qSOFA Score Research Articles

Comparison of four early warning scores in predicting the prognosis of critically ill patients in secondary hospitals

To explore the predictive value of acute physiology and chronic health evaluation II (APACHE II), sequential organ failure assessment (SOFA), quick sequential organ failure assessment (qSOFA) and modified early warning score (MEWS) in evaluating the prognosis of patients in intensive care unit (ICU) of secondary hospitals, and to provide guidance for clinical application. The clinical data of adult critical patients admitted to the ICU of Wanzhou District First People's Hospital from October 2022 to April 2023 were retrospectively analyzed. According to the clinical outcome of ICU, the patients were divided into improvement group and death group. The general information, blood routine, heart, liver and kidney function indicators, coagulation indicators, blood gas analysis, APACHE II score, SOFA score, qSOFA score, MEWS score at the time of admission to the ICU, the number of cases of invasive mechanical ventilation (IMV) and continuous blood purification (CBP) were compared between the two groups. Univariate analysis was performed, and multivariate Logistic regression analysis was used to analyze the related factors of death. Receiver operator characteristic curve (ROC curve) was used to analyze the predictive value of the four scores in ICU patients. A total of 126 patients were included, of which 45 patients died in the ICU and 81 patients improved and transferred out. Univariate analysis of death-related critically ill patients showed that procalcitonin (PCT), serum creatinine (SCr), blood urea nitrogen (BUN), albumin (ALB), prothrombin time (PT), activated partial prothrombin time (APTT), D-dimer, pH value, HCO3-, blood lactic acid (Lac), number of patients treated with IMV and CBP, APACHE II score, SOFA score, qSOFA score and MEWS score were significantly different between the two groups (all P < 0.05). Multivariate Logistic regression analysis showed that the APACHE II score [odds ratio (OR) = 1.115, 95% confidence interval (95%CI) was 1.025-1.213, P = 0.011], SOFA score (OR = 1.204, 95%CI was 1.037-1.398, P = 0.015), MEWS score (OR = 1.464, 95%CI was 1.102-1.946, P = 0.009), and APTT (OR = 1.081, 95%CI was 1.015-1.152, P = 0.016) were independent risk factors affecting the mortality of critically ill patients in the ICU. ROC curve analysis showed that APACHE II, SOFA, qSOFA, and MEWS scores could predict the prognosis of critically ill ICU patients, among which SOFA score had the strongest predictive effect, and the area under the curve (AUC) was 0.808. There was a statistically significant difference in the time required for the four scores (F = 117.333, P < 0.001), among which the MEWS scoring required the shortest time [(1.03±0.39) minutes], and the APACHE II scoring required the longest time [(2.81±1.04) minutes]. APACHE II, SOFA, qSOFA, and MEWS scores can be used to assess the severity of critically ill patients and predict in-hospital mortality. The SOFA score is superior to other scores in predicting severity. The MEWS is preferred because its assessment time is shortest. Early warning score can help secondary hospitals to detect potentially critical patients early and provide help for clinical rapid urgent emergency decision-making.

Utilidad predictiva de mortalidad de las escalas qSOFA, NEWS y GYM en el paciente anciano con infección en urgencias: estudio EDEN-5

ObjectiveTo analyze the prognostic accuracy of the scores NEWS, qSOFA, GYM used in hospital emergency department (ED) in the assessment of elderly patients who consult for an infectious disease. MethodsData from the EDEN (Emergency Department and Elderly Needs) cohort were used. This retrospective cohort included all patients aged ≥65years seen in 52 Spanish EDs during two weeks (from 1/4/2019 to 7/4/2019 and 30/3/2020 to 5/4/2020) with an infectious disease diagnosis in the emergency department. Demographic variables, comorbidities, Charlson and Barthel index and needed scores parameters were recorded. The predictive capacity for 30-day mortality of each scale was estimated by calculating the area under the receiver operating characteristic (ROC) curve, and sensitivity and specificity were calculated for different cut-off points. The primary outcome variable was 30-day mortality. ResultsSix thousand fifty-four patients were analyzed. Median age was 80years (IQR 73-87) and 45.3% women. Nine hundred and ninety-three (16.4%) patients died. NEWS score had better AUC than qSOFA (0.765; 95%CI: 0.725-0.806, vs. 0.700; 95%CI: 0.653-0.746; P<.001) and GYM (0.716; 95%CI: 0.675-0.758; P=.024), and there was no difference between qSOFA and GYM (P=.345). The highest sensitivity scores for 30-day mortality were GYM ≥1 point (85.4%) while the qSOFA score ≥2 points showed high specificity. In the case of the NEWS scale, the cut-off point ≥4 showed high sensitivity, while the cut-off point NEWS ≥8 showed high specificity. ConclusionNEWS score showed the highest predictive capacity for 30-day mortality. GYM score ≥1 showed a great sensitivity, while qSOFA ≥2 scores provide the highest specificity but lower sensitivity.

