High qSOFA Score Research Articles

Predictors of thirty-day mortality among patients with blood stream infection with WHO priority pathogens: single centre exploratory study from a referral teaching hospital in central India.

Bloodstream infection (BSI) is defined by the presence of viable microorganisms in the bloodstream. BSI is one of the major causes of sepsis and subsequent adverse clinical outcomes all across the globe. The present study was undertaken to identify clinico-epidemio-microbiological variables associated with 30-day mortality in patients having BSI with WHO priority pathogens. The study was conducted at a public sector tertiary care institute in central India from April 2019 to March 2021. Blood samples collected from patients with clinical suspicion of sepsis, were processed by automated bacterial culture system and interpreted as per CLSI guidelines. Calculated sample size was 150. Data was analyzed by R software. Respiratory tract infection was the most common source (43.3%) of BSI, followed by the gastrointestinal (20%) and urinary tract (18.7%). Among the patients, 33% required invasive mechanical ventilation, and 31% required inotropes. Diabetes mellitus (DM) was the most common co-morbidity (34%). The incidence of multi-drug resistant organisms (MDRO) was 59.3%. Escherichia coli was the most commonly (24%) isolated organism, followed by Klebsiella pneumoniae (17.3%) and Acinetobacter baumannii (16%). Higher age, higher qSOFA score / SIRS score / mean SOFA score at presentation had higher mortality. Use of mechanical ventilation and inotropes during treatment and isolation of critical category organisms of WPP and multi drug resistant organisms were independent 30-day mortality predictors.

Clinical Characteristics and Outcomes of COVID-Positive Maintenance Hemodialysis Patients: A Study from India.

This study describes to the clinical features and outcomes of patients on maintenance hemodialysis infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) delta variant. This was a retrospective analysis of case records of patients on maintenance hemodialysis admitted for management of coronavirus disease (COVID) infection. Our teaching hospital, being a state-designated referral center, had COVID admissions from March 2020 till December 2020. Epidemiological and clinical data were collected and analyzed. Factors influencing survival and the survival curve analysis were assessed. Of a total of 21,228 admissions during the period, 400 patients were referred for nephrology services. Of the 400 referrals, 226 were maintenance hemodialysis patients. Mean age of the group was 50 years, and fever was the most common presenting symptom. On multivariate analysis, factors influencing mortality were found to be older age, presence of diabetes, leukopenia, thrombocytopenia, hypoxemia, need for support, and a higher qSOFA score. The probability of survival of dialysis patients at the end of 19 days was 60%. During the pandemic by SARS-CoV-2 delta variant, majority of the nephrology referrals were for maintenance hemodialysis patients. Mortality was 38% in the study group, and the factors associated with mortality with a significant hazard ratio were older age and diabetes.

Repetitive endoscopic drainage as initial intervention is safe and effective for early treatment of pancreatic necrotic collections.

While endoscopic step-up approach with delayed drainage (more than 28 days from diagnosis) was shown to produce the best outcomes in the treatment of pancreatic walled-off necrosis (WON), we assessed our single centre experience of early versus delayed endoscopic drainage of pancreatic necrotic collections. Patients who underwent endoscopic drainage of pancreatic necrotic collections between 2011 and 2022 under Monash Health were identified. They were excluded if below 18 years old or their follow up data were missing. The included patients' medical records, pathology results, and imaging findings were retrospectively reviewed. A total of 60 patients were included. 31.58% required percutaneous drainage and 15% received either endoscopic or surgical necrosectomy. The disease related mortality was 8.47% and the average length of stay (LOS) was 70.92 days. No significant difference was shown in disease-related mortality (10.5% vs. 7.5%, P = 0.697) or LOS (75.35 vs. 68.7, P = 0.644) between early and delayed drainage cohorts, but patients who received early drainage have higher qSOFA score on the day of drainage (2 vs. 0, P = 0.004). Repetitive endoscopic drainage with selective percutaneous drainage is effective in the management of pancreatic necrotic collections. Early drainage should be considered in patients who developed severe sepsis.

