qSOFA In Patients Research Articles

EVALUATION OF QUICK SOFA IN DIAGNOSIS AND PROGNOSIS OF SEPSIS PATIENTS TREATED AT HUE CENTRAL HOSPITAL (4/2018 - 3/2020)

Background: Sepsis is a life - threatening organ dysfunction. Previous consensuses defined sepsis as infection with systemic inflammation response syndrome (SIRS). The new 2016 consensus selected SOFA and Quick SOFA instead of SIRS in diagnosing sepsis. 
 Objectives: 1. Describe clinical and subclinical characteristics of patients with sepsis. 2. Compare qSOFA and SIRS in the diagnosis and prognosis of the outcome of patients with sepsis. Subjects and method: Patients were diagnosed with sepsis based on the definition Sepsis - 2 (2001) or Sepsis - 3 (2016), treated at the Intensive Care Unit and the Department of Tropical Diseases, Hue Central Hospital. A prospective study.
 Results: There were 59 selected patients. The mean age was 60.22 ± 18.19 (28 - 90). Coagulation and cardiovascular dysfunction in patients with sepsis were the most common (61%), followed by kidneys (54%) and CNS (51%). Results of treatment: 44.1 % of patients had a septic shock; 28.8% died. In all patients, qSOFA ≥ 2 achieved rate was lower than SIRS ≥ 2 (72.9% compared to 98.3%). qSOFA0 had a high value in predicting ICU admission and had statistically significantly higher when compared to SIRS0. qSOFA0 had mean value in predicting in septic shock and had significantly higher when compared to SIRS0. qSOFA had a high value in predicting hospital mortality and had significantly higher when compared to SIR 0. 
 Conclusion: SIRS is more noted than qSOFA in patients with sepsis. qSOFA0 has higher value than SIRS 0 in predicting ICU admission and hospital mortality in patients with sepsis.

Prognostic value of the qSOFA in patients with acute exacerbation of idiopathic pulmonary fibrosis

BackgroundPatients with idiopathic pulmonary fibrosis (IPF) have a slowly progressive clinical course, although some develop acute exacerbations (AEs). An easily obtained composite score is desirable for predicting the survival rate in patients with AE of IPF (AE-IPF). We investigated the quick sequential organ failure assessment (qSOFA), originally developed to identify sepsis, as a predictor of mortality in patients with AE-IPF and compared it to other composite assessments. MethodsConsecutive patients with IPF admitted for their first AE between 2008 and 2019 were recruited retrospectively. The association between the qSOFA score obtained at admission and mortality was investigated. ResultsDuring the study period, 97 patients with AE-IPF were hospitalized. The hospital mortality was 30.9%. Multivariate logistic regression analysis revealed that both the qSOFA and the Japanese Association for Acute Medicine (JAAM)-disseminated intravascular coagulation (DIC) scores were significant predictors of hospital mortality (odds ratio [OR] 3.86, 95% confidence interval [CI] 1.43–10.3; p = 0.007 and OR 2.71, 95% CI 1.56–4.67; p = 0.0004; respectively). Kaplan–Meier survival curves showed that both scores were consistently associated with survival. Furthermore, the sum of the two scores was a more effective predictor than the individual scores. ConclusionsThe qSOFA score of patients admitted with AE-IPF was associated with both in-hospital and long-term mortality, which was also true for the JAAM-DIC score. The qSOFA score plus the JAAM-DIC score should be determined during the diagnostic evaluation of a patient with AE-IPF. Both scores combined may be more effective at predicting outcomes than individual scores.

A 2-year retrospective analysis of the prognostic value of MqSOFA compared to lactate, NEWS and qSOFA in patients with sepsis

PurposeSepsis is a life-threating organ dysfunction caused by a dysregulated host response to infection. Being a time-dependent condition, the present study aims to compare a recently established score, i.e., modified quick SOFA (MqSOFA), with other existing tools commonly applied to predict in-hospital mortality.MethodsAll cases of sepsis and septic shock consecutively observed at St. Anna University Hospital of Ferrara, Italy, from January 2017 to December 2018 were included in this study. Each patient was evaluated with MqSOFA, lactate assay, NEWS and qSOFA. Accurate statistical and logistic regression analyses were applied to our database.ResultsA total of 1001 consecutive patients with sepsis/septic shock were retrieved. Among them, 444 were excluded for incomplete details about vital parameters; thus, 556 patients were eligible for the study. Data analysis showed that MqSOFA, NEWS and lactate assay provided a better predictive ability than qSOFA in terms of in-hospital mortality (p < 0.001). Aetiology-based stratification in 5 subgroups demonstrated the superiority of NEWS vs. other tools in predicting fatal outcomes (p = 0.030 respiratory, p = 0.036 urinary, p = 0.044 abdominal, p = 0.047 miscellaneous and p = 0.041 for indeterminate causes). After Bonferroni’s correction, MqSOFA was superior to qSOFA over respiratory (p < 0.001) and urinary (p < 0.001) aetiologies. Age was an independent factor for negative outcomes (p < 0.001).ConclusionsMqSOFA, NEWS and lactate assay better predicted in-hospital mortality compared to qSOFA. Since sepsis needs a time-dependent assessment, an easier and non-invasive score, i.e., MqSOFA, could be used to establish patients’ outcome in the emergency setting.