Infectious causes of fever of unknown origin in developing countries: An international ID-IRI study

BackgroundFever of unknown origin (FUO) in developing countries is an important dilemma and further research is needed to elucidate the infectious causes of FUO. MethodsA multi-center study for infectious causes of FUO in lower middle-income countries (LMIC) and low-income countries (LIC) was conducted between January 1, 2018 and January 1, 2023. In total, 15 participating centers from seven different countries provided the data, which were collected through the Infectious Diseases-International Research Initiative platform. Only adult patients with confirmed infection as the cause of FUO were included in the study. The severity parameters were quick Sequential Organ Failure Assessment (qSOFA) ≥2, intensive care unit (ICU) admission, vasopressor use, and invasive mechanical ventilation (IMV). ResultsA total of 160 patients with infectious FUO were included in the study. Overall, 148 (92.5%) patients had community-acquired infections and 12 (7.5%) had hospital-acquired infections. The most common infectious syndromes were tuberculosis (TB) (n=27, 16.9%), infective endocarditis (n=25, 15.6%), malaria (n=21, 13.1%), brucellosis (n=15, 9.4%), and typhoid fever (n=9, 5.6%). Plasmodium falciparum, Mycobacterium tuberculosis, Brucellae, Staphylococcus aureus, Salmonella typhi, and Rickettsiae were the leading infectious agents in this study. A total of 56 (35.0%) cases had invasive procedures for diagnosis. The mean qSOFA score was 0.76±0.94 {median (interquartile range [IQR]): 0 (0–1)}. ICU admission (n=26, 16.2%), vasopressor use (n=14, 8.8%), and IMV (n=10, 6.3%) were not rare. Overall, 38 (23.8%) patients had at least one of the severity parameters. The mortality rate was 15 (9.4%), and the mortality was attributable to the infection causing FUO in 12 (7.5%) patients. ConclusionsIn LMIC and LIC, tuberculosis and cardiac infections were the most severe and the leading infections causing FUO.

Assessment of soluble thrombomodulin and soluble endoglin as endothelial dysfunction biomarkers in seriously ill surgical septic patients: correlation with organ dysfunction and disease severity.

Sepsis, a complex condition characterized by dysregulated immune response and organ dysfunction, is a leading cause of mortality in ICU patients. Current diagnostic and prognostic approaches primarily rely on non-specific biomarkers and illness severity scores, despite early endothelial activation being a key feature of sepsis. This study aimed to evaluate the levels of soluble thrombomodulin and soluble endoglin in seriously ill surgical septic patients and explore their association with organ dysfunction and disease severity. A case control study was conducted from March 2022 to November 2022, involving seriously ill septic surgical patients. Baseline clinical and laboratory data were collected within 24h of admission to the Surgical Intensive Care Unit. This included information such as age, sex, hemodynamic parameters, blood chemistry, SOFA score, qSOFA score, and APACHE-II score. A proforma was filled out to record these details. The outcome of each patient was noted at the time of discharge. The study found significantly elevated levels of soluble thrombomodulin and soluble endoglin in seriously ill surgical septic patients. The RTqPCR analysis revealed a positive correlation between soluble thrombomodulin and soluble endoglin levels with the qSOFA score, as well as, there was a positive association between RTqPCR soluble thrombomodulin and the SOFA score. These findings indicate a correlation between these biomarkers and organ dysfunction and disease severity. The study concludes that elevated levels of soluble thrombomodulin and soluble endoglin can serve as endothelial biomarkers for early diagnosis and prognostication in seriously ill surgical septic patients.