Predictive value of qsofa in early mortality risk stratification in acute pulmonary embolism

BackgroundPulmonary Embolism Severity Index (PESI) and simplified PESI (sPESI) methods are used in the evaluation of patients with suspected acute pulmonary thromboembolism (PTE). ObjectivesThis study aimed to provide a rapid mortality risk stratification in patients with acute pulmonary thromboembolism (PTE) immediately after admission without relying on laboratory data by using quick sequential organ failure assessment (qSOFA), a three-parameter scoring system with proven efficiency used for swift prediction of organ dysfunction, and compare it with Pulmonary Embolism Severity Index (PESI) and simplified PESI (sPESI). MethodsThis study included outpatients and inpatients diagnosed with acute PTE in our clinic and whose PESI, sPESI and qSOFA scores were calculated for early mortality risk classification. ResultsA total of 123 patients who were objectively diagnosed with PTE and followed up were prospectively observed. When their qSOFA scores were compared with the early mortality risk stratification in acute PTE, patients with a high qSOFA score were determined to be in the high-risk group in the early mortality risk stratification (p < 0.001). Overall, 69.2% of 26 patients with a high qSOFA risk (≥2) were found to be in the high-risk group in the early mortality risk binary stratification in acute PTE (p < 0.0001). ConclusionsThe qSOFA score provides guidance to identify patients with acute PTE with potentially life-threatening hemodynamic decompensation or collapse in need of reperfusion therapy.

Clinical profile of hospitalised moderate category COVID-19 patients: Short study from a Tertiary Care Centre in Delhi.

The clinical profile of hospitalized moderate-category COVID-19 patients has been understudied globally and in India. The present study was conducted to study the clinical profile and assess the proportions of patients who progressed to severe disease and its predictors among moderate COVID-19 patients. In this single-center observational study, 100 moderate-category COVID-19 patients as per Ministry of Health and Family Welfare (MoHFW) criteria of age ≥18 years of either sex, excluding pregnant females from February to November 2021, were studied by analyzing their clinical profiles and assessing Quick Sequential Organ Failure Assessment (qSOFA), National Early Warning Score 2 (NEWS-2), and chest computed-tomography severity score (CTSS) to predict progression to severe disease. Severe disease was defined as per MoHFW criteria. Out of 100 moderate-category COVID-19 patients, progression to severe disease was seen in 11 patients (11%), among which eight patients had expired, three patients were discharged, and the rest of the 89 patients (89%) who did not progress to severe disease were discharged. A higher age (62.2± 19.5 vs 54.8 ± 14.6 years), along with multivariate analysis revealing male sex (1.25 times), chronic kidney disease (2.86 times), leukocytosis (6.10 times), thrombocytopenia (1.04 times), anemia (9.3 times), a higher qSOFA score (3.6 times), and a higher NEWS-2 score on admission (1.56 times) had higher odds of progression to severe disease. A significant correlation (P < .05) of qSOFA score with serum LDH, ferritin, and hs-CRP levels; CT severity score with the serum ferritin, IL-6, and LDH levels; and NEWS-2 with serum LDH, hs-CRP, and ferritin levels were found. Moreover, the NEWS-2 score was found slightly better than qSOFA on receiver operating characteristic (ROC) curve analysis, with an area under the curve of 85.8% and 83.2%, respectively, predicting progression to severe disease. Our study revealed male gender, chronic kidney disease, leukocytosis, anemia, thrombocytopenia, a higher qSOFA and NEWS-2 score on admission, and further, NEWS-2 score better than qSOFA on ROC curve analysis, with an area under the curve of 85.8% and 83.2%, respectively, in predicting severe disease among hospitalized moderate COVID-19 patients.

Evaluation of qSOFA and variation of hematochemical profile in cats naturally infected with feline panleukopenia virus

