qSOFA Score Research Articles

Determination of the relationship between mortality and SOFA, qSOFA, MASCC scores in febrile neutropenic patients monitored in the intensive care unit.

PurposeFebrile neutropenia (FN) is a hematological emergency. It is challenging and confusing for the clinicians to make the decision of the febrile neutropenic patients under chemotherapy to be monitored at intensive care unit (ICU). The aim of this study was to define the factors supporting decision-making for the critical patients with febrile neutropenia.MethodsThe data of 60 patients, who were taken to the ICU while they were under treatment in the Hematology Clinic with a diagnosis of febrile neutropenia, were analyzed retrospectively, in order to identify clinically useful prognostic parameters.ResultsThe ICU mortality rate was 80%. Mortality was significantly associated with higher sequential organ failure assessment score (SOFA), quick sequential organ failure assessment score (qSOFA), and hematological SOFA (SOFAhem) scores on admission. All cases having SOFA score 10 and above and qSOFA score 2 and above died. In multivariate analysis, qSOFA score was found to be statistically significant in predicting mortality in regard to ICU admission (p = 0.004).ConclusionMortality of febrile neutropenic patients admitted to ICU is high. It would be appropriate to determine the extent of organ dysfunction instead of underlying disease, for making the decision of ICU admission. It should be noticed that the risk mortality is high for the FN cases with SOFA score 10 or above, qSOFA score 2 or above, and in need of mechanical ventilation and positive inotropic support; hence, early intervention is recommended. In our study, the most significant parameter in predicting ICU mortality was found to be qSOFA.

Urgent and emergency surgery for secondary peritonitis during the COVID-19 outbreak: an unseen burden of a healthcare crisis.

The COVID-19 pandemic has raised concerns about the negative impact of the fear of contagion on people’s willingness to seek medical care and the subsequent effects on patients’ prognosis. To date, not much is known about the outcomes of acute surgical diseases in this scenario. The aim of this multicenter observational study is to explore the effects of COVID-19 outbreak on the outcomes of patients who underwent surgery for peritonitis. Patients undergoing surgery for secondary peritonitis during the first COVID-19 surge in Italy (March 23–May 4, 2020—COVID period group) were compared with patients who underwent surgery during the same time interval of year 2019 (no-COVID period group). The primary endpoint was the development of postoperative complications. Logistic regression analysis was conducted to identify predictors of complications. Of the 332 patients studied, 149 were in the COVID period group and 183 were in the no-COVID period group. Patients in the COVID period group had an increased frequency of late presentations to the emergency departments (43% vs. 31.1%; P = 0.026) and a higher rate of postoperative complications (35.6% vs. 18%; P < 0.001). The same results were found in the subset analysis of patients with severe peritonitis at surgical exploration. The ASA score, severity of peritonitis, qSOFA score, diagnosis other than appendicitis, and COVID period resulted independent predictors of complications. During the COVID-19 pandemic patients with peritonitis had a higher rate of complicated postoperative courses, weighing on hospital costs and assistance efforts already pressured by the ongoing sanitary crisis.

A Prospective Cohort Study of the Quick Sequential Organ Failure Assessment (qSOFA) Score versus Systemic Inflammatory Response Syndrome (SIRS) Criteria in the Determination and Prognostication of Sepsis in a Philippine Tertiary Hospital

Background. Sepsis is a leading cause of mortality both locally and worldwide. Despite this, early diagnosis of sepsis remains challenging, with a significant number not fulfilling SIRS (Systemic Inflammatory Response Syndrome) criteria. In 2016, the Sepsis-3 guidelines modified its definition to include the qSOFA (Quick Sequential Organ Failure Assessment) score in an attempt to include a significant number of SIRS-negative septic patients. Methods. To compare the two, 295 adult patients in the emergency room with suspected infection were included in the study and simultaneously determined their qSOFA score and SIRS criteria. Three infection specialists adjudicated the presence of sepsis, and outcomes within the first 48 hours were acquired. Sensitivity, specificity, positive predictive and negative predictive values for qSOFA and SIRS were computed using constructed confusion matrices, and overall predictive accuracy was measured by the Area under the Receiver Operating Characteristic (AUROC) curve. Results. Of the 295 patients included in the study, 95 (32.2%) were deemed sepsis positive via adjudication. The qSOFA score was a specific (95.5%) but a poorly sensitive (46.3%) test compared to the SIRS criteria (sensitivity 73.7% and specificity 60%). Both qSOFA and the SIRS criteria significantly correlated with sepsis positivity, but the qSOFA score had superior overall predictive accuracy at 70.9% compared to the SIRS criteria. The adjudicators had moderate strength in agreement (Fleiss’ kappa = 0.39) and a percentage agreement of 60%. Conclusion. We concluded that the qSOFA score was a more accurate predictor of sepsis and a reliable predictor of in-hospital mortality, but should not be used as a sepsis screening tool due to the low sensitivity. We recommend that the SIRS criteria be maintained as a screening tool and to use the qSOFA score concurrently for time management.

Vital signs, clinical rules, and gut feeling: an observational study among patients with fever.