The value of the INFECTIONS scoring system in identifying bacterial infections among patients presenting at the emergency department of a middle-income country: A pilot study

PurposeTo investigate which scoring system is the most accurate tool in predicting mortality among the infected patients who present to the emergency department in a middle-income country, and to validate a new scoring system to predict bacterial infections. MethodsThis was a retrospective, single-center study among patients who were admitted via the emergency department of a public hospital. All patients who were started on antibiotics were included in the study, while patients aged < 18 years were excluded. Data collected includeding patients' demographics, vital signs and basic laboratory parameters like white blood cell count and creatinine. The sensitivity and specificity of different scoring systems were calculated as well as their negative and positive predictive values. Logistic regression was used to derive a novel early warning system for bacterial infections. The area under the receiver operating characteristic (AUROC) was computed for each scoring model. ResultsIn total, 109 patients were included in this study. The quick sequential organ failure assessment (qSOFA), search out severity and rapid acute physiology score had the highest AUROC (≥ 0.89) for predicting mortality, while qSOFA and universal vital assessment were the simplest scoring systems with an AUROC > 0.85; however, these scoring systems failed to predict whether patients were truly infected. The INFECTIONS (short for impaired mental status, not conscious, fast heart rate, elevated creatinine, high temperature, on inotrope, low oxygen, high neutrophils and high sugar) model reached an AUROC of 0.88 to more accurately predict the infectious state of a patient. ConclusionsMiddle-income countries should use the qSOFA or universal vital assessment score to identify the sickest patients in emergency department. The INFECTIONS score may help recognize patients with bacterial infections, but it should be further validated in multiple countries prior to widely use.

Can we recognize severe community-acquired pneumonia without pneumonia severity index? Use of modified qSOFA with procalcitonin

ObjectiveThe aim of this study is to analyze the diagnostic value of Quick Sequential Organ Failure Assessment (qSOFA), modified qSOFA, National Early Warning Score (NEWS) and NEWS + Lactate (NEWS + L) scores in the detection of severe community-acquired pneumonia (CAP). MethodsThis research is a retrospective cohort study. Patients admitted to the Emergency Department (ED) with the diagnosis of CAP were divided into severe and mild pneumonia regarding their Pneumonia Severity Index (PSI) scores. The accuracies of lactate, procalcitonin (PCT) values, NEWS and qSOFA scores, as well as score combinations (NEWS + L and qSOFA + PCT) in predicting patients with severe CAP were analyzed. ResultsMedian qSOFA value in the severe CAP group (0 [IQR 0–1]) was found to be higher than median qSOFA value (0 [IQR 0-0]) in the mild CAP group (p < 0.001). The rate of qSOFA positivity (qSOFA ≥ 2) was significantly higher in the severe CAP group (17.1%, n = 21) compared to the mild CAP group (1.3%, n = 1) (p < 0.001). Median qSOFA + PCT for the severe CAP group (2 [IQR 1–2]) was higher than the mild CAP group (1 [IQR 0–1]) (p < 0.001). Mean NEWS score for severe CAP (4.95 ± 3.09) was found to be 1.69 (95% CI 0.92–2.46) higher than mean NEWS score of the mild CAP group (3.26 ± 2.39) (p < 0.001). The severe CAP NEWS + L score (6.97 ± 3.71) was higher than the mild CAP NEWS + L score (4.94 ± 2.48) (p < 0.001). Blood lactate level was not significant in the evaluation of severe CAP (p = 0.221). PCT (AUROC = 0.685 [95% CI 0.610–0.760]; p = 0.038), NEWS score (AUROC = 0.658 95% CI [0.582–0.733]; p < 0.001), qSOFA (AUROC = 0.686) were calculated to have adequate accuracy for the detection of severe CAP. [95% CI 0.613–0.759]; p = 0.037), NEWS + L score (AUROC = 0.665 [95% CI 0.589–0.740]; p = 0.038). The qSOFA + PCT score (AUROC = 0.758 [95% 0.691–0.825]; p = 0.034) was also found to be a highly accurate predictor of severe CAP. ConclusionIn this study, we found a combination of qSOFA and PCT to be the most reliable method of detecting severe CAP.