Abstract Feline panleukopenia (FP) is a fatal viral disease that predisposes cats to sepsis and organ failure. Owing to a wide variety of clinical findings, hematochemical examinations are significant for the determination of early signs of disease-related complications. The aim of this study is to investigate the diagnostic efficacy of certain hematochemical parameters together with quick Sepsis-related Organ Failure Assessment (qSOFA) in cats with FP. A total of 10 healthy and 30 panleukopenic cats were included in this study. Physical examinations revealed that the body temperature was highest in septic panleukopenic cats (p &lt; 0.009) and they had higher qSOFA scores (p = 0.000). Hemogram analysis revealed that leukocyte, lymphocyte, granulocyte, erythrocyte, and hemoglobin levels were lower in non-septic panleukopenic cats compared with the healthy ones (p &lt; 0.030). Also, monocyte and mean corpuscular hemoglobin levels were lower in septic ones (p &lt; 0.048). Serum biochemistry profiling revealed higher blood urea nitrogen, creatinine, alanine aminotransferase, lactate dehydrogenase, total bilirubin, and C-reactive protein levels in panleukopenic cats (p &lt; 0.033). As a result, it was concluded that although the qSOFA is not sufficient to distinguish sepsis in cats, unlike dogs, in order to achieve a positive clinical outcome, when evaluated together with hematochemical variables, it may help in making early diagnosis of FP-related complications.

Increase Mortality Rate in Sepsis Patients with qSOFA Score Greater than Two

Objective: To look for patients of sepsis with a qSOFA score of more than two and an association of a high qSOFA score with mortality and other socio-demographic factors.&#x0D; Study Design: Comparative cross-sectional study.&#x0D; Place and Duration of Study: Department of Medicine, Combined Military Hospital, Sialkot Pakistan, from Nov 2021 to May 2022.&#x0D; Methodology: All baseline and relevant investigations were carried out at the time of initial clinical assessment, and the qSOFA score was calculated by a consultant medical specialist for all the patients diagnosed with the septic condition. Patients were followed up for two weeks to look for mortality.&#x0D; Results: A total of 500 patients, managed for sepsis during the study period were included in the study. Of them, 298(59.6) were males, while 202(40.4) were females. Out of all the patients in the study, 379(75.8) had a qSOFA score of two or less than two, while 121(24.2) had a qSOFA score of more than two. Increased mortality, patients with more than 50 years and comorbid illnesses were found statistically significantly more in the group having a qSOFA score of more than two (p-value&lt;0.001).&#x0D; Conclusion: Mortality was significantly high in patients with sepsis who had a qSOFA score greater than two at the time of initial assessment compared to those with a score of two or less.

Utility of myxedema score as a predictor of mortality in myxedema coma.

Myxedema crisis (MC) is a rare condition. There is a dearth of data regarding the predictors of mortality in MC. Predictive scores for mortality specific to the clinical and biochemical profile of MC are still lacking. All consecutive patients presenting with MC from September 2006 to December 2020 comprised the new cohort. Patients managed between January 1999 and August 2006 comprised the old cohort. Both cohorts were compared for the determination of secular trends. Combined analysis of both the cohorts was done for clinico-demographic profile and predictors of mortality. Myxedema score (MS) and qSOFA (Quick Sequential Organ Failure Assessment) score were evaluated in all the patients. A total of forty-one patients (new cohort; n = 18 and old cohort; n = 23) were enrolled into the study. There was a female predominance (80.5%). Nearly half (51.2%) of the patients were newly diagnosed with hypothyroidism on admission. Overall mortality was 60.9%. On comparative analysis among survivors and non-survivors, female gender (OR 20.4, p value 0.018), need for mechanical ventilation (OR16.4, p value 0.009), in-hospital hypotension (OR 9.1, p value 0.020), and high qSOFA score (OR 7.1, p value 0.023) predicted mortality. MS of > 90 had significantly higher mortality (OR-11.8, p value - 0.026) while MS of > 110 had 100% mortality. There was no change in secular trends over last 20years. There was no difference in outcome of patients receiving oral or IV levothyroxine. Myxedema crisis is associated with high mortality despite improvement in health care services. The current study is first to elucidate the role of the MS in predicting mortality in patients with MC.

Percutaneous Endoscopic Interbody Debridement and Fusion (PEIDF) Decreases Risk of Sepsis and Mortality in Treating Infectious Spondylodiscitis for Patients with Poor Physical Status, a Retrospective Cohort Study.

