Prognostic Value of Severity Score Change for Septic Shock in the Emergency Room.

Tae Sik Hwang,Ha Young Park,Young Sook Park,Hyun Woo Park

doi:10.3390/diagnostics10100743

Abstract

The vital signs or laboratory test results of sepsis patients may change before clinical deterioration. This study examined the differences in prognostic performance when systemic inflammatory response syndrome (SIRS), Sequential Organ Failure Assessment (SOFA), quick SOFA (qSOFA) scores, National Early Warning Score (NEWS), and lactate levels were repeatedly measured. Scores were obtained at arrival to triage, 1 h after fluid resuscitation, 1 h after vasopressor prescription, and before leaving the emergency room (ER) in 165 patients with septic shock. The relationships between score changes and in-hospital mortality, mechanical ventilation, admission to the intensive care unit, and mortality within seven days were compared using areas under receiver operating characteristic curve (AUROCs). Scores measured before leaving the ER had the highest AUROCs across all variables (SIRS score 0.827 [0.737–0.917], qSOFA score 0.754 [0.627–0.838], NEWS 0.888 [0.826–0.950], SOFA score 0.835 [0.766–0.904], and lactate 0.872 [0.805–0.939]). When combined, SIRS + lactate (0.882 [0.804–0.960]), qSOFA + lactate (0.872 [0.808–0.935]), NEWS + lactate (0.909 [0.855–0.963]), and SOFA + lactate (0.885 [0.832–0.939]) showed improved AUROCs. In patients with septic shock, scoring systems show better predictive performances at the timepoints reflecting changes in vital signs and laboratory test results than at the time of arrival, and combining them with lactate values increases their predictive powers.

Highlights

Sepsis accounts for about 30–50% of in-hospital deaths and often does not present with serious symptoms at the time of visit; 55.9% of cases involve normal blood pressure (BP) and lactate levels under 4 mmol/L [1]
Scoring systems have been created for their own goal, and emergency room (ER) doctors use scoring systems to assess disease severity and predict prognosis in patients suspected of having infections or septicemia [5]
This emergency center is a secondary medical institution visited by 60,000 patients a year, with eight emergency medical specialists and four emergency medical residents working in shifts 24 h a day, and the treatment for septic shock patients is based on early goal-directed therapy

Summary

Introduction

Sepsis accounts for about 30–50% of in-hospital deaths and often does not present with serious symptoms at the time of visit; 55.9% of cases involve normal blood pressure (BP) and lactate levels under 4 mmol/L [1]. The condition of sepsis patients may deteriorate rapidly or unexpected cardiac arrest may occur, early signs indicating the risk of deterioration do appear, which can be captured through routinely measured clinical data, such as vital signs or laboratory test results [2,3,4]. Sepsis was previously identified and defined using the systemic inflammatory response syndrome (SIRS) criteria, though this definition was limited by its poor specificity [7,8]. SIRS was not developed as an early warning score but was designed to screen for and define sepsis, and SIRS criteria include parameters that are known to have limited predictive power for clinical deterioration [9].

Methods

Results

Discussion

Conclusion