Non-utility of sepsis scores for identifying infection in surgical intensive care unit patients

Krebs, Elizabeth D.; Hassinger, Taryn E.; Guidry, Christopher A.; Berry, Puja S.; Elwood, Nathan R.; Sawyer, Robert G.

doi:10.1016/j.amjsurg.2018.11.044

Cited by 15 publications

(27 citation statements)

References 23 publications

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“…Since the SOFA score consists of much more detailed intensive care variables than the qSOFA score and the SIRS criteria, the speci city is higher, but sensitivity remains low. These arguments are in accordance with the ndings of Gando et al as well as Krebs et al, who demonstrated that the SIRS criteria, SOFA score, and qSOFA score were not able to predict sepsis in the emergency department or surgical ICU [18,26].…”

Section: Discussionsupporting

confidence: 90%

“…Even though qSOFA and SOFA scores are widely accepted as tools for the identi cation of septic patients, they failed to predict sepsis in each individual group of patients in our study. These ndings are supported by Krebs et al, who also evaluated the qSOFA and SOFA scores as well as the SIRS criteria in 1,942 prospective patient days within a cohort of surgical trauma ICU patients, concluding that all scores failed to predict the development of new infections [18]. But, also in an out-of-ICU setting, a failure of the qSOFA score (and SIRS criteria) has already been described in a collective of patients attending the emergency room (n = 1,045) [26].…”

Section: Discussionmentioning

confidence: 60%

“…However, surgical patients are also at risk for postoperative infections. Clinical signs of infection in these patients are challenging, since they might also be caused by the surgery itself, implicating the need for thorough risk strati cation [17,18]. Lacking evidence, it is yet not de ned whether these patients should be evaluated as ICU or non-ICU patients when it comes to the identi cation of sepsis, raising the question as to whether the SOFA or qSOFA score should be used.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of qSOFA score, SOFA Score, and SIRS Criteria for the Prediction of Infection and Mortality Among Surgical Intermediate and Intensive Care Patients

Koch

Edinger

Fischer

et al. 2020

Preprint

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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) score 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 sepsis and mortality in IMCU patients. Methods Retrospective data analysis included 13,780 surgical patients treated at the IMCU, ICU, or both between 01/01/2012 and 09/30/2018. 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 1,306 (18.3%) of IMCU, 1,365 (35.5%) of ICU, and 1,734 (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 sepsis 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 sepsis in surgical ICU or IMCU patients with suspected infection. 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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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 60%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Comparison of qSOFA score, SOFA Score, and SIRS Criteria for the Prediction of Infection and Mortality Among Surgical Intermediate and Intensive Care Patients

Koch

Edinger

Fischer

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Even though qSOFA and SOFA scores are widely accepted as tools for the identi cation of septic patients, they failed to predict suspected infection in each individual group of patients in our study. These ndings are supported by Krebs et al, who also evaluated the qSOFA and SOFA scores as well as the SIRS criteria in 1,942 prospective patient days within a cohort of surgical trauma ICU patients, concluding that all scores failed to predict the development of new infections [18]. But, also in an out-of-ICU setting, a failure of the qSOFA score (and SIRS criteria) has already been described in a collective of patients attending the emergency room (n = 1,045) [26].…”

Section: Discussionmentioning

confidence: 60%

“…However, surgical patients are also at risk for postoperative infections. Clinical signs of infection in these patients are challenging, since they might also be caused by the surgery itself, implicating the need for thorough risk strati cation [17,18]. Lacking evidence, it is yet not de ned whether these patients should be evaluated as ICU or non-ICU patients when it comes to the identi cation of sepsis, respectively severe infection, raising the question as to whether the SOFA or qSOFA score should be used.…”

Section: Introductionmentioning

confidence: 99%

Comparison of qSOFA score, SOFA score, and SIRS criteria for the prediction of infection and mortality among surgical intermediate and intensive care patients

Koch

Edinger

Fischer

et al. 2020

Preprint

View full text Add to dashboard Cite

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) score 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 01/01/2012 and 09/30/2018. 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 1,306 (18.3%) of IMCU, 1,365 (35.5%) of ICU, and 1,734 (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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Sepsis Resuscitation

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The Acute Management of Surgical Disease

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Non-utility of sepsis scores for identifying infection in surgical intensive care unit patients

Cited by 15 publications

References 23 publications

Comparison of qSOFA score, SOFA Score, and SIRS Criteria for the Prediction of Infection and Mortality Among Surgical Intermediate and Intensive Care Patients

Comparison of qSOFA score, SOFA Score, and SIRS Criteria for the Prediction of Infection and Mortality Among Surgical Intermediate and Intensive Care Patients

Comparison of qSOFA score, SOFA score, and SIRS criteria for the prediction of infection and mortality among surgical intermediate and intensive care patients

Sepsis Resuscitation

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