SOFA and qSOFA usefulness for in-hospital death prediction of elderly patients admitted for suspected infection in internal medicine

Falsetti, Lorenzo; Martino, Marianna; Zaccone, Vincenzo; Viticchi, Giovanna; Raponi, Alessia; Moroncini, Gianluca; Fioranelli, Agnese; Pentima, Chiara Di; Martini, Alessandro; Nitti, Cinzia; Salvi, Aldo; Burattini, Maurizio; Tarquinio, Nicola

doi:10.1007/s15010-020-01494-5

Cited by 16 publications

(11 citation statements)

References 23 publications

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“…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.…”

Section: Discussionsupporting

confidence: 88%

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

et al. 2021

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Prognostic accuracy of the quick sequential organ failure assessment (qSOFA) score for mortality may be limited in elderly patients. Using our multi-institutional database, we classified obstructive acute pyelonephritis (OAPN) patients into young and elderly groups, and evaluated predictive performance of the qSOFA score for in-hospital mortality. qSOFA score ≥ 2 was an independent predictor for in-hospital mortality, as was higher age, and Charlson comorbidity index (CCI) ≥ 2. In young patients, the area under the curve (AUC) of the qSOFA score for in-hospital mortality was 0.85, whereas it was 0.61 in elderly patients. The sensitivity and specificity of qSOFA score ≥ 2 for in-hospital mortality was 80% and 80% in young patients, and 50% and 68% in elderly patients, respectively. For elderly patients, we developed the CCI-incorporated qSOFA score, which showed higher prognostic accuracy compared with the qSOFA score (AUC, 0.66 vs. 0.61, p < 0.001). Therefore, the prognostic accuracy of the qSOFA score for in-hospital mortality was high in young OAPN patients, but modest in elderly patients. Although it can work as a screening tool to determine therapeutic management in young patients, for elderly patients, the presence of comorbidities should be considered at the initial assessment.

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Section: Discussionsupporting

confidence: 88%

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

et al. 2021

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“…In addition, the high proportion of co-existing comorbidities (e.g., diabetes mellitus, chronic kidney disease) in our patients can impair their immune system, increasing susceptibility to infection, which causes higher mortality risk (6,9). The distribution of the infection source proportion in our patients was similar to that in previous studies on elderly patients with sepsis (26,27). Our results revealed that the respiratory tract was the most common site of sepsis, which is also in line with previous studies (28,29).…”

Section: Discussionsupporting

confidence: 79%

Prognostic Values of the Timing of Antibiotic Administration and the Sepsis Bundle Component in Elderly Patients With Septic Shock: A Retrospective Study

Liang

Yang

Hung

et al. 2021

Shock

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Introduction: Elderly patients are more susceptible to sepsis and septic shock. Early administration of broad-spectrum antibiotics is a key element of the sepsis management of bundle. Our study aimed to investigate the association between the timing of antibiotics administration and the risk of adverse outcomes in elderly patients with septic shock, and to examine the prognostic value of other bundle elements. Method: This is a single-center, retrospective, casecontrol study including elderly patients (aged ! 65 years) diagnosed with septic shock in the emergency department between October 1, 2018, and December 31, 2019. Eligible patients were divided into early (within 1 h) and late (beyond 1 h) groups according to the time interval between septic shock recognition and initial antibiotic administration. The characteristics, sepsis-related severity scores, management strategy, and outcomes were recorded. A multivariate logistic regression model was used to identify the independent prognostic factors. Results: A total of 331 patients were included in the study. The overall 90-day mortality rate was 43.8% (145/331). There were no significant differences in baseline characteristics, sepsis-related severity scores, and management strategy between the two groups. There was no significant difference between the early and late groups in the rate of intensive care unit transfer (46.4% vs. 46.6%, P ¼ 0.96), endotracheal intubation (28.3% vs. 27.5%, P ¼ 0.87), renal replacement therapy (21.7% vs. 21.8%, P ¼ 1.00), or 90-day mortality (44.2% vs. 43.5%, P ¼ 0.90). Serum lactate level (hazard ratio [HR] ¼ 1.15, P < 0.01) and source control (HR ¼ 0.56, P ¼ 0.03) were identified as independent factors associated with 90-day mortality. Conclusion: The timing of antibiotic administration was not associated with adverse outcomes in elderly patients with septic shock. Serum lactate level and source control implementation were independent prognostic factors in these patients.

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“…In recent years, interest in qSOFA and SOFA scores has increased significantly [9,26]. There have been a few studies that have analyzed the use of these scores in non-infectious pathologies [4,27], but, as far as we know, this is the first study to evaluate these scores in a cohort of patients transferred to the hospital by ambulance; that is to say, cases that have previously been evaluated and treated by EMS healthcare workers.…”

Section: Discussionmentioning

confidence: 99%

Role of qSOFA and SOFA Scoring Systems for Predicting In-Hospital Risk of Deterioration in the Emergency Department

López-Izquierdo

Brio-Ibañez

Martin-Rodríguez

et al. 2020

IJERPH

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The objective of this study was to analyze and compare the usefulness of quick sequential organ failure assessment score (qSOFA) and sequential organ failure assessment (SOFA) scores for the detection of early (two-day) mortality in patients transported by emergency medical services (EMSs) to the emergency department (ED) (infectious and non-infectious). We performed a multicentric, prospective and blinded end-point study in adults transported with high priority by ambulance from the scene to the ED with the participation of five hospitals. For each score, the area under the curve (AUC) of the receiver operating characteristic (ROC) curve was calculated. We included 870 patients in the final cohort. The median age was 70 years (IQR 54–81 years), and 338 (38.8%) of the participants were women. Two-day mortality was 8.3% (73 cases), and 20.9% of cases were of an infectious pathology. For two-day mortality, the qSOFA presented an AUC of 0.812 (95% CI: 0.75–0.87; p < 0.001) globally with a sensitivity of 84.9 (95% CI: 75.0–91.4) and a specificity of 69.4 (95% CI: 66.1–72.5), and a SOFA of 0.909 (95% CI: 0.86–0.95; p < 0.001) with sensitivity of 87.7 (95% CI: 78.2–93.4) and specificity of 80.7 (95% CI: 77.4–83.3). The qSOFA score can serve as a simple initial assessment to detect high-risk patients, and the SOFA score can be used as an advanced tool to confirm organ dysfunction.

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SOFA and qSOFA usefulness for in-hospital death prediction of elderly patients admitted for suspected infection in internal medicine

Cited by 16 publications

References 23 publications

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

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

Prognostic Values of the Timing of Antibiotic Administration and the Sepsis Bundle Component in Elderly Patients With Septic Shock: A Retrospective Study

Role of qSOFA and SOFA Scoring Systems for Predicting In-Hospital Risk of Deterioration in the Emergency Department

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