Positive Rate and Utility of Blood Culture among Nursing and Healthcare-associated Pneumonia Inpatients: A Cross-sectional Study.

Objective Although blood cultures to identify the presence of bacteremia are recommended for nursing- and healthcare-associated pneumonia (NHCAP), the incidence of true bacteremia and the relationship between true bacteremia and the outcome remain unclear. Physicians can therefore sometimes be confused regarding whether or not blood cultures should be obtained for NHCAP patients. This study assessed the incidence of true bacteremia and the relationship between true bacteremia and the outcome of NHCAP in a Japanese hospital setting. Methods We retrospectively analyzed NHCAP patients hospitalized between April 2016 and March 2021. The primary outcome was the incidence of true bacteremia in blood cultures. The incidence of true bacteremia was also examined according to quick Sequential Organ Failure Assessment (qSOFA) and A-DROP scores. In addition, we compared the incidence of true bacteremia between survivors and non-survivors. Results In total, 205 patients were included in this study. Blood cultures were obtained from 150 of the 205 patients (73.2%). Positive blood cultures were detected in 26 patients (17.3%), of which only 8 cases (5.3%; 95% confidence interval, 2.3-10.2%) were considered true bacteremia. Trend analyses for the incidence of true bacteremia according to qSOFA and A-DROP scores did not show any statistically significant results (p=0.49 for qSOFA; p=0.14 for A-DROP). The proportion of true bacteremia cases did not differ significantly between survivors and non-survivors. Conclusions The incidence of true bacteremia among NHCAP patients was very low. A strategy for determining indications for obtaining blood cultures from NHCAP patients needs to be established.

Construction and validation of machine learning models for sepsis prediction in patients with acute pancreatitis

BackgroundThis study aimed to construct predictive models for the risk of sepsis in patients with Acute pancreatitis (AP) using machine learning methods and compared optimal one with the logistic regression (LR) model and scoring systems.MethodsIn this retrospective cohort study, data were collected from the Medical Information Mart for Intensive Care III (MIMIC III) database between 2001 and 2012 and the MIMIC IV database between 2008 and 2019. Patients were randomly divided into training and test sets (8:2). The least absolute shrinkage and selection operator (LASSO) regression plus 5-fold cross-validation were used to screen and confirm the predictive factors. Based on the selected predictive factors, 6 machine learning models were constructed, including support vector machine (SVM), K-nearest neighbour (KNN), multi-layer perceptron (MLP), LR, gradient boosting decision tree (GBDT) and adaptive enhancement algorithm (AdaBoost). The models and scoring systems were evaluated and compared using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and the area under the curve (AUC).ResultsA total of 1, 672 patients were eligible for participation. In the training set, 261 AP patients (19.51%) were diagnosed with sepsis. The predictive factors for the risk of sepsis in AP patients included age, insurance, vasopressors, mechanical ventilation, Glasgow Coma Scale (GCS), heart rate, respiratory rate, temperature, SpO2, platelet, red blood cell distribution width (RDW), International Normalized Ratio (INR), and blood urea nitrogen (BUN). The AUC of the GBDT model for sepsis prediction in the AP patients in the testing set was 0.985. The GBDT model showed better performance in sepsis prediction than the LR, systemic inflammatory response syndrome (SIRS) score, bedside index for severity in acute pancreatitis (BISAP) score, sequential organ failure assessment (SOFA) score, quick-SOFA (qSOFA), and simplified acute physiology score II (SAPS II).ConclusionThe present findings suggest that compared to the classical LR model and SOFA, qSOFA, SAPS II, SIRS, and BISAP scores, the machine learning model-GBDT model had a better performance in predicting sepsis in the AP patients, which is a useful tool for early identification of high-risk patients and timely clinical interventions.

