The Prognostic Value of N-Terminal pro-Brain Natriuretic Peptide (NT-proBNP) in Major Burn Patients With Sepsis.

To investigate the predictive value of heparin binding protein (HBP) for sepsis. From June 2019 to December 2020, 188 patients admitted to the department of emergency of Hunan Provincial People's Hospital were enrolled. The patients were divided into non-sepsis group (87 patients) and sepsis group (101 patients) according to Sepsis-3 criteria. Gender, age, white blood cell count (WBC), C-reactive protein (CRP), procalcitonin (PCT), HBP, sequential organ failure assessment (SOFA) score, quick SOFA (qSOFA) score, modified early warning score (MEWS) and patients' recent medication history were recorded, the differences in the above indicators between the two groups were compared. The risk factors of sepsis were analyzed by Logistic regression. Spearman correlation analysis was used to analyze the correlation between HBP, PCT, CRP and SOFA score to evaluate the predictive value of HBP, PCT and CRP for the severity of septic organ failure. Receiver operating characteristic curve (ROC curve) were drawn to evaluate the diagnostic value of HBP, PCT and CRP for sepsis. Compared with the non-sepsis group, the sepsis group had significantly higher levels of HBP, PCT, CRP, WBC, SOFA score, qSOFA score, and MEWS [HBP (μg/L): 55.46 (24.57, 78.49) vs. 5.90 (5.90, 9.01), PCT (μg/L): 6.83 (1.75, 30.64) vs. 0.23 (0.12, 0.75), CRP (mg/L): 67.35 (26.23, 123.23) vs. 4.45 (2.62, 47.22), WBC (×109/L): 11.84 (7.18, 16.06) vs. 6.58 (5.47, 8.99), SOFA score: 6 (4, 8) vs. 0 (0, 0), qSOFA score: 2 (1, 3) vs. 0 (0, 1), MEWS: 4 (3, 6) vs. 1 (0, 2)], the length of hospital stay was significantly prolonged [days: 10 (4, 17) vs. 0 (0, 7)], and the mortality was significantly increased [29.7% (30/101) vs. 4.6% (4/87)], with statistical significance (all P < 0.05). Correlation analysis showed that HBP, PCT and CRP were significantly positively correlated with SOFA score (r values were 0.60, 0.33, and 0.38, respectively, all P < 0.01), among which HBP had the strongest correlation, CRP was the second, and PCT was the weakest. Logistic regression analysis showed that HBP, PCT and CRP levels were independent risk factors for sepsis [odds ratio (OR) were 1.015, 1.094, 1.067, 95% confidence intervals (95%CI) were 1.007-1.022, 1.041-1.150, 1.043-1.093, all P < 0.01]. ROC curve analysis showed that HBP, PCT and CRP all had some diagnostic value for sepsis [the area under ROC curve (AUC) were 0.92, 0.87, 0.80, 95%CI were 0.88-0.97, 0.82-0.92, 0.74-0.87, respectively, all P < 0.01]. Among them, the diagnostic efficacy of HBP was higher when the cut-off value was ≥ 15.11 μg/L, its sensitivity and specificity were 86.14% and 89.66%, respectively, which were higher than the sensitivity (81.19%) and specificity (80.46%) when the PCT cut-off value was ≥ 1.17 μg/L. However, CRP had the best sensitivity of 94.06% for the diagnosis of sepsis but lacked of specificity (63.22%). HBP can be used as a biological indicator for predicting sepsis and can assess the severity of organ failure in septic patients.

The sequential organ failure assessment (SOFA) and quick sequential organ failure assessment (qSOFA) scores are new tools which are used to assess sepsis based on the Third International Consensus Definitions for Sepsis and Septic Shock Task Force. This study aimed to evaluate the feasibility of using the SOFA and qSOFA to predict post-ureteroscopic lithotripsy (URSL) sepsis. Patients who underwent URSL due to ureteral stone obstruction were retrospectively reviewed using SOFA and qSOFA scores. Patient characteristics including age, gender, comorbidities, American Society of Anesthesiologists Classification, stone burden, stone location, hydronephrosis status, infectious status, preoperative SOFA and qSOFA score were collected. Preoperative factors were analyzed to determine if they were correlated with postoperative sepsis. A total of 830 patients were included in this study, of whom 32 (3.9%) had postoperative sepsis. Multivariate analysis revealed that older age, proximal ureteral stones, severe hydronephrosis, and high preoperative qSOFA or SOFA score were significantly associated with postoperative sepsis. The areas under the curves of a qSOFA score ≥ 1 and SOFA score ≥ 2 for predicting postoperative sepsis were 0.754 and 0.823, respectively. Preoperative qSOFA and SOFA scores are convenient and effective for predicting post-URSL sepsis. Further preventive strategies should be performed in these high-risk patients.

