Predictive value of geriatric-quickSOFA in hospitalized older people with sepsis

Abstract

Background QuickSOFA, a prognostic score proposed for patients with infection, has shown a poor predictive value in the geriatric population, probably because of the inappropriateness of the Glasgow Coma Scale (GCS) in assessing acute alteration of mental status in older patients. Indeed, the GCS might result chronically low in older patient with pre-existing cognitive disorders. The aim of this study was to develop an alternative quickSOFA (geriatric-quickSOFA), using the presence of delirium, assessed according to DSM-5 criteria, instead of GCS assessment, to predict mortality in hospitalized older patients with sepsis. Methods Retrospective observational study in Acute Geriatrics Unit of St. Anna Hospital of Ferrara (Italy). The study enrolled 165 patients hospitalized between 2017 and 2018 with diagnosis of sepsis or septic shock. Demographic, clinical data and 30-day survival were collected for each patient. Based on arterial blood pressure, respiratory rate, and the presence of delirium, geriatric-quickSOFA was calculated at admission. Primary outcome was 30-day mortality. Results One hundred sixty-five patients were enrolled with a median age of 88 years; 60.6% were men. High quickSOFA score was not significantly correlated neither with in-hospital nor 30-day mortality. High geriatric-qSOFA score was significantly related to both in-hospital (13.3%vs 51.5%, p = 0.0003) and 30-day mortality (30.0%vs 84.3%, p < 0.00001). Conclusion Geriatric-quickSOFA is significantly associate with short-term mortality risk in older patients with sepsis. Geriatric quickSOFA seems to represent a more suitable and useful predictive tool than the traditional quickSOFA in the geriatric population.

Prognostic Accuracy of the qSOFA Score for In-Hospital Mortality in Elderly Patients with Obstructive Acute Pyelonephritis: A Multi-Institutional Study

“…The current study demonstrated the different predictive performance of the qSOFA score for in-hospital mortality between young and elderly OAPN patients; the qSOFA score predicted in-hospital mortality with high accuracy in young patients (AUC, 0.85), whereas its prognostic accuracy was modest in elderly patients (AUC, 0.61). This trend was also observed in several previous studies, in which the AUC of the qSOFA score was less than 0.70 in elderly patients [ 17 , 18 , 19 ]. The sensitivity and specificity of qSOFA score ≥ 2 for in-hospital mortality were 80% and 80% in young patients, and 50% and 68% in elderly patients, respectively.…”

Prognostic value of PaO2/FiO2, SOFA and D-dimer in elderly patients with sepsis

“…Sepsis has become one of the main causes of death in the geriatric population. 16 Elderly patients with sepsis account for 58-65% of all patients with sepsis. [17][18][19] Studies have shown that the incidence and mortality of sepsis increase with age.…”

Factors for predicting 28‐day mortality in older patients with suspected of having sepsis in the emergency department

“…21 The qSOFA lacks effectiveness in predicting sepsis mortality among hospitalized patients. 14,26,27 Remelli et al identified a geriatric-quick SOFA incorporating clinical parameters and delirium. 26 Their multivariable logistic regression, including age, male gender, basic and instrumental ADL, and bedridden status, showed increased odds ratios for in-hospital and 30-day mortality.…”

“…14,26,27 Remelli et al identified a geriatric-quick SOFA incorporating clinical parameters and delirium. 26 Their multivariable logistic regression, including age, male gender, basic and instrumental ADL, and bedridden status, showed increased odds ratios for in-hospital and 30-day mortality. Similarly, our study revealed concurrent risk factors for patient dependence (at least one independent basic ADL) and altered mental status.…”

“…A previous dependent patient status independently predicts outcomes in older individuals 21 . The qSOFA lacks effectiveness in predicting sepsis mortality among hospitalized patients 14,26,27 . Remelli et al.…”