Systemic immune-inflammation index combined with quick sequential organ failure assessment score for predicting mortality in sepsis patients

ObjectiveTo evaluate the prognostic ability of systemic immune-inflammation index (SII) combine with quick Sequential Organ Failure Assessment (qSOFA) criteria in predicting the 28-day mortality of sepsis. MethodsA retrospective cohort study was conducted, with the population comprised in whom sepsis was confirmed. Clinical and laboratory data recorded were analyzed. The score of Sequential Organ Failure Assessment (SOFA), SII, qSOFA were calculated. Multivariable regression, receiver operating characteristic (ROC) analysis and Kaplan-Meier method were used to identify and compared the predictors of prognosis among SOFA, qSOFA, and the combination of SII with qSOFA. ResultsA total of 349 patients admitted from December 2020 and December 2022 were included in the cohort. 95 (27.2%) of whom had died by day 28. The SII, SOFA, and qSOFA scores were significant higher in the non-survivors than that of survivors (P < 0.05), and identified as independent predictors of sepsis mortality. The addition of SII to qSOFA shown an area under receiver operator characteristic (AUROC) of 0.840 (95% CI: 0.787–0.884), manifested an effective ability in predicting poor outcome than other scoring systems. The optimum cutoff for SII (>1.7668) and qSOFA (>1) represented a high risk level in 28-day mortality of sepsis, were performed and identified in Kaplan-Meier survival curves (log-rank test, HR: 6.942, 95% CI: 3.976–12.121; P < 0.0001). ConclusionThe SII in addition to qSOFA provided an effective prognostic tool for predicting mortality in sepsis.

Predictors of Length of Stay, Rehospitalization and Mortality in Community-Acquired Pneumonia Patients: A Retrospective Cohort Study.

Community-acquired pneumonia (CAP) represents one of the leading causes of hospitalization and has a substantial impact on the financial burden of healthcare. The aim of this study was to identify factors associated with the length of hospital stay (LOHS), rehospitalization and mortality of patients admitted for CAP. A retrospective cohort study was conducted with patients presenting to a Swiss public hospital between January 2019 and December 2019. Zero-truncated negative binomial and multivariable logistic regression analyses were performed to assess risk factors. A total of 300 patients were analyzed (median 78 years, IQR [67.56, 85.50] and 53% males) with an average LOHS of 7 days (IQR [5.00, 9.00]). Of the 300 patients, 31.6% (97/300) were re-hospitalized within 6 months, 2.7% (8/300) died within 30 days and 11.7% (35/300) died within 1 year. The results showed that sex (IRR = 0.877, 95% CI = 0.776-0.992, p-value = 0.036), age (IRR = 1.007, 95% CI = 1.002-1.012, p-value = 0.003), qSOFA score (IRR = 1.143, 95% CI = 1.049-1.246, p-value = 0.002) and atypical pneumonia (IRR = 1.357, 95% CI = 1.012-1.819, p-value = 0.04) were predictive of LOHS. Diabetes (OR = 2.149, 95% CI = 1.104-4.172, p-value = 0.024), a higher qSOFA score (OR = 1.958, 95% CI = 1.295-3.002, p-value = 0.002) and rehabilitation after discharge (OR = 2.222, 95% CI = 1.017-4.855, p-value = 0.044) were associated with a higher chance of being re-hospitalized within 6 months, whereas mortality within 30 days and within one year were both associated with older age (OR = 1.248, 95% CI = 1.056-1.562, p-value = 0.026 and OR = 1.073, 95% CI = 1.025-1.132, p-value = 0.005, respectively) and the presence of a cancer diagnosis (OR = 32.671, 95% CI = 4.787-369.1, p-value = 0.001 and OR = 4.408, 95% CI = 1.680-11.43, p-value = 0.002, respectively). This study identified routinely available predictors for LOHS, rehospitalization and mortality in patients with CAP, which may further advance our understanding of CAP and thereby improve patient management, discharge planning and hospital costs.

Impact of qSOFA Score on the Outcome of Patients in ICU with Respiratory Tract Infection