To study the predicting value of four different scoring systems such as the acute physiology and chronic health evaluation II (APACHE II) score, sequential organ failure assessment (SOFA) score, quick SOFA (qSOFA) score and systemic inflammatory response syndrome (SIRS) score for the prognosis of septic patients. A retrospective analysis were conducted. Septic patients in intensive care unit (ICU) of the First People's Hospital of Chenzhou form July 1st, 2012 to June 30th, 2016 were enrolled. Patients were divided into survival group and death group according to 28-day outcome. The difference of clinic data, the worst clinical index value within 24 hours, whether mechanical ventilation performed on first day, length of stay in ICU, APACHE II score, SOFA score, qSOFA score and SIRS score were compared between the two groups. The significant different factors of sepsis outcome in univariate analysis were analyzed by multiple logistic regression, and the ability of four scoring systems was tested by receiver operating characteristic (ROC) curve. 311 patients were enrolled in this study (221 survivals, 90 deaths, 28-day mortality rate 28.9%). Univariate analysis showed age, mechanical ventilation ratio, urine output, length of stay in ICU and the fastest heart beat rate (HR), the lowest systolic blood pressure (SBP), the lowest mean arterial pressure (MAP), HCO3-, minimum arterial blood oxygen partial pressure (PaO2), minimum oxygenation index (PaO2/FiO2), the maximum fraction of inspired oxygen (FiO2), Na+, the highest concentration of blood urea nitrogen (BUN), the highest concentration of serum creatinine (SCr), minimum concentration of plasma albumin (Alb), Glasgow coma score (GCS) score, APACHE II score, SOFA score, qSOFA score, within 24 hours after diagnosis were significantly different between two groups (all P < 0.05). Multiple logistic regression showed age [odds ratio (OR) = 1.388, 95% confidence interval (95%CI) = 1.074-1.794, P = 0.012], PaO2/FiO2 (OR = 0.459, 95%CI = 0.259-0.812, P = 0.007), concentration of plasma Alb (OR = 0.523, 95%CI = 0.303-0.903, P = 0.020), GCS score (OR = 0.541, 95%CI = 0.303-0.967, P = 0.038) and SOFA scores (OR = 3.189, 95%CI = 1.813-5.610, P = 0.000) were independent risk factors for sepsis outcome. ROC curve test showed the APACHE II score, SOFA score and qSOFA score had the ability to predict the outcome in critical ill patients with sepsis, the SOFA score of the most powerful, the area under the ROC curve (AUC) was 0.700, when the cut-off value was 7.5 points, the sensitivity was 73.3% and specificity was 58.8%. APACHE II score, SOFA score and qSOFA score have the predictive properties for septic patients. SOFA score is an independent prognostic risk factor of sepsis, while qSOFA score can be widely used in clinical practice as the advantage of quick evaluating.

Comparison of qSOFA and SOFA score for predicting mortality in severe sepsis and septic shock patients in the emergency department of a low middle income country

