Abstract
BackgroundSepsis is a global healthcare challenge and reliable tools are needed to identify patients and stratify their risk. Here we compare the prognostic accuracy of the sepsis-related organ failure assessment (SOFA), quick SOFA (qSOFA), systemic inflammatory response syndrome (SIRS), and national early warning system (NEWS) scores for hospital mortality and other outcomes amongst patients with suspected infection at an academic public hospital.Measurements and main results10,981 adult patients with suspected infection hospitalized at a U.S. academic public hospital between 2011–2017 were retrospectively identified. Primary exposures were the maximum SIRS, qSOFA, SOFA, and NEWS scores upon inclusion. Comparative prognostic accuracy for the primary outcome of hospital mortality was assessed using the area under the receiver operating characteristic curve (AUROC). Secondary outcomes included mortality in ICU versus non-ICU settings, ICU transfer, ICU length of stay (LOS) >3 days, and hospital LOS >7 days. Adjusted analyses were performed using a model of baseline risk for hospital mortality. 774 patients (7.1%) died in hospital. Discrimination for hospital mortality was highest for SOFA (AUROC 0.90 [95% CI, 0.89–0.91]), followed by NEWS (AUROC 0.85 [95% CI, 0.84–0.86]), qSOFA (AUROC 0.84 [95% CI, 0.83–0.85]), and SIRS (AUROC 0.79 [95% CI, 0.78–0.81]; p<0.001 for all comparisons). NEWS (AUROC 0.94 [95% CI, 0.93–0.95]) outperformed other scores in predicting ICU transfer (qSOFA AUROC 0.89 [95% CI, 0.87–0.91]; SOFA AUROC, 0.84 [95% CI, 0.82–0.87]; SIRS AUROC 0.81 [95% CI, 0.79–0.83]; p<0.001 for all comparisons). NEWS (AUROC 0.86 [95% CI, 0.85–0.86]) was also superior to other scores in predicting ICU LOS >3 days (SOFA AUROC 0.84 [95% CI, 0.83–0.85; qSOFA AUROC, 0.83 [95% CI, 0.83–0.84]; SIRS AUROC, 0.75 [95% CI, 0.74–0.76]; p<0.002 for all comparisons).ConclusionsMultivariate prediction scores, such as SOFA and NEWS, had greater prognostic accuracy than qSOFA or SIRS for hospital mortality, ICU transfer, and ICU length of stay. Complex sepsis scores may offer enhanced prognostic performance as compared to simple sepsis scores in inpatient hospital settings where more complex scores can be readily calculated.
Highlights
Sepsis is a major healthcare challenge in the United States and globally, and is associated with profound mortality, morbidity, and healthcare costs [1,2,3,4,5,6,7]
Discrimination for hospital mortality was highest for sepsis-related organ failure assessment (SOFA) (AUROC 0.90 [95% confidence interval (CI), 0.89–0.91]), followed by national early warning score (NEWS) (AUROC 0.85 [95% CI, 0.84–0.86]), quick sepsis-related organ failure assessment (qSOFA) (AUROC 0.84 [95% CI, 0.83–0.85]), and systemic inflammatory response syndrome (SIRS) (AUROC 0.79 [95% CI, 0.78–0.81]; p
A recent meta-analysis comparing the qSOFA score with SIRS criteria concluded that the qSOFA score was more predictive of hospital mortality but SIRS was superior for sepsis diagnosis [22]
Summary
Sepsis is a major healthcare challenge in the United States and globally, and is associated with profound mortality, morbidity, and healthcare costs [1,2,3,4,5,6,7]. Internal and external validation studies have demonstrated the superiority of the qSOFA and SOFA scores for the identification and mortality prognostication of sepsis patients, when compared to the systemic inflammatory response syndrome (SIRS) criteria [10, 12,13,14,15]. While the Sepsis-3 authors initially proposed the qSOFA and SOFA scores as tools to identify patients with organ dysfunction among those with suspected infection, there is widespread interest in using these and other scores in prognosticating patient outcomes secondary to sepsis [16,17,18,19,20,21]. We compare the prognostic accuracy of the sepsis-related organ failure assessment (SOFA), quick SOFA (qSOFA), systemic inflammatory response syndrome (SIRS), and national early warning system (NEWS) scores for hospital mortality and other outcomes amongst patients with suspected infection at an academic public hospital. NEWS (AUROC 0.94 [95% CI, 0.93–0.95]) outperformed other scores in predicting ICU transfer
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