Background: Postoperative immunosuppression is associated with blood loss and surgical trauma during surgery and subsequently predisposes patients to increased morbidity. Spine endoscopic surgery has been accepted as an effective surgical technique with less surgical trauma and less blood loss for the complication of infectious spondylodiscitis. Therefore, the aim of this study was to investigate whether PEIDF could reduce the morbidity rates for patients with infectious spondylodiscitis. Methods: We launched a retrospective cohort study on the comparison of the perioperative prognosis between PEIDF and conventional open surgery for single-level lumbar infectious spondylodiscitis in patients with poor physical health (ASA ≥ 4) from 2014 to 2019. Results: Forty-four patients were included in this study. Fifteen of them underwent PEIDF, and the rest of the 29 patients were treated with open surgery. Less surgical blood loss (p < 0.001) and intraoperative transfusions (p < 0.001) with a better decline of CRP (p = 0.017) were statistically significant in patients receiving PEIDF. Patients undergoing conventional open surgery encountered more postoperative sepsis (p = 0.030), a higher qSOFA score (p = 0.044), and prolonged-time for CRP normalization (p = 0.001). Conclusions: PEIDF minimizes a poor postoperative outcome due to less surgical trauma, intraoperative blood loss, and the need for a blood transfusion.

Accuracy of Quick Sequential Organ Failure Assessment Score & Systemic Inflammatory Response Syndrome Criteria in Predicting Adverse Outcomes in Emergency Surgical Patients With Suspected Sepsis: A Prospective Observational Study.

Purpose: Due to the mixed population enrolled in different studies i.e., medical and surgical cases, conflicting data exists about the accuracy of quick sequential organ failure assessment (qSOFA) and systemic inflammatory response syndrome (SIRS) scores in predicting adverse outcomes in patients with suspected sepsis presenting to the surgical emergency.Method: A prospective observational study was done in the department of surgery of a tertiary teaching hospital, India from June 2018 to July 2019. Consecutive patients who visited the surgical emergency department with suspected sepsis were included. Patients were followed up until hospital discharge or death.Results: Of the 410 patients screened, 287 were included in the analysis. The median age was 52 years (interquartile range, 41 to 61years) and 208 (72.8%) were men. Around 56.8% of patients had intra-abdominal pathology, and 43.2% had skin and soft -tissue infection. Sixty-nine (24%) patients died during their hospitalization, 98 (34.1%) patients had organ dysfunction, and 168 (58.5%) patients needed admission to the intensive care unit (ICU). A higher qSOFA score (≥2) was associated with organ dysfunction, ICU admission, and in-hospital mortality. The specificity, positive predictive value and diagnostic accuracy of qSOFA for organ dysfunction (85.7%, 67.8%, 76.3%), ICU admission (92.4%, 89.3%, 64.5%), and in-hospital mortality (81.6%, 52.4%, 77.4%) was higher than SIRS. The area under the receiver operating characteristic curve for qSOFA for these variables was also higher than for SIRS (0.826 vs. 0.524, 0.823 vs. 0.577, and 0.823 vs. 0.555, respectively).Conclusion: qSOFA is a better model for predicting adverse outcomes and mortality, organ dysfunction, and ICU admission in surgical patients. However, SIRS indicates intervention requirements in a surgical patient better than qSOFA.

COVID-19 and C. auris: A Case-Control Study from a Tertiary Care Center in Lebanon.

Many healthcare centers around the world have reported the surge of Candida auris (C. auris) outbreaks during the COVID-19 pandemic, especially among intensive care unit (ICU) patients. This is a retrospective study conducted at the American University of Beirut Medical Center (AUBMC) between 1 October 2020 and 15 June 2021, to identify risk factors for acquiring C. auris in patients with severe COVID-19 infection and to evaluate the impact of C. auris on mortality in patients admitted to the ICU during that period. Twenty-four non-COVID-19 (COV−) patients were admitted to ICUs at AUBMC during that period and acquired C. auris (C. auris+/COV−). Thirty-two patients admitted with severe COVID-19 (COV+) acquired C. auris (C. auris+/COV+), and 130 patients had severe COVID-19 without C. auris (C. auris−/COV+). Bivariable analysis between the groups of (C. auris+/COV+) and (C. auris−/COV+) showed that higher quick sequential organ failure assessment (qSOFA) score (p < 0.001), prolonged length of stay (LOS) (p = 0.02), and the presence of a urinary catheter (p = 0.015) or of a central venous catheter (CVC) (p = 0.01) were associated with positive culture for C. auris in patients with severe COVID-19. The multivariable analysis showed that prolonged LOS (p = 0.008) and a high qSOFA score (p < 0.001) were the only risk factors independently associated with positive culture for C. auris. Increased LOS (p = 0.02), high “Candida score” (p = 0.01), and septic shock (p < 0.001) were associated with increased mortality within 30 days of positive culture for C. auris. Antifungal therapy for at least 7 days (p = 0.03) appeared to decrease mortality within 30 days of positive culture for C. auris. Only septic shock was associated with increased mortality in patients with C. auris (p = 0.006) in the multivariable analysis. C. auris is an emerging pathogen that constitutes a threat to the healthcare sector.