BackgroundIt is crucial to rapidly identify sepsis so that adequate treatment may be initiated. Accordingly, the Sequential Organ Failure Assessment (SOFA) and the quick SOFA (qSOFA) scores are used to evaluate intensive care unit (ICU) and non-ICU patients, respectively. As demand for ICU beds rises, the intermediate care unit (IMCU) carries greater importance as a bridge between the ICU and the regular ward. This study aimed to examine the ability of SOFA and qSOFA scores to predict suspected infection and mortality in IMCU patients.MethodsRetrospective data analysis included 13,780 surgical patients treated at the IMCU, ICU, or both between January 01, 2012, and September 30, 2018. Patients were screened for suspected infection (i.e., the commencement of broad-spectrum antibiotics) and then evaluated for the SOFA score, qSOFA score, and the 1992 defined systemic inflammatory response syndrome (SIRS) criteria.ResultsSuspected infection was detected in 1306 (18.3%) of IMCU, 1365 (35.5%) of ICU, and 1734 (62.0%) of IMCU/ICU encounters. Overall, 458 (3.3%) patients died (IMCU 45 [0.6%]; ICU 250 [6.5%]; IMCU/ICU 163 [5.8%]). All investigated scores failed to predict suspected infection independently of the analyzed subgroup. Regarding mortality prediction, the qSOFA score performed sufficiently within the IMCU cohort (AUCROC SIRS 0.72 [0.71–0.72]; SOFA 0.52 [0.51–0.53]; qSOFA 0.82 [0.79–0.84]), while the SOFA score was predictive in patients of the IMCU/ICU cohort (AUCROC SIRS 0.54 [0.53–0.54]; SOFA 0.73 [0.70–0.77]; qSOFA 0.59 [0.58–0.59]).ConclusionsNone of the assessed scores was sufficiently able to predict suspected infection in surgical ICU or IMCU patients. While the qSOFA score is appropriate for mortality prediction in IMCU patients, SOFA score prediction quality is increased in critically ill patients.

To explore the value of plasma histones in predicting the prognosis of sepsis patients. The patients with sepsis admitted to intensive care unit (ICU) of Subei People's Hospital of Jiangsu Province Affiliated to Yangzhou University from May 2016 to June 2018 were enrolled as the research subjects, and healthy volunteers were selected as healthy control at the same period. The plasma levels of histones, cardiac troponin I (cTnI), N-terminal pro-brain natriuretic peptide (NT-proBNP), sequential organ failure assessment (SOFA) score, lactate (Lac), procalcitonin (PCT) on admission 24 hours, and use of vasoconstrictor agents, the length of ICU stay and ICU mortality were recorded. The patients were divided into survival group and death group according to the prognosis, and the differences of each index between the two groups were compared. Multivariate binary Logistic regression analysis was carried out to identify the independent risk factors of death. The correlation between histone and the levels of cTnI, NT-proBNP, PCT and Lac was analyzed. The value of plasma histone, cTnI, NT-proBNP, PCT and Lac in predicting the prognosis of patients was analyzed by receiver operating characteristic (ROC) curve. According to the threshold value of histone in predicting prognosis, the patients were divided into two groups, and the differences of various indicators between the two groups were compared. (1) A total of 93 sepsis patients were included, with 29 cases of ICU death, and the mortality was 31.2%. (2) Compared with the healthy control group, histones, cTnI, NT-proBNP were significant increased, besides, histones, cTnI in the death group were further increased compared with the survival group; in addition, SOFA, proportion of vasoconstrictor use were also significant higher than those in the survival group [histones (mg/L): 0.33 (0.28,0.45) vs. 0.22 (0.17,0.29), cTnI (μg/L): 0.25±0.13 vs. 0.20±0.08, SOFA: 11 (8, 12) vs. 9 (8, 11), the rate of vasopressor use: 93.1% (27/29) vs. 68.8% (44/64), all P < 0.05]. Statistically significant indicators between the two groups were included in multivariate binary Logistic regression analysis. The result showed that the independent risk factors affecting the prognosis of patients were the rate of vasopressor use [odds ratio (OR) = 5.277, P = 0.043] and the level of histone (OR = 79.244, P = 0.036). (3) The plasma histone level were positively correlated with cTnI (r = 0.577, P = 0.000), SOFA (r = 0.469, P = 0.000), NT-proBNP (r = 0.349, P = 0.001) and Lac (r = 0.357, P = 0.000), while there was no significant correlation between histone and PCT (r = 0.133, P = 0.205). (4) ROC curve analysis showed that the area under ROC curve (AUC) of histone predicting prognosis was 0.769 (P = 0.000); when the cut-off point was 0.30 mg/L, the sensitivity and specificity were 72.4% and 81.2% respectively. The AUC of SOFA score was 0.653 (P = 0.018), and the sensitivity and specificity were 58.6% and 70.3% respectively when the cut-off point was 10.50; while cTnI, NT-proBNP, Lac and PCT had little value in predicting the prognosis of patients. (5) Compared with the group with histone level lower than 0.3 mg/L, the group with histones level greater than 0.3 mg/L had higher SOFA score, more doses of vasopressor, higher cTnI, NT-proBNP, Lac and PCT levels, and higher ICU mortality [SOFA: 11 (10, 12) vs. 9 (8, 10), use of vasopressor: 84.8% (28/33) vs. 76.7% (46/60), cTnI (μg/L): 0.28 (0.19, 0.32) vs. 0.18 (0.12, 0.22), NT-proBNP (ng/L): 3 624.0 (2 800.0, 5 260.0) vs. 2 512.0 (1 361.8, 3 590.8), Lac (mmol/L): 2.25 (1.85, 3.50) vs. 1.60 (1.25, 2.35), PCT (μg/L): 2.10 (1.30, 4.03) vs. 1.60 (1.26, 2.33), ICU mortality: 48.5% (16/33) vs. 21.7% (13/60), all P < 0.05], while no statistical difference in the length of ICU stay was found. The independent risk factors for ICU mortality of sepsis patients were high histone level and the use of vasopressor. Plasma histone can be regarded as an indicator in predicting the prognosis of patients with sepsis.

