Validation of prognostic accuracy of the SOFA score, SIRS criteria, and qSOFA score for in‐hospital mortality among cardiac‐, thoracic‐, and vascular‐surgery patients admitted to a cardiothoracic intensive care unit

Abstract

Sepsis-3 Definition: Sepsis is defined as life-threatening organ dysfunction due to a dysregulated host response to infection. The clinical criteria of sepsis include organ dysfunction, which is defined as an increase of two points or more on the sequential organ failure assessment (SOFA). For patients with infection, an increase of 2 SOFA points yields an overall mortality rate of 10%. Patients with suspected infection who are likely to have a prolonged intensive care unit (ICU) stay or to have in-hospital mortality can be promptly identified at the bedside with a quick SOFA (qSOFA) score of 2 or higher.Importance: The sepsis-3 criteria have emphasized the value of a change of two or more points on the SOFA, introduced the qSOFA, and removed the systemic inflammatory response syndrome (SIRS) criteria from the sepsis definition.Objective: To externally validate and assess the discriminatory capacities of an increase in the SOFA score by two or more points, the presence of two or more SIRS criteria, or a qSOFA score of 2 or more points for outcomes in 5109 patients, the vast majority of whom were postcardiac surgery patients who were admitted to a Cardiothoracic Surgical ICU in Singapore.Design, Setting, and Participants: A retrospective cohort analysis of 5109 patients with an infection-related primary admission diagnosis in the cardiothoracic intensive care unit (CTICU) at the National University Hospital (NUH) in Singapore from 2010 to 2016. Exposures:The SOFA, qSOFA, and SIRS criteria were applied to the data representing the worst condition within 24 hours of ICU admission.Main Outcomes and Measures: The primary outcome was in-hospital mortality.Discrimination was assessed using the area under the receiver operating characteristic curve (AUROC).Results: In 5109 patients, the average mortality of patients with an increase in the SOFA scores of less than 2 points was 3.5% (n = 64), and it was 6% (n = 199

Comparison of qSOFA score, SOFA score, and SIRS criteria for the prediction of infection and mortality among surgical intermediate and intensive care patients

“…Furthermore, a meta-analysis of 229,480 patients compared the qSOFA score and SIRS criteria for their ability to predict patient mortality and revealed only a slightly better performance of the qSOFA score, which supports the findings of our study [22]. However, some studies revealed a high power for the prediction of mortality: Kovach et al analyzed hospital mortality in a retrospective data set of 3749 surgical and medical ICU patients with suspected infection, while Zhang et al investigated retrospectively 5109 cardiac surgical patients, with both studies resulting in AUCROC > 0.8 for the prediction of mortality by using the SOFA and qSOFA scores [21,23]. However, it must be highlighted that, contrary to our approach, the patients of Kovach's study were adjusted for a baseline risk factor for death, which increased the predictive quality of the SOFA score, while Zhang et al only included cardiac surgical patients, which are hardly comparable with the sources of systemic inflammation in our study.…”

Comparison of qSOFA score, SOFA score, and SIRS criteria for the prediction of infection and mortality among surgical intermediate and intensive care patients

“…Furthermore, a meta-analysis of 229,480 patients compared the qSOFA score and SIRS criteria for their ability to predict patient mortality, and revealed only a slightly better performance of the qSOFA score, which supports the ndings of our study [23]. However, some studies revealed a high power for the prediction of mortality: Kovach et al analyzed hospital mortality in a retrospective data set of 3,749 surgical and medical ICU patients with suspected infection, while Zhang et al investigated retrospectively 5,109 cardiac surgical patients, with both studies resulting in AUCROC > 0.8 for the prediction of mortality by using the SOFA and qSOFA scores [22,24]. However, it must be highlighted that, contrary to our approach, the patients of Kovach´s study were adjusted for a baseline risk factor for death, which increased the predictive quality of the SOFA score, while Zhang et al only included cardiac surgical patients, which are hardly comparable with the sources of systemic in ammation in our study.…”

Comparison of qSOFA score, SOFA Score, and SIRS Criteria for the Prediction of Infection and Mortality Among Surgical Intermediate and Intensive Care Patients

“…Furthermore, a meta-analysis of 229,480 patients compared the qSOFA score and SIRS criteria for their ability to predict patient mortality, and revealed only a slightly better performance of the qSOFA score, which supports the ndings of our study [23]. However, some studies revealed a high power for the prediction of mortality: Kovach et al analyzed hospital mortality in a retrospective data set of 3,749 surgical and medical ICU patients with suspected infection, while Zhang et al investigated retrospectively 5,109 cardiac surgical patients, with both studies resulting in AUCROC > 0.8 for the prediction of mortality by using the SOFA and qSOFA scores [22,24].…”