Abstract Background The quick Sequential Organ Failure Assessment (qSOFA) score is a bedside prompt that may identify patients with suspected infections who are greater risk for poor outcome in the intensive care unit (ICU). Objectives To assess the impact of qSOFA score on the outcome of patients in ICU with respiratory tract infection. Patients and Methods This Observational prospective study study carried out at ICU department of Ain Shams University Hospitals and Al Mahala Chest Hospital during the period from 1 February 2020 till March 2021 and included 122 patients presented by respiratory infection. Diagnosis of infection based on clinical, laboratory, radiological and/or microbiological evidence in accordance with guidelines for diagnosis of infection. All patients subjected to full history, physical examination, full laboratory tests (including arterial blood gas, complete blood cell with differentiation, international normalized ratio, kidney function tests, liver function tests, random blood sugar, C-reactive protein, erythrocyte sedimentation rate, serum sodium and serum potassium), chest X-ray and/or computerized tomography of chest, sputum cytological analysis and sputum culture. Measurement of qSOFA done in all patients. Results The median of qSOFA score in survivors was 0 while in nonsurvivors 1 at admission and after 48 hours with a significant difference between both groups. In overall patients qSOFA cutoff 1 has sensitivity and specificity 70% &amp; 80.37%, respectively. Conclusion The qSOFA scores were associated with in hospital mortality, hospital admission, ICU admission, and hospital length of stay in patients likely to be admitted both with and without suspected infection, qSOFA is an easy tool that can be used to predict outcomes.

FTP2.1 Management settings and follow-up of acute diverticulitis

Abstract Aims This audit evaluated our management of acute diverticulitis against the NICE and ACPGBI guidelines. We explored follow-up luminal investigations to ensure patients safety, and practicality of ambulatory management to potentially improve bed capacity and reduce costs. Method Retrospective data of patients presented acutely with CT-proven diverticulitis from 01/06/2021 to 31/10/2021 was collected. We focused on clinical, biochemical and radiological severity, management, and follow-up investigations. Results Records of 142 patients were evaluated, most of them had mild clinical disease with significant qSOFA score in only 8 patients. Most of patients had WCC of less than 15 and CRP of less than 100. Even in radiological severity, class 1a of modified Hinchey classification (uncomplicated disease) dominated with 96 patients. Interestingly, only 22 patients were treated via ambulatory care, while the remaining 120 received inpatient care. 10 of the inpatient treated patients required HDU/ ITU support and most of the hospital stays were 7 days or less. The treatment was predominantly non-operative, with only 4 patients required surgery and 6 others required radiological drainage. The 1-year follow-up showed only 16 readmissions. As for the follow-up investigations, 45 did not have any follow-up investigations or clinic reviews, 14 of them had complicated diverticulitis. Of the 97 patients who were followed up, 88 patients had endoscopic evaluation and 8 underwent CT colonography. Conclusion Since most patients of acute diverticulitis present with clinically, biochemically, and radiologically mild and uncomplicated disease, ambulatory management should be encouraged where possible. While 1-year readmissions remain low, it is crucial that patients, especially those with complicated disease, receive luminal investigations.

The S-S.M.A.R.T: A New Prognostic Tool for Patients with Suspected Sepsis in the Emergency Department.

The sepsis screening tool is essential because it enables the rapid identification of high-risk patients and facilitates prompt treatment. Quick Sequential Organ Failure Assessment (qSOFA) is a widely used screening tool for sepsis. However, it has limitations in predicting patient prognosis. We developed the S-S.M.A.R.T (sepsis evaluation with shock index, mental status, age, and ROX index on triage) and aimed at evaluating it as a screening tool for patients with suspected sepsis in the emergency department. We conducted a single-center retrospective chart review of patients with suspected sepsis in the emergency department. We compared the prognosis prediction abilities of the S-S.M.A.R.T and qSOFA scores in patients with suspected sepsis. The primary outcome was 7-day mortality, and the secondary outcomes included 30-day mortality and ICU admission. The receiver operating characteristic (ROC) curve analysis and the chi-square test were used. In total, 401 patients were enrolled. The mean age of the patients was 72.2 ± 15.6 years, and 213 (53.1%) of them were female. The S-S.M.A.R.T had superior predictive ability for prognosis of patients with suspected sepsis compared to qSOFA (area under the ROC curve (AUC) of 0.789 vs. 0.699; p=0.02 for 7-day mortality, AUC of 0.786 vs. 0.681; p < 0.001 for 30-day mortality, AUC 0.758 vs 0.717; p=0.05 for ICU admission). The S-S.M.A.R.T can be useful in predicting the prognosis of patients with suspected sepsis in the emergency department.