Sepsis continues to carry a high rate of mortality, which makes effective and simple evaluation methods for predicting the prognosis of septic patients especially important. In this study, we retrospectively analyzed the relationships between three scoring systems including Sequential Organ Failure Assessment (SOFA) score, Quick SOFA (qSOFA) score, and Logistic Organ Dysfunction System (LODS) score and the prognoses of septic patients. The baseline data, SOFA score, qSOFA score, LODS score, 28-day prognosis, and 90-day prognosis of patients who met the diagnostic criteria of sepsis were retrieved from the Medical Information Mart for Intensive Care III (MIMIC-III) database. Receiver operating characteristic (ROC) curves were drawn for various indicators, and comparisons were drawn between the areas under the ROC curves (AUC) of the different scoring systems. The 28-day AUC was 0.661 (0.652, 0.670) for SOFA, 0.558 (0.548, 0.568) for qSOFA, and 0.668 (0.658, 0.677) for LODS; AUC-qSOFA vs. AUC-LODS was 0.103 (0.087, 0.120) (P<0.001), and AUC-qSOFA vs. AUC-LODS was 0.110 (0.094, 0.125) (P<0.001). The 90-day AUC was 0.630 (0.621, 0.640) for SOFA, 0.551 (0.541, 0.560) for qSOFA, and 0.644 (0.635, 0.653) for LODS; AUC-SOFA vs. AUC-qSOFA was 0.079 (0.065, 0.094) (P<0.001), and AUC-qSOFA vs. AUC-LODS was 0.093 (0.079, 0.107) (P<0.001). SOFA score, qSOFA score, and LODS score can all be used to predict the prognosis of septic patients. LODS score and SOFA score have higher accuracy than qSOFA score; however, qSOFA is simpler to use, making it a more suitable tool in an emergency setting.

Sepsis is a major cause of death in hospitalised patients worldwide. Most studies for assessing outcomes in sepsis are from the western literature. Sparse data from Indian settings are available comparing the systemic inflammatory response syndrome (SIRS), Sequential Organ Failure Assessment (SOFA) and quick SOFA (qSOFA) (sepsis 3 criteria) for assessing outcomes in sepsis. In this study, we aimed to compare the SIRS criteria and sepsis 3 criteria to assess disease outcome at day 28 (recovery/mortality) in a North Indian tertiary care teaching hospital. A prospective observational study was performed in the Department of Medicine from 2019 to early 2020. Patients admitted to the medical emergency with clinical suspicion of sepsis were included. Systemic inflammatory response syndrome, qSOFA and SOFA scores were calculated at the time of presentation to the hospital. Patients were followed through the course of their hospital stay. Out of 149 patients, 139 were included in the analysis. Patients who died had significantly higher mean SOFA, qSOFA scores and mean change in SOFA score than patients who survived (P value <0.01). There was no statistical difference between recovery and deaths at similar SIRS scores. A 40.30% fatality rate was recorded. Systemic inflammatory response syndrome had low Area Under Curve (AUC) (0.47) with low sensitivity (76.8) and specificity (21.7). SOFA had the maximum AUC (0.68) compared to qSOFA (0.63) and SIRS (0.47). SOFA also had the maximum sensitivity (98.1) while the qSOFA score had the maximum specificity (84.3). SOFA and qSOFA scores had superior predictive ability as compared to the SIRS score in assessing mortality in sepsis patients.

