The Value of Quick Sepsis-Related Organ Failure Assessment Scores in Patients With Acute Pancreatitis Who Present to Emergency Departments: A Three-Year Cohort Study

Abstract

Background Distinguishing sepsis from other inflammatory syndromes continues to be a clinical challenge. The goal of risk stratification tools is to differentiate sepsis from other conditions. We compare the ability of quick sepsis-related organ failure assessment (qSOFA) and systemic inflammatory responses syndrome (SIRS) scores to predict prolonged length of stay (LOS) among patients who presented to the emergency department and hospital ward with acute pancreatitis (AP). Methods We compiled a retrospective database of all adult patients hospitalized for AP during 2015 - 2018 at a single tertiary care center. Independent t -tests, Pearson’s correlation and multiple regressions were performed with hospital LOS as the dependent variable, versus demographic characteristics and etiology of the pancreatitis as independent variables. Prolonged LOS was defined as > 5 days. Results The sensitivity and specificity of an SIRS score of 2 or greater for the detection of patients with prolonged LOS were 61% and 80%, respectively. The qSOFA score of 2 or greater corresponded to a diagnosis of significant AP with a specificity of 99% and a sensitivity of 4%. Multiple regression analysis demonstrated that each point increase in an SIRS score is associated with 2.24 days in additional hospital LOS. Interestingly, SIRS scores were found to correlate with the LOS, but not qSOFA. Conclusion The qSOFA is a tool designed to identify patients at high risk of mortality due to sepsis. The data suggest that as with sepsis, patients with AP who are triaged with only qSOFA could be underrecognized and subsequently undertreated. Secondarily, the data suggest that SIRS scoring has the potential to promptly predict how long patients with AP will stay in the hospital.

Edaravone Protects against Pancreatic and Intestinal Injury after Acute Pancreatitis <i>via</i> Nuclear Factor-κB Signaling in Mice

“…22) Furthermore, the activation of TLR4 expressed in pancreatic acinar cells can promote the secretion of IL-1β, which further alters intestinal permeability and causes other manifestations of pancreatitis. 23) Previous study has also shown that activation of inflammatory responses and bacterial translocation after intestinal injury are major risk factors for AP. 24,25) In this context, we considered that intervening in the pathogenesis of AP would be an effective way to treat it.…”

“…23) Previous study has also shown that activation of inflammatory responses and bacterial translocation after intestinal injury are major risk factors for AP. 24,25) In this context, we considered that intervening in the pathogenesis of AP would be an effective way to treat it. EDA has a significant beneficial effect in liver injury 26) and in cerebral ischemia.…”

Derivation and validation of the ED-SAS score for very early prediction of mortality and morbidity with acute pancreatitis: a retrospective observational study

“…Further, selection bias may exist, as patients who were discharged directly from the ED were excluded from the analysis; this limits the analysis to those with more severe cases of acute pancreatitis. We did not perform a direct comparison between the ED-SAS score and other common scoring systems or ED predictors of mortality such as the quick Sepsis Related Organ Failure Assessment score, which may have utility in evaluating acute pancreatitis, as it does in sepsis [ 26 ]. In addition, the design for assessing mortality may underestimate the true rates, given that subjects were not directly contacted, as electronic health record data were used to determine 30- and 180-day mortality.…”

Emergency mortality of non-trauma patients was predicted by qSOFA score

“…The qSOFA score has been used as a new tool for sepsis and septic shock [ 4 ]. It was developed as a risk stratification tool for patients who are admitted outside the ICU, such as those in ED [ 11 – 13 ]. Seymour et al [ 11 ] studied 148,907 suspected infected patients, of whom 4% died.…”