Utilization of systemic inflammatory response syndrome criteria in predicting mortality among geriatric patients with influenza in the emergency department

Abstract

Background Systemic Inflammatory Response Syndrome (SIRS) criteria are often used to evaluate the risk of sepsis and to identify in-hospital mortality among patients with suspected infection. However, utilization of the SIRS criteria in mortality prediction among geriatric patients with influenza in the emergency department (ED) remains unclear. Therefore, we conducted a research to delineate this issue. Methods This is a retrospective case–control study including geriatric patients (age ≥ 65 years) with influenza, who presented to the ED of a medical center between January 1, 2010 and December 31, 2015. Vital signs, past history, subtype of influenza, demographic data, and outcomes were collected from all patients and analyzed. We calculated the accuracy for predicting 30-days mortality using the SIRS criteria. We also performed covariate adjustment of the area under the receiver operating characteristic curve (AUROC) via regression modeling. Results We recruited a total of 409 geriatric patients in the ED, with mean age 79.5 years and an equal sex ratio. The mean SIRS criteria score was 1.9 ± 1.1. The result of a Hosmer–Lemeshow goodness-of-fit test was 0.34 for SIRS criteria. SIRS criteria score ≥ 3 showed better mortality prediction, with odds ratio (OR) 3.37 (95% confidence interval (CI), 1.05–10.73); SIRS score ≥ 2 showed no statistical significance, with p = 0.85 (OR, 1.15; 95% CI, 0.28–4.69). SIRS score ≥ 3 had acceptable 30-days mortality discrimination, with AUROC 0.77 (95% CI, 0.68–0.87) after adjustment. SIRS score ≥ 3 also had a notable negative predictive value of 0.97 (95% CI, 0.94–0.99). Conclusion The presence of a higher number of SIRS criteria (≥ 3) showed greater accuracy for predicting mortality among geriatric patients with influenza.

Two-stage prediction model for in-hospital mortality of patients with influenza infection

“…Some studies have attempted to evaluate the efficacy of various tools for predicting risk of mortality in patients with influenza infection. The predictive tools assessed in these studies consider systemic inflammatory response syndrome (SIRS), quick Sequential Organ Failure Assessment scores (qSOFA), and clinical parameters like sex, age, triage category and underlying comorbidities [10][11][12][13][14]. In a single-center, retrospective cohort study conducted in Taiwan, Chu et al reported that the area under the receiver operating characteristic curve (AUROC) of a qSOFA model for predicting inhospital mortality in influenza patients was 0.864 [12].…”

National Early Warning Score for predicting intensive care unit admission among elderly patients with influenza infections in the emergency department: an effective disposition tool during the influenza season

“…Influenza-infected elderly patients who were admitted to the ICU had a significantly higher percentage of a history of diabetes and CAD. A previous study showed that CAD may affect prognosis in elderly patients with influenza infections 10 because influenza infections may exaggerate underlying cardiac disease and increase the chances of myocardial infarction among patients with a history of CAD. 27 Meanwhile, patients with a history of diabetes may be more susceptible to sepsis because of the impairment of innate immune response caused by poor glycaemic control.…”

“…Moreover, a study showed that systemic inflammatory response syndrome (SIRS) criteria ≥3 among geriatric patients with influenza showed a greater accuracy for poor prognosis, which is different from the usual SIRS criteria cut-off point of 2 among non-geriatric patients. 10 Therefore, we conducted this study to validate the utilisation of NEWS in predicting ICU admission among elderly patients with influenza infections.…”

Two-stage Prediction Model for in-hospital Mortality of Patients With Influenza Infection

“…However, it may not be a good tool for screening and triage because of its poor sensitivity. A retrospective study conducted by Tai et al recruited 409 geriatric patients in the ED and reported that SIRS scores greater than or equal to three showed moderate performance for prediction of mortality (OR = 3.37, 95% CI: 1.05-10.73; sensitivity 60%, speci city 70%) (14). Other studies have challenged the value of qSOFA and SIRS criteria in predicting mortality and complications in the ED, even in sepsis patients [19,20].…”

“…Some studies have attempted to evaluate the e cacy of various tools for predicting risk of mortality in patients with in uenza infection. The predictive tools assessed in these studies consider systemic in ammatory response syndrome (SIRS), quick Sequential Organ Failure Assessment scores (qSOFA), and clinical parameters like sex, age, triage category and underlying comorbidities [10][11][12][13][14]. In a single-center, retrospective cohort study conducted in Taiwan, Chu et al reported that the area under the receiver operating characteristic curve (AUROC) of a qSOFA model for predicting in-hospital mortality in in uenza patients was 0.864 [12].…”