Predictors of mortality in acute hospitalised COVID-19 pneumonia patients: A retrospective cohort study at two tertiary-level hospitals in Zambia

Background. The global COVID-19 pandemic has resulted in increased acute hospitalisations, a high demand for intensive care and high in-hospital mortality, placing a huge burden on healthcare systems. Objectives. To assess in-hospital mortality outcomes and associated factors in acute hospitalised COVID-19 pneumonia patients in Zambia. Methods. We performed a retrospective cohort review of patients admitted to two tertiary-level hospitals in Zambia from 1 March 2020 to 28 February 2021. We examined the factors (demographic, clinical and laboratory) that were associated with in-hospital mortality using multivariate logistic analysis. Adjusted odds ratios with their 95% confidence intervals (CIs) are reported. Results. Of 350 patients, 59.4% were aged ≥55 years and 52.6% were male. The commonest comorbidities were hypertension, diabetes mellitus (DM), HIV/AIDS and chronic kidney disease (49.6%, 28.5%, 22.0% and 8.1%, respectively). The overall in-hospital mortality rate was 42.6%, and mortality was significantly increased in patients aged ≥55 years (52.0% v. 48.0%) and in those with DM (52.1% v. 47.9%), cardiac disease (68.0% v. 32.0%), a Quick Sequential (Sepsis-Related) Organ Failure Assessment (q-SOFA) score ≥2 (75.4% v. 24.6%), and admission blood glucose levels ≥7.0 mmol/L (66.3% v. 33.7%). Compared with patients who survived, who spent a median (interquartile range) of 6 (3 - 10) days in hospital, the median time between admission and death in those who died was 2.5 (1 - 6) days. In multivariate logistic analysis, age ≥55 years, a q-SOFA score ≥2 and a random blood sugar level ≥7.0 mmol/L were predictors of in-hospital mortality, with adjusted odds ratios of 1.54 (95% CI 1.09 - 2.17), 2.17 (95% CI 1.40 - 3.38) and 1.65 (95% CI 1.18 - 2.30), respectively. Raised serum creatinine was not associated with in-hospital COVID-19 mortality after adjusting for other confounders. Conclusions. This study highlights that high in-hospital COVID-19 mortality was associated with a high q-SOFA score, hyperglycaemia on admission and older age. The study reinforces the need to invest in emergency healthcare services for optimal management of COVID-19 patients presenting with high q-SOFA scores in resource-limited countries.

The Effectiveness of National Early Warning Score, Quick Sequential Organ Failure Assessment, Charlson Comorbidity Index, and Elixhauser Comorbidity Index Scores in Predicting Mortality Due to COVID-19 in Elderly Patients.

Introduction: As the mortality rate in coronavirus disease 2019 (COVID-19) patients older than 65 years is considerable, evaluation of in-hospital mortality is crucial. This study aimed to evaluate in-hospital mortality in COVID-19 patients older than 65 years using the National Early Warning Score (NEWS), Quick Sequential Organ Failure Assessment (q-SOFA), Charlson Comorbidity Index (CCI), and Elixhauser Comorbidity Index (ECI).Methods: This retrospective study included data from 480 patients with confirmed COVID-19 and age over 65 years who were evaluated in a university emergency department in Turkey. Data from eligible but deceased COVID-19 patients was also included. NEWS, q-SOFA, CCI, and ECI scores were retrospectively calculated. All clinical data was accessed from the information management system of the hospital, retrieved, and analyzed.Results: In-hospital mortality was seen in 169 patients (169/480). Low oxygen saturation, high C-reactive protein (CRP) and urea levels, and high q-SOFA and ECI scores helped us identify mortality in high-risk patients. A statistically significant difference was found in mortality estimation between q-SOFA and ECI (p <0.001), respectively.Conclusion: Q-SOFA and ECI can be used both easily and practically in the early diagnosis of in-hospital mortality in COVID-19 positive patients over 65 years of age admitted to the emergency department. Low oxygen saturation, high CRP and urea levels, and high q-SOFA and ECI scores are helpful in identifying high-risk patients.

