Prognostic value of serial score measurements of the national early warning score, the quick sequential organ failure assessment and the systemic inflammatory response syndrome to predict clinical outcome in early sepsis

Abstract

Background and importance Sepsis is a common and potentially lethal syndrome, and early recognition is critical to prevent deterioration. Yet, currently available scores to facilitate recognition of sepsis lack prognostic accuracy. Objective To identify the optimal time-point to determine NEWS, qSOFA and SIRS for the prediction of clinical deterioration in early sepsis and to determine whether the change in these scores over time improves their prognostic accuracy. Design Post hoc analysis of prospectively collected data. Settings and participants This study was performed in the emergency department (ED) of a tertiary-care teaching hospital. Adult medical patients with (potential) sepsis were included. Outcome measures and analysis The primary outcome was clinical deterioration within 72 h after admission, defined as organ failure development, the composite outcome of ICU-admission and death. Secondary outcomes were the composite of ICU-admission/death and a rise in SOFA at least 2. Scores were calculated at the ED with 30-min intervals. ROC analyses were constructed to compare the prognostic accuracy of the scores. Results In total, 1750 patients were included, of which 360 (20.6%) deteriorated and 79 (4.5%) went to the ICU or died within 72 h. The NEWS at triage (AUC, 0.62; 95% CI, 0.59–0.65) had a higher accuracy than qSOFA (AUC, 0.60; 95% CI, 0.56–0.63) and SIRS (AUC, 0.59; 95% CI, 0.56–0.63) for predicting deterioration. The AUC of the NEWS at 1 h (0.65; 95% CI, 0.63–0.69) and 150 min after triage (0.64; 95% CI, 0.61–0.68) was higher than the AUC of the NEWS at triage. The qSOFA had the highest AUC at 90 min after triage (0.62; 95% CI, 0.58–0.65), whereas the SIRS had the highest AUC at 60 min after triage (0.60; 95% CI, 0.56–0.63); both are not significantly different from triage. The NEWS had a better accuracy to predict ICU-admission/death <72 h compared with qSOFA (AUC difference, 0.092) and SIRS (AUC difference, 0.137). No differences were found for the prediction of a rise in SOFA at least 2 within 72 h between the scores. Patients with the largest improvement in any of the scores were more prone to deteriorate. Conclusion NEWS had a higher prognostic accuracy to predict deterioration compared with SIRS and qSOFA; the highest accuracy was reached at 1 h after triage.

Comparing 11 early warning scores and three shock indices in early sepsis prediction in the emergency department

“…Notably, the time at which vital signs are measured for EWSs determination may affect the discriminatory performance. In a post-hoc study on 1,750 patients with serial vital sign measurements every 30 min during the first 4 h in the ED, Zonneveld et al [45] reported that the AUROC of NEWS for sepsis prediction (Sepsis-3 definition) at triage was 0.62, compared with 0.60 for qSOFA and 0.59 for SIRS. The AUROC was generally higher at 1 h and 150 min after triage.…”

Comparison of seven prehospital early warning scores to predict long-term mortality: a prospective, multicenter, ambulance-based study

“…Broadly speaking, we considered two types of score: generic scores-systems (NEWS2, MREMS, or ViEWS) applicable across all acute illnesses [17][18][19][20], which included RAPS, derived from the Acute Physiology and Chronic Health Evaluation II and customized for use in ambulance services; specific scores for particular conditions [21], such as CART, used in cardiovascular pathology, TEWS for trauma and injuries pathologies, and qSOFA, employed for patients with presumed infection in order to identify misleading cases of sepsis [22].…”

Therapeutic potential of mesenchymal stromal/stem cells in critical‐care patients with systemic inflammatory response syndrome

“…In contrast to patients without SIRS, patients who develop it are more likely to be admitted to the ICU, to require a higher level of care and to experience a higher mortality rate at 28 days. 4 , 5 , 6 Sepsis is the primary cause of death from infection, which mortality reaches levels of 25%–30% and increases with the shock and multiorgan failure progression. 1 , 7 This makes SIRS be among the most common causes of mortality.…”