Abstract
BackgroundDespite on-going advances in medical treatment, the burden of disease of pneumonia remains high. We aimed to determine the association of the qSOFA score with in-hospital mortality, length of hospitalisation, and admission to the intensive care unit (ICU) in patients with pneumonia. Further, in a subgroup analysis, the outcomes were compared for qSOFA in comparison to other risk scores, including the CURB-65 and SIRS scores.MethodsIn a retrospective analysis, admission data from the ED of the Bern University Hospital, Switzerland, were screened to identify patients admitted for pneumonia. In addition to clinical characteristics, qSOFA and CURB-65 scores and SIRS criteria were assessed and evaluated with respect to the defined study outcomes.Results527 patients (median age 66 IQR 50–76) were included in this study. The overall in-hospital mortality was 13.3% (n = 70); 22.0% (n = 116) were transferred to the ICU. The median length of hospitalisation was 7 days (IQR 4–12). In comparison to qSOFA-negative patients, qSOFA-positive patients had increased odds ratios for in-hospital mortality (OR 2.6, 95%:1.4, 4.7, p<0.001) and ICU admission (3.5, 95% CI: 2.0. 5.8, p<0.001) and an increased length of stay (p<0.001). For ICU admission, the specificity of qSOPA-positivity (≥2) was 82.1% and sensitivity 43.0%. For in-hospital mortality, the specificity of qSOPA-positivity (≤2) was 88.9% and sensitivity 24.4%.In the subgroup analysis (n = 366). The area under the receiver operating curve for ICU admission was higher for qSOFA than for the CURB-65 score (p = 0.013). The evaluated scores did not differ significantly in their prognostication of in-hospital mortality (p>0.05).ConclusionsThe qSOFA score is associated with in-hospital mortality, ICU admission and length of hospitalisation in ED patients with pneumonia. Subgroup analysis revealed that qSOFA is superior to CURB-65 in respect to prognostication of ICU admission.
Highlights
Pneumonia is defined as an acute infection of the pulmonary parenchyma, presenting with an acute infiltrate in the chest X-ray [1, 2]
In comparison to quick sequential organ failure score (qSOFA)-negative patients, qSOFA-positive patients had increased odds ratios for in-hospital mortality and intensive care unit (ICU) admission (3.5, 95% CI: 2.0. 5.8, p
The qSOFA score is associated with in-hospital mortality, ICU admission and length of hospitalisation in emergency department (ED) patients with pneumonia
Summary
Pneumonia is defined as an acute infection of the pulmonary parenchyma, presenting with an acute infiltrate in the chest X-ray [1, 2]. The aim of the consensus was to take into account emerging knowledge on immune function in sepsis, where sepsis was defined as a dysregulated host response to an external pathogen [5] This new definition aims to make criteria for diagnosis of sepsis more specific than the proposed SIRS criteria published in the prior 1992 2nd international consensus, which are of rather low specificity and lead to a high percentage of false positives [5]. This led to a new sepsis definition; a change in sequential organ failure (SOFA) score of more than two points with either proven or suspected infection is diagnostic [5]. In a subgroup analysis, the outcomes were compared for qSOFA in comparison to other risk scores, including the CURB-65 and SIRS scores
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