The third Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) defined sepsis as an organ dysfunction consequent to infection. A Sequential Organ Failure Assessment (SOFA) score at least 2 identifies sepsis. In this study, procalcitonin (PCT) and midregional pro-adrenomedullin (MR-proADM) were evaluated along with SOFA and quick SOFA (qSOFA) scores in patients with sepsis or septic shock. A total of 109 septic patients and 50 patients with noninfectious disease admitted at the Department of Internal Medicine and General Surgery of the University Hospital Campus Bio-Medico of Rome were enrolled. PCT and MR-proADM were measured with immunoluminometric assays (Brahms, Hennigsdorf, Germany). Data were analyzed with receiver-operating characteristic (ROC) curve analysis, likelihood ratios, and Mann-Whitney U test using MedCalc 11.6.1.0 package. At ROC curve analysis, PCT showed the highest area under the curve and positive likelihood ratio values of 27.42 in sepsis and 43.62 in septic shock. MR-proADM and SOFA score showed a comparable performance. In septic shock, lactate showed the most accurate diagnostic ability. In sepsis, the best combination was PCT with MR-proADM with a posttest probability of 0.988. Based upon these results, an algorithm for sepsis and septic shock diagnosis has been developed. MR-proADM, SOFA, and qSOFA scores significantly discriminated survivors from nonsurvivors. PCT and MR-proADM test combination represent a good tool in sepsis diagnosis and prognosis suggesting their inclusion in the diagnostic algorithm besides SOFA and qSOFA scores. Furthermore, MR-proADM as marker of organ dysfunction, with a turn around time of about 30 min, has the advantage to be more objective and rapid than SOFA score.

Non-utility of sepsis scores for identifying infection in surgical intensive care unit patients

BackgroundHospital-acquired pneumonia (HAP) is the most common hospital-acquired infection in China with substantial morbidity and mortality. But no specific risk assessment model has been well validated in patients with HAP. The aim of this study was to investigate the published risk assessment models that could potentially be used to predict 30-day mortality in HAP patients in non-surgical departments.MethodsThis study was a single-center, retrospective study. In total, 223 patients diagnosed with HAP from 2012 to 2017 were included in this study. Clinical and laboratory data during the initial 24 hours after HAP diagnosis were collected to calculate the pneumonia severity index (PSI); consciousness, urea nitrogen, respiratory rate, blood pressure, and age ≥65 years (CURB-65); Acute Physiology and Chronic Health Evaluation II (APACHE II); Sequential Organ Failure Assessment (SOFA); and Quick Sequential Organ Failure Assessment (qSOFA) scores. The discriminatory power was tested by constructing receiver operating characteristic (ROC) curves, and the areas under the curve (AUCs) were calculated.ResultsThe all-cause 30-day mortality rate was 18.4% (41/223). The PSI, CURB-65, SOFA, APACHE II, and qSOFA scores were significantly higher in non-survivors than in survivors (all P < 0.001). The discriminatory abilities of the APACHE II and SOFA scores were better than those of the CURB-65 and qSOFA scores (ROC AUC: APACHE II vs. CURB-65, 0.863 vs. 0.744, Z = 3.055, P = 0.002; APACHE II vs. qSOFA, 0.863 vs. 0.767, Z = 3.017, P = 0.003; SOFA vs. CURB-65, 0.856 vs. 0.744, Z = 2.589, P = 0.010; SOFA vs. qSOFA, 0.856 vs. 0.767, Z = 2.170, P = 0.030). The cut-off values we defined for the SOFA, APACHE II, and qSOFA scores were 4, 14, and 1.ConclusionsThese results suggest that the APACHE II and SOFA scores determined during the initial 24 h after HAP diagnosis may be useful for the prediction of 30-day mortality in HAP patients in non-surgical departments. The qSOFA score may be a simple tool that can be used to quickly identify severe infections.

