need to Know

Kaafarani

Rattan

et al. 2020

Surgical Infections

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“…However, some recent studies demonstrated contrary results concerning the usefulness of the qSOFA score in patients with trauma, burns, pneumonia, leukaemia, liver cirrhosis and sepsis qSOFA, quick Sequential Organ Failure Assessment; DqSOFA, subtracting the worst value of the qSOFA score from 1 hr after presentation from the qSOFA score at presentation. [11][12][13][14][21][22][23][24][25][26][27]. These controversies are estimated to vary according to the severity of the disease, the timing of the measurement and the measurement method [22][23][24][25][26][27].…”

Section: Discussionmentioning

confidence: 99%

The qSOFA Score: A Simple and Accurate Predictor of Outcome in Patients with Glyphosate Herbicide Poisoning

Cho

Chun

Moon

2018

Basic Clin Pharma Tox

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This study aimed to investigate whether the quick Sequential Organ Failure Assessment (qSOFA) score at emergency department (ED) presentation can help improve the risk assessment of glyphosate-surfactant herbicide (GlySH) poisoning complications. A total of 150 patients presenting with acute glyphosate herbicide ingestion were enrolled in this retrospective observational study. The qSOFA scores at presentation, ΔqSOFA (calculated by subtracting the worst qSOFA score from 1 hr after admission from the qSOFA score at presentation), baseline characteristics, clinical courses and outcome were collected and analysed. A total of 41 patients had life-threatening complications (27.3%), and 14 patients died (9.3%). Patients with a qSOFA score of 0 at presentation had a 1.5% incidence rate of complications. As the qSOFA score at presentation increased from 1 to 3, the rate of life-threatening complications significantly increased from 29.6% to 100%. Patients with a ΔqSOFA of 1 had a higher frequency of complications than did patients with a ΔqSOFA of 0. The qSOFA score (OR: 8.39, 95% CI: 3.51-26.67) and ΔqSOFA (OR: 27.60, 95% CI: 3.87-575.67) were associated with the development of life-threatening complications in the multivariate analysis. The qSOFA score showed high sensitivity (97.56%), and the ΔqSOFA score showed high specificity (99.08%). The values of area under the curve were significantly higher in the models using the qSOFA and ΔqSOFA than they were in the models using previously known prognostic factors (p < 0.01). The clinician should pay more attention to patients with high qSOFA scores at presentation or an increase in the qSOFA score 1 hr after admission.

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“…Despite qSOFA showing better outcome prediction than SIRS, the primary criticism of qSOFA has been concern over its lack of sensitivity for various outcomes. (19,(23)(24)(25) Churpek et al investigated several early warning scores to predict the composite outcome of death and ICU transfer in admitted patients in the ED and wards. (26) qSOFA outperformed SIRS for the composite outcome; however qSOFA's sensitivity was 54% compared to 91% for SIRS.…”

Section: Discussionmentioning

confidence: 99%

The Association of qSOFA, SOFA, and SIRS with Mortality in Emergency Department Pneumonia

Mecham¹,

Dean²,

Wilson³

et al. 2018

JRI

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The 2016 Sepsis-3 consensus statement removed the Systemic Inflammatory Response Syndrome (SIRS) criteria from the definition of sepsis, in part for its poor specificity. (1, 2) In its place, Sepsis-3 recommended the Sequential Organ Failure Assessment (SOFA) be used to assist in identifying sepsis among patients with infection. SOFA was selected based on a detailed analysis of its performance in contrast to the Sepsis-2 definition derived from expert opinion. The SOFA score better identified patients at risk of sepsis, as well as its associated organ dysfunction and mortality risk. (3) Because SOFA is more time and resource intensive than SIRS and is not fully calculable pre-hospital or at initial emergency department (ED) triage, the Sepsis-3 group developed the quick SOFA (qSOFA). qSOFA has three clinical components and offers clinicians the ability to rapidly assess a patient without need of laboratory results. Pneumonia is the leading infectious cause of hospitalization among U.S. adults, and the most common cause of severe sepsis. (4, 5) Several pneumonia mortality risk scores are used in the ED to guide disposition and management. Because we anticipate calculation of qSOFA and SOFA will soon become common in the ED, we investigated whether these scores would offer any value in pneumonia triage. We sought to investigate qSOFA's association with mortality in pneumonia patients, and its potential to inform ED decision making as an alternative to traditional pneumonia severity and mortality risk scores. In a large population of ED patients with pneumonia, we aimed to determine how well SIRS, SOFA, and qSOFA correlate with 30 day all-cause mortality, ED disposition, and intensive care unit (ICU) admission.

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Low Accuracy of Positive qSOFA Criteria for Predicting 28-Day Mortality in Critically Ill Septic Patients During the Early Period After Emergency Department Presentation

Cited by 88 publications

References 28 publications

Sepsis 2019: What Surgeons Need to Know

Sepsis 2019: What Surgeons Need to Know

The qSOFA Score: A Simple and Accurate Predictor of Outcome in Patients with Glyphosate Herbicide Poisoning

The Association of qSOFA, SOFA, and SIRS with Mortality in Emergency Department Pneumonia

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