Real-time artificial intelligence system for bacteremia prediction in adult febrile emergency department patients

BackgroundArtificial intelligence (AI) holds significant potential to be a valuable tool in healthcare. However, its application for predicting bacteremia among adult febrile patients in the emergency department (ED) remains unclear. Therefore, we conducted a study to provide clarity on this issue. MethodsAdult febrile ED patients with blood cultures at Chi Mei Medical Center were divided into derivation (January 2017 to June 2019) and validation groups (July 2019 to December 2020). The derivation group was utilized to develop AI models using twenty-one feature variables and five algorithms to predict bacteremia. The performance of these models was compared with qSOFA score. The AI model with the highest area under the receiver operating characteristics curve (AUC) was chosen to implement the AI prediction system and tested on the validation group. ResultsThe study included 5,647 febrile patients. In the derivation group, there were 3,369 patients with a mean age of 61.4 years, and 50.7% were female, including 508 (13.8%) with bacteremia. The model with the best AUC was built using the random forest algorithm (0.761), followed by logistic regression (0.755). All five models demonstrated better AUC than the qSOFA score (0.560). The random forest model was adopted to build a real-time AI prediction system integrated into the hospital information system, and the AUC achieved 0.709 in the validation group. ConclusionThe AI model shows promise to predict bacteremia in adult febrile ED patients; however, further external validation in different hospitals and populations is necessary to verify its effectiveness.

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.

Quick Sequential Organ Failure Assessment Score Is a Better Predictor of Septic Shock After Percutaneous Nephrolithotomy: A Secondary Analysis of Two Multicenter Prospective Trials.

Introduction: Recent retrospective literature suggests that the quick sequential organ failure assessment (qSOFA) scoring tool is a potentially superior tool over use of the systemic inflammatory response syndrome (SIRS) criteria to predict septic shock after percutaneous nephrolithotomy (PCNL) surgery. Here we examine use of qSOFA and SIRS to predict septic shock within data series collected prospectively on PCNL patients as part of a greater study of infectious complications. Materials and Methods: We performed a secondary analysis of two prospective multicenter studies including PCNL patients across nine institutions. Clinical signs informing SIRS and qSOFA scores were collected no later than postoperative day 1. The primary outcome was sensitivity and specificity of SIRS and qSOFA (high-risk score of greater-or-equal to two points) in predicting admission to the intensive care unit (ICU) for vasopressor support. Results: A total of 218 cases at 9 institutions were analyzed. One patient required vasopressor support in the ICU. The sensitivity/specificity was 100%/72.4% (McNemar's test p < 0.001) for SIRS and was 100%/90.8% (McNemar's test p < 0.001) for qSOFA. Conclusion: Although positive predictive value for both qSOFA and SIRS in prediction of post-PCNL septic shock is low, prospectively collected data demonstrate use of qSOFA may offer greater specificity than SIRS criteria when predicting post-PCNL septic shock.

Comparison of Prognostic Scores for Patients with COVID-19 Presenting with Dyspnea in the Emergency Department

BackgroundEasy-to-use bedside risk assessment is crucial for patients with COVID-19 in the overcrowded emergency department (ED). ObjectiveThe aim of this study was to explore the prognostic ability of ratio of percutaneous oxygen saturation (SpO2) to fraction of inspired oxygen (FiO2) (S/F); ratio of SpO2/FiO2 to respiratory rate (ROX); National Early Warning Score (NEWS); quick Sequential Organ Failure Assessment (qSOFA); and confusion, respiratory rate, blood pressure, and age ≥ 65 years (CRB-65) in patients with COVID-19 presenting with dyspnea to the ED. MethodsIn this retrospective observational study, clinical and demographic details of patients with COVID-19 were obtained at ED admission. S/F, ROX, NEWS, CRB-65, and qSOFA scores were calculated at the time of ED arrival. Accuracy of these five indices to predict the need for invasive mechanical ventilation (IMV) within 48 h, intensive care unit (ICU) admission, and early (7-day) mortality were determined using receiver operating characteristic curves. ResultsA total of 375 patients were included in this study. Fifty patients (13.3%) required IMV within 48 h and 58 patients (15.5%) were transferred to the ICU. Seven-day mortality was 6.7% and 28-day mortality was 18.1%. Among all five scores determined from patient data on ED admission, ROX, S/F, and NEWS presented greater discriminatory performance than CRB-65 and qSOFA in predicting IMV within 48 h, ICU admission, and early mortality. ConclusionsEmergency physicians can effectively use S/F, ROX, and NEWS scores for rapid risk stratification of patients with COVID-19 infection. Moreover, from the perspective of simplicity and ease of calculation, we recommend the use of the S/F ratio.