HIV-associated talaromycosis (HAT) is a severe fungal infection for which established severity assessment methods are lacking. The Sequential Organ Failure Assessment (SOFA) and quick SOFA (qSOFA) scores were evaluated in 464 patients with HAT to assess their associations with inflammatory markers, hospital stay, and 30-day mortality. SOFA scores were negatively correlated with blood culture positivity time (r = -0.470, P < 0.001) and positively correlated with IL-6, IL-10, and CRP (all P < 0.001). Patients with fungemia had higher SOFA scores (2.3 ± 2.4 vs. 1.2 ± 0.6, P < 0.001). Mortality increased with qSOFA scores: 8.9% (score 0), 16.5% (score 1), and 55.0% (score ≥2; P < 0.001). For SOFA, mortality was 4.5% (scores 0-1), 6.8% (2-3), 22.0% (4-5), 52.2% (6-7), and 85.7% (≥8; P < 0.001), repectively. Survivors' SOFA scores improved by day 7 (1.6 ± 1.6 to 1.0 ± 1.4, P < 0.001), while non-survivors worsened by day 7 (4.8 ± 3.4 to 5.1 ± 5.6, P = 0.027) compared to day 0. Among the surviving patients, the hospital stay days were 21.0 (14.0-27.0) for scores 0-1, 22.0 (16.0-29.0) for scores 2-3, 27.0 (20.3-43.5) for scores 4-6 and 29.0 (5.5-38.0) for scores ≥6 (P = 0.005). Multivariate analysis identified qSOFA [adjusted odds ratio (AOR):1.564, P = 0.018], SOFA [AOR:1.533, P = 0.001], and non-amphotericin B deoxycholate (non-AmBd) therapy [AOR:2.732, P = 0.026] were independent predictors of 30-day mortality. SOFA and qSOFA both predicted poor outcomes in patients with HAT. Early diagnosis and preemptive AmBd therapy should be prioritized for patients with HAT who had high SOFA/qSOFA scores.

Purpose To analyze the clinical significance of the sequential organ failure assessment (SOFA) score in the diagnosis, treatment, and prognostic assessment of sepsis. Methods 140 patients with sepsis from January 2020 to January 2021 were selected as the observation group, and 40 healthy people were selected as the control group. The observation group was divided into mild group, severe group, and septic shock group by single blind grouping according to the condition of the disease, and they were also divided into survival group and death group according to the prognosis. Collect the fasting venous blood of the subjects in each group in the morning, compare the levels of total bilirubin (TBIL), blood creatinine (CR), and platelet count (PLT) in each group, and record and compare the patients' respiratory system oxygen partial pressure/inhaled oxygen concentration (po2/fio2), acute physiology and chronic health scoring system II (APACHE II), sequential organ failure assessment (sofa) score, q-SOFA score, and △SOFA score; Pearson analysis was used to analyze the correlation between SOFA score and other indicators; multivariate logistic regression was used to analyze the prognostic risk factors of patients with sepsis; receiver-operating characteristic curve (ROC) was used to analyze the value of SOFA score alone and in combination in the diagnosis, condition, and prognosis of sepsis. Results There were significant differences in Apache II score, SOFA score, q-SOFA score map, po2/fio2, PLT, GCS, TBIL, and serum creatinine (SCR) between the control group and the observation group (P < 0.05). There were significant differences in Apache II score, SOFA score, q-SOFA score, mean arterial pressure (map) po2/fio2, PLT, Glasgow Coma Score (GCS), TBIL, SCR, and △SOFA score among patients in mild, severe, and septic shock groups (P < 0.05). There were significant differences in age, Apache II score, SOFA score, q-SOFA score, map, po2/fio2, PLT, GCS, TBIL, SCR, and △SOFA score between survival group and death group (P < 0.05). SOFA score and q-SOFA score were significantly positively correlated with TBIL and SCR and significantly negatively correlated with po2/fio2 and PLT; △SOFA score was significantly negatively correlated with TBIL and SCR and significantly positively correlated with map, po2/fio2, PLT, and GCS. Apache II score, SOFA score, and q-SOFA score were independent risk factors for sepsis patients, and △SOFA score, po2/fio2, and GCS score were protective factors (P < 0.05). ROC curve analysis showed that the AUC of sepsis combined with SOFA score and q-SOFA score was 0.880; the AUC of sepsis assessed by SOFA score, q-SOFA score, and △SOFA score was 0.929; the AUC of sepsis prognosis assessed by SOFA score, q-SOFA score, and △SOFA score was 0.900. Conclusion SOFA score, q-SOFA score, and △SOFA score were abnormally expressed in patients with sepsis and were risk factors for the severity of the patient's condition and prognosis. The SOFA score, q-SOFA score, and △SOFA score were risk factors for the severity and prognosis of patients with sepsis and had some value in diagnosing sepsis and assessing the condition and prognosis, of which the combined value of the three was higher.

