Abstract
BackgroundThe quick sequential organ failure assessment (qSOFA) alone has a poor sensitivity for predicting mortality in patients with complicated intra-abdominal infections, and plasma lactate levels have been shown to have a strong association with mortality in critically ill patients. Therefore, this study aimed to compare the performance of qSOFA with a score derived from a combination of qSOFA and serum lactate levels for predicting mortality in surgical patients with complicated intra-abdominal infections.MethodsThis retrospective study was performed at a university hospital. The medical records of 457 patients who presented to the emergency department (ED) between January 2008 and December 2016 and required emergency gastrointestinal surgery for a complicated intra-abdominal infection were reviewed retrospectively. qSOFA criteria, sequential organ failure assessment (SOFA) scores, and plasma lactate levels during their ED stay were collected. We performed area under receiver operating characteristic (AUROC) curve and sensitivity analysis to compare the performance of qSOFA alone with that of a score derived from the use of a combination of the qSOFA and lactate levels for predicting patient mortality.ResultsFifty patients (10.9%) died during hospitalization. The combined qSOFA and lactate level score was superior to qSOFA alone (AUROC = 0.754 vs. 0.717, p = 0.039, respectively) and comparable to the full SOFA score (AUROC = 0.754 vs. 0.795, p = 0.127, respectively) in predicting mortality. Sensitivity and specificity of qSOFA alone were 46 and 86%, respectively, and those of the combined score were 72 and 73%, respectively (p < 0.001).ConclusionA score derived from the qSOFA and serum lactate levels had better predictive performance with higher sensitivity than the qSOFA alone in predicting mortality in patients with complicated intra-abdominal infections and had a comparable predictive performance to that of the full SOFA score.
Highlights
The quick sequential organ failure assessment alone has a poor sensitivity for predicting mortality in patients with complicated intra-abdominal infections, and plasma lactate levels have been shown to have a strong association with mortality in critically ill patients
Study population We retrospectively reviewed the medical records of 1226 adult patients who underwent emergency gastrointestinal surgery for a complicated intra-abdominal infection from January 2008 to December 2016
The quick sequential organ failure assessment (qSOFA) score showed a better predictive performance compared to systemic inflammatory response syndrome (SIRS) criteria, but this difference was not statistically significant (AUROC = 0.717, 95% confidence intervals (CI) = 0.673–0.758 vs. area under receiver operating characteristic (AUROC) = 0.672, 95% CI = 0.599– 0.745; p = 0.325)
Summary
The quick sequential organ failure assessment (qSOFA) alone has a poor sensitivity for predicting mortality in patients with complicated intra-abdominal infections, and plasma lactate levels have been shown to have a strong association with mortality in critically ill patients. Owing to advances in our understanding of the pathophysiology of sepsis, a 2016 consensus conference redefined sepsis as “life-threatening organ dysfunction caused by a dysregulated host response to infection” [4]. Based on this new definition, sepsis is diagnosed when a ≥ 2-point change occurs in the sequential organ failure assessment (SOFA) score because of an infection. Others have questioned its utility as a quick screening tool due to its poor sensitivity [8,9,10]
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