Comparison of Early and Late Intubation in COVID-19 and Its Effect on Mortality.

Background: Best practices for management of COVID-19 patients with acute respiratory failure continue to evolve. Initial debate existed over whether patients should be intubated in the emergency department or trialed on noninvasive methods prior to intubation outside the emergency department. Objectives: To determine whether emergency department intubations in COVID-19 affect mortality. Methods: We conducted a retrospective observational chart review of patients who had a confirmed positive COVID-19 test and required endotracheal intubation during their hospital course between 1 March 2020 and 1 June 2020. Patients were divided into two groups based on location of intubation: early intubation in the emergency department or late intubation performed outside the emergency department. Clinical and demographic information was collected including comorbid medical conditions, qSOFA score, and patient mortality. Results: Of the 131 COVID-19-positive patients requiring intubation, 30 (22.9%) patients were intubated in the emergency department. No statistically significant difference existed in age, gender, ethnicity, or smoking status between the two groups at baseline. Patients in the early intubation cohort had a greater number of existing comorbidities (2.5, p = 0.06) and a higher median qSOFA score (3, p ≤ 0.001). Patients managed with early intubation had a statistically significant higher mortality rate (19/30, 63.3%) compared to the late intubation group (42/101, 41.6%). Conclusion: COVID-19 patients intubated in the emergency department had a higher qSOFA score and a greater number of pre-existing comorbidities. All-cause mortality in COVID-19 was greater in patients intubated in the emergency department compared to patients intubated outside the emergency department.

Outcomes of hospitalized patients with COVID-19 during the course of the pandemic in a fully integrated health system.

BackgroundGiven the rapid spread of COVID-19 and its associated morbidity and mortality, healthcare providers throughout the world have been forced to constantly update and change their care delivery models.ObjectiveTo assess the outcomes of COVID-19 hospitalized patients during the course of the pandemic in a well-integrated health system.MethodsThe study used data from the electronic health medical records to assess trends in clinical profile and outcomes of hospitalized adult COVID-19 patients hospitalized in our 5-hospital health system from March 2020-May 2021 (n = 6865). Integration of the health system began in February 2020 and was fully actualized by March 30, 2020.ResultsMortality decreased from 15% during first peak (March-May 2020; the rate includes 19% in March-April and 10% in May 2020) to 6% in summer-fall 2020, increased to 13% during the second peak (November 2020-January 2021), and dropped to 7% during the decline period (February-May 2021) (p<0.01). Resource utilization followed a similar pattern including a decrease in ICU use from 35% (first peak) to 16% (decline period), mechanical ventilation from 16% (first peak, including 45% in March 2020) to 9–11% in subsequent periods (p<0.01). Independent predictors of inpatient mortality across multiple study periods included older age, male sex, higher multi-morbidity scores, morbid obesity, and indicators of severe illness on admission such as oxygen saturation ≤90% and high qSOFA score (all p<0.05). However, admission during the first peak remained independently associated with increased mortality even after adjustment for patient-related factors: odds ratio = 1.8 (1.4–2.4) (p<0.0001).ConclusionsThe creation of a fully integrated health system allowed us to dynamically respond to the everchanging COVID-19 landscape. In this context, despite the increasing patient acuity, our mortality and resource utilization rates have improved during the pandemic.