Background: The purpose of the present study was to examine the role of mean platelet volume (MPV) in comparison with Sequential Organ Failure Assessment (SOFA), quick SOFA (qSOFA), and Mortality in Severe Sepsis in the Emergency Department (MISSED) scoring systems in predicting hospital mortality among patients with severe sepsis. Methods: This follow-up study was conducted on patients over 18 years with severe sepsis, who were referred to the emergency department. Complete blood count (CBC) samples were sent to the laboratory for MPV measurement. Also, the required samples for determining SOFA and MISSED scores were collected. A senior emergency medicine resident completed the questionnaires upon patient admission and during follow-ups. Hospital mortality was considered as the outcome of the study. All statistical analyses were performed using SPSS version 20. Results: Among 428 patients with severe sepsis, 200 cases were recruited in this study from May 1, 2017, to May 1, 2018. The frequency of hospital mortality was 56 (28%). In the univariate analysis, there was a significant relationship between hospital mortality and age, base excess (BE), MPV, platelet distribution width (PDW), SOFA score, qSOFA score, and MISSED score (p < 0.0001). Based on the backward conditional method in the multivariate analysis, three variables, including SOFA, qSOFA, and MISSED scores, which showed a significant relationship with hospital mortality, remained in the final model. Conclusion: It seems that MPV plays a less significant role in determining the outcomes of severe sepsis in patients. qSOFA and MISSED scores, especially SOFA score, are of great significance in determining the prognosis of these patients.

BackgroundSeveral prognostic scores and molecular patterns have been developed to predict increased in-hospital mortality in septic patients. This prospective study aimed to evaluate the prognostic value of systemic inflammatory response syndrome (SIRS), Sequential Organ Failure Assessment (SOFA), quick SOFA (qSOFA), lactate quick SOFA (LqSOFA) and cytokine production levels in emergency department sepsis patients to predict in-hospital mortality.MethodsA total of 106 septic patients were enrolled. Baseline SOFA, SIRS, qSOFA and LqSOFA scores were calculated, and plasma levels of interleukin (IL)-6, IL-10, tumor necrosis factor-α (TNF-α) and interleukin-33 receptor (IL-33R) were measured on admission.ResultsSOFA, qSOFA, LqSOFA scores were significantly lower in sepsis survivors. IL-33R levels were significantly higher in non-survivors (P = 0.021). The best predictive score for sepsis based on the area under the receiver operating characteristic (ROC) curve was qSOFA (0.764, 95% confidence interval (CI) = 0.663 - 0.866), followed by LqSOFA (0.738, 95% CI = 0.63 - 0.845), SOFA (0.713, 95% CI = 0.604 - 0.822) and SIRS (0.603, 95% CI = 0.478 - 0.729). The addition of IL-33R levels (cut-off values > 55,393 pg/mL) to qSOFA and SOFA significantly increased the diagnostic accuracy of both scores with area under the curve (AUC) of 0.78 (95% CI = 0.695 - 0.85) and 0.740 (95% CI = 0.636 - 0.844), respectively. When evaluating early (within 72 h) in-hospital mortality, both IL-10 and IL-33R were significantly higher in non-survivors (124 pg/mL vs. 41 pg/mL in survivors, 195,610 pg/mL vs. 62,767 pg/mL in survivors, respectively). When added to qSOFA and SOFA scores (cut-off levels 74.5 pg/mL and 55,393 pg/mL for IL-10 and IL-33R, respectively), they significantly increased their diagnostic accuracy.ConclusionsSepsis prognostic scores were significantly lower in sepsis survivors. IL-10 levels had a significant impact in predicting early (within 72 h) in-hospital mortality and IL-33R levels in predicting both early and total in-hospital mortality, especially when combined with SOFA and qSOFA scores.