Abstract
Prognostic accuracy of the quick sequential organ failure assessment (qSOFA) score for mortality may be limited in elderly patients. Using our multi-institutional database, we classified obstructive acute pyelonephritis (OAPN) patients into young and elderly groups, and evaluated predictive performance of the qSOFA score for in-hospital mortality. qSOFA score ≥ 2 was an independent predictor for in-hospital mortality, as was higher age, and Charlson comorbidity index (CCI) ≥ 2. In young patients, the area under the curve (AUC) of the qSOFA score for in-hospital mortality was 0.85, whereas it was 0.61 in elderly patients. The sensitivity and specificity of qSOFA score ≥ 2 for in-hospital mortality was 80% and 80% in young patients, and 50% and 68% in elderly patients, respectively. For elderly patients, we developed the CCI-incorporated qSOFA score, which showed higher prognostic accuracy compared with the qSOFA score (AUC, 0.66 vs. 0.61, p < 0.001). Therefore, the prognostic accuracy of the qSOFA score for in-hospital mortality was high in young OAPN patients, but modest in elderly patients. Although it can work as a screening tool to determine therapeutic management in young patients, for elderly patients, the presence of comorbidities should be considered at the initial assessment.
Highlights
Sepsis is a life-threatening condition with a higher mortality rate compared with stroke or acute coronary syndrome [1]
The area under the curve (AUC) of the quick sequential organ failure assessment (qSOFA) score was 0.61, which was statistically similar to that of the systemic inflammatory response syndrome (SIRS) score
Analogous findings were obtained for the composite of intensive care unit (ICU) admission and/or in-hospital mortality; the qSOFA score (AUC, 0.88, 95% CI, 0.83–0.93) had significantly better prognostic accuracy than the SIRS score (AUC, 0.63, 95% CI, 0.53–0.73) in young patients (p < 0.001, Figure S2B), whereas no significant difference was observed between them in elderly patients (AUC of the qSOFA score, 0.73, 95% CI, 0.65–0.80, AUC of the SIRS score, 0.65, 95% CI, 0.57–0.74, p = 0.10, Figure S2C)
Summary
Sepsis is a life-threatening condition with a higher mortality rate compared with stroke or acute coronary syndrome [1]. The definition of sepsis based on a combination of the systemic inflammatory response syndrome (SIRS) score and infection had been used since 1991 [2], the Sepsis-3 Task Force updated its definition as “life threatening organ dysfunction caused by a dysregulated host response to infection” in 2016 [3]. In this new definition, organ dysfunction was defined by the sequential organ failure assessment (SOFA) score, in which six organ systems (hepatic, renal, central nervous, coagulation, cardiovascular, and respiratory) are assessed [3]. Its role as an initial screening tool remains uncertain, because several studies reported its low prognostic accuracy [6,7,8]
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