Abstract
ObjectiveIn hospitalized patients, the risk of sepsis-related mortality can be assessed using the quick Sepsis-related Organ Failure Assessment (qSOFA). Currently, different tools that predict deterioration such as the National Early Warning Score (NEWS) have been introduced in clinical practice in Emergency Departments (ED) worldwide. It remains ambiguous which screening tool for mortality at the ED is best. The objective of this study was to evaluate the predictive performance for mortality of two sepsis-based scores (i.e. qSOFA and Systemic Inflammatory Response Syndrome (SIRS)-criteria) compared to the more general NEWS score, in patients with suspected infection directly at presentation to the ED.MethodsWe performed a retrospective cohort study. Patients who presented to the ED between June 2012 and May 2016 with suspected sepsis in a large tertiary care center were included. Suspected sepsis was defined as initiation of intravenous antibiotics and/or collection of any culture in the ED. Outcome was defined as 10-day and 30-day mortality after ED presentation. Predictive performance was expressed as discrimination (AUC) and calibration using Hosmer-Lemeshow goodness-of-fit test. Subsequently, sensitivity, and specificity were calculated.ResultsIn total 8,204 patients were included of whom 286 (3.5%) died within ten days and 490 (6.0%) within 30 days after presentation. NEWS had the best performance, followed by qSOFA and SIRS (10-day AUC: 0.837, 0.744, 0.646, 30-day AUC: 0.779, 0.697, 0.631). qSOFA (≥2) lacked a high sensitivity versus SIRS (≥2) and NEWS (≥7) (28.5%, 77.2%, 68.0%), whilst entailing highest specificity versus NEWS and SIRS (93.7%, 66.5%, 37.6%).ConclusionsNEWS is more accurate in predicting 10- and 30-day mortality than qSOFA and SIRS in patients presenting to the ED with suspected sepsis.
Highlights
Sepsis is a syndrome characterised by both signs of infection and manifestations of a systemic host response [1]
National Early Warning Score (NEWS) is more accurate in predicting 10- and 30-day mortality than quick Sepsis-related Organ Failure Assessment (qSOFA) and Systemic Inflammatory Response Syndrome (SIRS) in patients presenting to the Emergency Departments (ED) with suspected sepsis
Sepsis is currently defined as a “life-threatening organ dysfunction caused by a dysregulated host response to infection”, in which organ dysfunction is represented by an increase of at least two points in the Sequential Organ Failure Assessment (SOFA) score [1]
Summary
Sepsis is a syndrome characterised by both signs of infection and manifestations of a systemic host response [1]. Sepsis is the primary cause of mortality from infection. The definition of sepsis has changed throughout the last decades. In February 2016 the Third International Consensus Definition for Sepsis (Sepsis-3) replaced the Sepsis-2 definition dating from 2001 [1,2,3]. Sepsis is currently defined as a “life-threatening organ dysfunction caused by a dysregulated host response to infection”, in which organ dysfunction is represented by an increase of at least two points in the Sequential Organ Failure Assessment (SOFA) score [1]. The Systemic Inflammatory Response Syndrome (SIRS) score, which was part of the definition in Sepsis-1 and -2, has been abandoned
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