Predictive value of quick sequential organ failure assessment (qSOFA) score in risk assessment and outcome prediction in blunt trauma patients: A prospective observational study

BackgroundThere is a plethora of trauma scoring systems currently in place. A lot of these scoring systems, however, are complex and thus have a limited utility in the emergency department. The present study was conducted to evaluate the relatively easy to calculate quick Sequential Organ Failure Assessment (qSOFA) Score in blunt trauma victims. We ought to study its utility in predicting outcomes in blunt trauma patients and its usefulness to guide resource allocation in the emergency department. MethodsA prospective observational study was performed on blunt trauma patients who had presented to the emergency department of our tertiary care center, over a period of 6 months. Their qSOFA scores were calculated and these patients were observed for their course in the hospital. The predictive validity of this score was then studied for the outcome prediction in these patients. ResultsA total of 246 patients were enrolled. Maximum 36.4% of patients had a qSOFA score of 0 and 10.1% were with a score of 3. Higher qSOFA scores were associated with higher in-hospital mortality, higher needs for an ICU admission, higher needs for mechanical ventilation. However, it did not reliably predict the need for an emergency surgery in these patients. ConclusionsqSOFA score serves as a reliable tool to predict adverse outcomes in blunt trauma victims. It helps with the quick allocation of resources in the emergency department.

To study the contributing factors and outcomes of Clostridioides difficile infection in patients with solid tumors

BackgroundClostridioides difficile infection (CDI) is a considerable healthcare burden, and now identified as the leading cause of acquired diarrheal illness in patients receiving antibiotics. Patients with malignancies are more prone to acquire CDI, owing to their frequent exposure to risk factors. ObjectiveThis study aims to investigate the factors affecting the outcome of Clostridioides Difficile Infection in patients with solid tumors at our community healthcare center. MethodsThis is a retrospective study that included a total of 59 patients with solid tumors who were hospitalized for Clostridioides difficile infection. ResultsThe median age of the study population was 79 years with 39 males and 20 females. The patients had a diagnosis of a malignancy involving the following sites: prostate (25), lung (19), colon (7), bladder (4), breast (3), and renal (1). There were 52 cases of first time and 7 cases of recurrent CDI admissions. 40 patients were detected to have CDI at presentation while 19 patients were diagnosed with CDI after admission. CDI was categorized as follows: non-severe (29), severe (28), and very severe (2). There were 33 patients on chemotherapy and 20 patients undergoing radiotherapy. Twenty-seven patients had a recent history of cancer care-related procedures or interventions. Twenty-nine patients were from either a rehabilitation center or a long-term nursing care facility. There were 39 recent hospitalizations with 29 patients receiving antibiotics. Almost half of the patients were on proton pump inhibitors (29) and 12 were on steroids (20.3%) at the time of developing CDI. Patients with a high-risk qSOFA score of 2 or more (p-value = 0.008) or a high white blood cell count of >15 × 109/L (p-value = 0.016) at the time of admission were found to have higher in-hospital mortality. Critical care data suggested that 9 patients required intensive care, 7 patients required vasopressor support, and 6 needed mechanical ventilation. Patients were treated with either vancomycin alone (13), or metronidazole alone (25), or combination therapy with vancomycin + metronidazole (21). The median duration of hospital stay was 6 days with 11 fatalities (18.64%). ConclusionsCDI causes significant morbidity in patients with malignancies. A high qSOFA score and leukocytosis are significantly associated with high morbidity and thus should be used to prioritize and intensify inpatient care of these patients.

Hyperuricaemia as a predictor of hospital outcome in patients with sepsis: results of a prospective study

BackgroundEarly management of sepsis in the emergency department improves patient outcomes. The identification of at-risk patients for aggressive management by an easily available biomarker could go a long way in the triage of patients in the emergency department. It is postulated that during sepsis, the majority of patients undergo ischaemic reperfusion injury or inflammation, and uric acid with its oxidant and antioxidant properties may be playing some role and, hence, the measurement of uric acid could possibly predict the hospital course in patients with sepsis. We were prompted to undertake this study as serum uric acid estimation is readily available and economical compared to newly evolving biomarkers in sepsis. Estimation of serum uric acid levels on arrival to the emergency department may prove a useful predictor of hospital outcome in patients with sepsis especially in regions with limited resources.ResultsOf 102 patients, 55 (53.9%) were males. The mean age of the study cohort was 63.2 ± 10.48. Patients with higher qSOFA scores had higher uric acid levels on admission. While 12 (11.8%) patients had a septicaemic shock, acute kidney injury was recorded in 48 (47.1%) patients and 11 (10.8%) patients required dialysis. Thirty-four (33.3%) patients had respiratory failure, and of these, 21 (20.6%) patients required mechanical ventilation. The overall median stay in the medical intensive care (MICU) was 3days (range 2–7 days). The patients with higher uric acid levels had higher rates of respiratory failure but did not reach significant levels. In 15 (14.7%) patients, 7 males expired (mortality rate of 14.7%). There was a significant association between SOFA score and mortality. Patients who succumbed to sepsis had higher serum uric acid levels on arrival.ConclusionsPatients with higher qSOFA scores had higher uric acid levels on admission. Hyperuricaemia predicted acute kidney injury, a requirement of mechanical ventilation and mean hospital stay in patients with sepsis. Further studies may be required to confirm the association.