Predictors of In-Hospital Mortality in Older Inpatients with Suspected Infection

ObjectivesTo determine the rate and predictors of death in older individuals with suspected infection at any time during hospital stay in a geriatric acute ward and the prognostic ability of different tools [quick Sequential (Sepsis-related) Organ Failure Assessment (qSOFA), Modified and National Early Warning Scores (MEWS) and (NEWS)] in such population. DesignProspective observational single-center cohort study. Setting and ParticipantsAmong patients admitted to an acute geriatric unit of an Italian University Hospital with at least 1 sepsis risk factor, all subjects with suspected infection at admission or during hospital stay (defined as antibiotic prescription and associated culture test) were considered. MethodsA geriatric assessment including comorbidity and social, functional, and cognitive status was performed for each patient. Clinical parameters were evaluated at least twice daily throughout hospital stay; qSOFA, MEWS, and NEWS were derived, with positive cutoffs set at ≥2, ≥5, and ≥7, respectively. ResultsAmong 305 older inpatients (median age 86.0 years, 49.2% female), 21% died during hospital stay. Sepsis was diagnosed in 31.8% of the overall sample and in 64.1% of deceased patients. Deceased patients showed a significantly higher prevalence of prior institutionalization, functional dependence, cognitive impairment, and multimorbidity. The prognostic accuracy of the qSOFA score at infection onset was only fair (area under the receiver operating characteristic curve 0.72; 95% CI, 0.65–0.79, P < .001) and comparable with that of MEWS and NEWS. After multivariable analysis, in-hospital death was positively associated with male sex [odds ratio (OR), 2.11; 95% CI, 1.01–4.44; P = .048] and abnormal white blood cells count (OR, 4.93; 95% CI, 2.36–10.29; P < .001), platelet count (OR, 2.61; 95% CI, 1.10–6.16; P = .029) and serum creatinine (OR, 2.70; 95% CI, 1.30–5.61; P = .008), along with any of the score considered, and negatively associated with autonomy in instrumental activities (OR, 0.78; 95% CI, 0.68–0.90; P < .001). ConclusionsPrognosis in older inpatients with infection or sepsis appears to be determined both by the geriatric characteristics and by the severity of the acute event, expressed by recommended tools and blood test results.

An Examination of Infection Incidence and Management in Systemic Lupus Erythematosus Patients: A Five-Year Review from a Saudi Arabian Center.

BACKGROUND Systemic lupus erythematosus (SLE) is a chronic autoimmune condition often associated with an increased susceptibility to infections. The infections in patients with SLE, primarily involving the skin, respiratory tract, and urinary tract, can significantly complicate disease management. This study aimed to evaluate the occurrence, management, and patient outcomes associated with infections in a group of 74 SLE patients at a single center in Saudi Arabia, spanning a 5-year period. MATERIAL AND METHODS An observational, retrospective study was conducted at the King Khalid University Hospital, Riyadh, Saudi Arabia. Patient medical records from January 2016 to December 2020 were examined. All adult SLE patients (age >14 years, as per hospital policy), confirmed by SLICC criteria, and admitted due to infections (determined by quick Sequential Organ Failure Assessment or qSOFA scores) were included in the study. RESULTS Of the 74 SLE patients studied, 79.7% were administered hydroxychloroquine. A majority (83.8%) were classified as low-risk for sepsis-associated mortality based on qSOFA scores (0-1), a fact noted by 41.9% of rheumatology fellows. The sputum cultures most frequently identified were Klebsiella pneumoniae, yeast, and Haemophilus influenzae (each accounting for 33.3% of cases). Furthermore, 4.1% of patients had extended-spectrum beta-lactamases infections, and 2.7% tested positive for COVID-19. A history of sepsis was more commonly observed among non-survivors (P=0.010). CONCLUSIONS The majority of patients were classified as low-risk for sepsis-associated mortality based on qSOFA scores, with two-thirds prescribed antibiotics within 1 h. The primary causes of death were multiorgan failure and cardiac arrest.