Limited prognostic accuracy of the CRB-65 and qSOFA in patients presenting with pneumonia and immunosuppression

BackgroundScores for risk prediction used in immunocompetent patients with sepsis or pneumonia are poorly evaluated in immunocompromised patients. Therefore, we evaluated the prognostic value of the qSOFA- and CRB-65-criteria in immunocompromised patients presenting with pneumonia. MethodsRetrospective cohort study including consecutive patients hospitalized with pneumonia and immunosuppression without treatment restrictions. The qSOFA and CRB-65 criteria were documented in the emergency department. Outcome was defined as need of mechanical ventilation (MV) or vasopressor support (VS) and/or hospital-mortality. Results41 of 198 (21%) patients reached the outcome and 10% died. Both, the CRB-65 and qSOFA- were independently associated with the outcome (all p<0.01), but age was not predictive. ROC curve analysis showed moderate predictive potential for both scores (CRB-65: AUC 0.63 and qSOFA: 0.69). With scores of 0, the negative predictive values were below 90% (CRB-65: 9/60 and qSOFA: 12/105 missed patients). With scores > 1, the positive predictive values were 36% (CRB-65) and 58% (qSOFA), respectively. ConclusionsBoth, the qSOFA and the CRB-65 only showed moderate prognostic value, and negative predictive values were inadequate to exclude organ failure or death in patients with immunosuppression. In this population, age was not a predictive parameter. Patients with > 1 positive vital sign criterion measured by both scores should be assessed for organ failure.

P0639COMPARISON OF SIRS AND QSOFA CRITERIAS IN RECOGNITION OF SEPSIS RELATED ACUTE KIDNEY INJURY

Abstract Background and Aims Sepsis is life-threatening organ dysfunction caused by a dysregulated host response to infection. Epidemiological studies have shown that the incidence of sepsis is increasing and therefore it is a public health problem. AKI is often associated with critical illnesses such as sepsis, and is associated with prolonged hospital stay, need for intensive care, increased morbidity and mortality. Although the mechanism of sepsis-induced AKI is not fully understood, it is thought that it has a different pathogenesis and requires a different approach and therefore it has been the focus of the studies. The aim of this study was to compare the criteria of SIRS and qSOFA in patients with suspected infection to determine which is more valuable in predicting sepsis associated AKI. Method SIRS and qSOFA scores of 120 patients with sepsis who were admitted to the Emergency Department of Marmara University Hospital were calculated at the time of admission. Age, gender and chronic diseases were recorded. The laboratory values at the time of admission and follow-up were recorded and the factors associated with the development of AKI were investigated by statistical analysis. Results Of the patients evaluated in the study, 60.8% (n = 73) were male and 39.2% (n = 47) were female. The median age was 66 (18-89) years. About 96% (n = 116) of the patients met the SIRS criteria, 54.2% (n = 65) met the qSOFA criteria, and 51.7% (n = 62) met both the SIRS and qSOFA criteria. AKI was found in 62.5% (n = 75) of the patients. According to AKIN staging, 40 (53.3%) patients had stage 1, 19 (25.3%) patients had stage 2 and 16 (21.4%) patients had stage 3 AKI. There was no correlation between SIRS criteria and development of AKI. However, all patients who received 3 points from qSOFA criteria developed AKI. According to the results of multivariate analysis, age, abnormal mental status and procalcitonin were associated with development of AKI. Conclusion Sepsis-associated AKI is related with deterioration in clinical outcomes, early diagnosis and treatment is important. According to our results, the risk of AKI is higher in patients with qSOFA score 3 but not SIRS criterias.