The Role of the Quick Sequential Organ Failure Assessment Score (qSOFA) in the Pre-Hospitalization Prediction of Covid19 Prognosis

Objective: Researchers have been investigating numerous biomarkers and scoring systems to predict the prognosis of coronavirus disease 2019 (COVID-19). We aimed to determine the effectiveness of the quick sequential organ failure assessment (qSOFA) scoring system in pre-hospital emergency health care for predicting COVID-19 prognosis in terms of the intensive care unit (ICU) admission and mortality. Materials and Methods: We enrolled 9850 patients suspected to have COVID-19 who were transferred by 112 emergency medical services (EMS) between April 1, 2020 and July 1, 2020. Demographic and clinical data of the patients were obtained from the Ankara Emergency Health Services Automation System. The qSOFA score was calculated based on the data obtained from the ambulance medical records. Results: The 28-day mortality rate was 6.2% (n=13) and the cut-off for the qSOFA score was >1 [area under the curve (AUC)=0.955, sensitivity 84.62%, specificity 90.4%, p 1 (AUC=0.942;sensitivity 97.37%;specificity 84.97%;p<0.001;95% CI, 0.901-0.969). The mortality risk was 51.8 times more in patients with a high qSOFA score (p<0.001;95% CI, 10.682-251.340). Moreover, patients with a high qSOFA score were 47.7 times more likely to require ICU admission (p<0.001;95% CI, 16.735-136.039). Conclusion: Thus, the pre-hospital qSOFA score that comprises the ambulance vital signs of the patients can be used to predict ICU admissions and mortality in patients with COVID-19. [ABSTRACT FROM AUTHOR] Copyright of Erciyes Medical Journal / Erciyes Tip Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Clinical features and outcomes of 84 COVID-Positive hemodialysis patients in a resource poor setting from India.

With the declaration of severe acute respiratory syndrome novel coronavirus-2019 as pandemic by the World Health Organization on March 11, 2020, there has been a steady rise in number of cases. Chronic kidney disease and dialysis population are risk factors for increased severity of illness. Literature about the coronavirus disease 2019 (COVID-19) in dialysis population is scarce. Management of COVID-19 patients in resource poor setting in a developing country does vary compared to developed nations. Nonavailability of the advanced laboratory facility and the newer medicines forces the treating team to manage the patients with available investigations and drugs. We aimed at analysis of clinical characteristics and outcomes of 84 patients on maintenance hemodialysis (HD). Data of all COVID-positive patients on maintenance HD, who were referred to our center were collected. All patients were given HD on NIKISSO machines. Outcomes of all the admitted patients were analyzed. Maintenance HD group formed majority of the kidney referrals (54%). Age group that was commonly affected was >50 years. Factors associated with mortality were age, diabetes, thrombocytopenia, prolonged baseline activated partial thromboplastin time, admission hypoxemia, high qSOFA score. Institutional Ethics Committee approval has been obtained for the study. Methodology of the study was in accordance with the Declaration of Helsinki. Verbal consent was obtained from patients/ attendants. In the ongoing COVID pandemic, in a developing nation where resources are constrained, it is difficult to salvage the critically ill patients. With the drugs available and the changing strategies, treatment was given to all the patients admitted with bedside renal replacement therapies. Our mortality rate was high compared to other studies due to delay in referral, admission hypoxemia, and late initiation of steroids.