Epidemiology of Quick Sequential Organ Failure Assessment Criteria in Undifferentiated Patients and Association With Suspected Infection and Sepsis

The role of Quick Sequential Organ Failure Assessment (qSOFA) criteria in sepsis screening and management is controversial, particularly as they were derived only in patients with suspected infection. We examined the epidemiology and prognostic value of qSOFA in undifferentiated patients. We identified patients with≥ 2 qSOFA criteria within 1day of admission among all adults admitted to 85 US hospitals from 2012 to 2015 and assessed for suspected infection (using clinical cultures and administration of antibiotics) and sepsis (as defined on the basis of Sepsis-3 criteria). We also examined the discrimination of qSOFA for in-hospital mortality among patients with and without suspected infection, using regression models. Of 1,004,347 hospitalized patients, 271,500 (27.0%) were qSOFA-positive on admission. Compared with qSOFA-negative patients, qSOFA-positive patients were older (median age, 65 vs58 years), required ICU admission more often (28.5%vs6.5%), and had higher mortality (6.7%vs0.8%) (P< .001 for all comparisons). Sensitivities of qSOFA for suspected infection and sepsis were 41.3%(95%CI, 41.1%-41.5%) and 62.8%(95%CI, 62.4%-63.1%), respectively; positive predictive values were 31.0%(95%CI, 30.8%-31.1%) and 17.4%(95%CI, 17.2%-17.5%). The area under the receiver operating characteristic curve for mortality was lower for qSOFA in patients with suspected infection vsthose without (0.814 vs0.875; P< .001). Only one in three patients who are qSOFA-positive on admission has suspected infection, and one in six has sepsis. qSOFA also has low sensitivity for identifying suspected infection and sepsis, and its prognostic significance is not specific to infection. More sensitive and specific tools for sepsis screening and risk stratification are needed.

181 Early Variation of qSOFA for Risk Stratification in Emergency Infected Patients

In 2016, the SEPSIS-3 consensus redefined the concept of sepsis and suggested that the use of quick sequential organ failure assessment (qSOFA) could early identify patients at risk of poor outcomes. The score is based on the early assessment of three items: respiratory rate ≥22/min, altered mentation, and systolic blood pressure ≤100 mm Hg. Several studies have since validated this score in emergency department (ED) patients. However, the potential variability of qSOFA in ED patients has not been considered in prior publications. The purpose of this study was to evaluate whether serial evaluation of the qSOFA score (ΔqSOFA) during the first three hours could increase the prognostic accuracy of qSOFA in patients presenting to the ED with suspicion of infection. This was an international prospective cohort study conducted by 17 adult EDs between October 2016 and April 2017 in France, Spain and Belgium. Consecutive patients with a clinical suspicion of infection and qSOFA score ≥ 2 were included. The qSOFA was measured at 0, 1 and 3 hours (H0, H1 and H3 respectively), and patients were followed up until death or hospital discharge. The primary objective was to assess the prognostic accuracy of ΔqSOFAH0H3 (qSOFAH0 minus qSOFAH3). The primary end point was in-hospital mortality, truncated at 28 days. Secondary end points include a composite severity endpoint of death or ICU stay of more than 72 hours. On the 533 recruited patients, 7 were excluded for missing values and 14 because they had a qSOFA=1 at inclusion, leaving 512 for analysis. Mean age was 71 (standard deviation 18) and 56% were men. Infection was confirmed in 454 patients (88%), with a respiratory or urinary source in most cases (50% and 20% respectively). During the first three hours, patients received a median of 1500ml of fluids (interquartile range 1000 - 2000). A total of 140 patients (27%) met the primary endpoint of in-hospital mortality, and 257 (50%) the composite severity endpoint. Two hundred eighty seven patients (55%) had an improved qSOFA score at H3. The value of ΔqSOFAH0H3 was inversely associated with the risk of death (Figure 1). Overall, the improvement of at least one point in qSOFA within 3 hours was associated with a reduced risk of in-hospital death (18% vs 37%, 19% difference [95% confidence interval [CI] 12% - 27%]) and of the composite endpoint (41.3% vs 61.1%, 20% difference [95% CI 11% - 129%]). The area under the ROC curve of ΔqSOFA was 0.65 [95% CI 0.59 - 0.69] for the prediction of in-hospital death, and 0.63 [95% CI 0.57 - 0.66] for the composite endpoint. Similar trends with smaller effect size were found with the variation of qSOFA between H0 and H1, and H1 and H3. Among ED patients with infection and an initial qSOFA score of at least two, an improvement of this score during the first 3 hours is associated with a reduction of in-hospital mortality. However, the variation of qSOFA in the early hours has only mediocre prognostic value.