BackgroundGPs decide which patients with fever need referral to the emergency department (ED). Vital signs, clinical rules, and gut feeling can influence this critical management decision.AimTo investigate which vital signs are measured by GPs, and whether referral is associated with vital signs, clinical rules, or gut feeling.Design & settingProspective observational study at two out-of-hours (OOH) GP cooperatives in the Netherlands.MethodDuring two 9-day periods, GPs performed their regular work-up in patients aged ≥18 years with fever (≥38.0°C). Subsequently, researchers measured missing vital signs for completion of the systemic inflammatory response syndrome (SIRS) criteria and the quick Sequential Organ Failure Assessment (qSOFA) score. Associations between the number of referrals, positive SIRS and qSOFA scores, and GPs’ gut feelings were investigated.ResultsGPs measured and recorded all vital signs required for SIRS criteria and qSOFA score calculations in 24 of 108 (22.2%) assessed patients, and referred 45 (41.7%) to the ED. Higher respiratory rates, temperatures, clinical rules, and gut feeling were associated with referral. During 7-day follow-up, nine (14.3%) of 63 patients who were initially not referred were admitted to hospital.ConclusionGPs measured and recorded all vital signs for SIRS criteria and qSOFA score in one-in-five patients with fever, and referred half of 63 patients who were SIRS-positive and almost all of 22 patients who were qSOFA-positive. Some vital signs and gut feeling were associated with referral, but none were consistently present in all patients who were referred. The vast majority of patients who were not initially referred remained at home during follow-up.

Clinical observation and analysis on the significance of quick sequential organ failure assessment in 74 non-ICU patients with sepsis.

Sepsis is an important disease that endangers human health and is the main cause of death in ICU patients, which has been a focus of clinical treatment. This study aims to evaluate the significance of the readily available quick sequential organ failure assessment (qSOFA) score in clinical cases of sepsis. A retrospective cross-sectional study of patients with sepsis treated in the Department of Infectious Diseases, the Affiliated Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology from January 2015 to December 2016 was conducted, and the patients were divided into a high-score group (≥2 points) and the low-score group (<2 points) according to the diagnostic criteria for sepsis (Sepsis 3.0). The differences in disease outcome and inflammatory indicators were compared between groups. A total of 74 patients with sepsis were included in this study. When the cutoff qSOFA score was 2 points, the patients in the high-score group showed a higher mortality rate (71.43%), and the patients in the low-score group showed a higher improvement rate (87.76%). The inflammatory indicators did not show statistically significant differences between the two groups. The qSOFA score can better predict the prognoses of non-ICU patients with sepsis compared with traditional inflammatory indicators. Clinicians should raise their awareness about qSOFA and improving its accuracy.

Comparison of Systemic Inflammatory Response Syndrome and quick Sequential Organ Failure Assessment scores in predicting bacteremia in the emergency department.

AimThe emergency department requires simple and useful clinical indicators to identify bacteremia. This retrospective study explored the Systemic Inflammatory Response Syndrome (SIRS) and quick Sequential Organ Failure Assessment (qSOFA) scores for predicting bacteremia.MethodsBetween April and September 2017, we assessed blood cultures of 307 patients in our emergency department. We calculated the SIRS and qSOFA scores for these patients and evaluated their correlation with bacteremia.ResultsOf 307 patients, 66 (21.5%) had bacteremia, 237 (77.2%) were SIRS‐positive, and 123 (40.0%) were qSOFA‐positive. The sensitivity and specificity of the SIRS score for predicting bacteremia were 87.9% and 25.7%, respectively. The sensitivity and specificity of the qSOFA score were 47.0% and 61.8%, respectively. Multivariate analysis revealed that body temperature (odds ratio, 2.16; 95% confidence interval, 1.22–3.84; P = 0.009) and blood pressure (odds ratio, 2.72; 95% confidence interval, 1.39–5.35; P = 0.004) significantly associated with bacteremia.ConclusionsThe SIRS score was a more sensitive indicator than the qSOFA score for predicting bacteremia.

Role of Arterial Serum Lactate as a Predictor of Undifferentiated Shock on Admission and its Outcome- A Cohort Study

Introduction: Patients with elevated serum lactate levels may be at risk for considerable morbidity and mortality and require a prompt, thoughtful and systematic approach for diagnosis and treatment. Aim: To find an association of on admission arterial serum lactate with outcome in Intensive Care Unit (ICU) patients. Materials and Methods: This observational cohort study was conducted on 168 patients at Poona Hospital and Research Centre, Pune, India, between June 2018 to November 2019 after obtaining Institutional Ethical Clearance. The patients included were above 18 years of age who had Systolic Blood Pressure (SBP) &lt;90 mmHg, Heart Rate (HR) &gt;100/min and Respiratory Rate (RR) &gt;20/min. The arterial serum lactate level were examined on the day of admission, 12 hours and 24 hours. The need of ionotropic support, duration of ICU stay and mortality in one month was noted. The primary outcome measures were to study the association of on admission arterial serum lactate level with a duration of ICU stay and in-hospital mortality, whereas the secondary outcome measure was to study the association of on admission arterial serum lactate with the requirement of ionotropic support. Analysis of data was done using Statistical Package for Social Sciences for Windows, version 20.0. Results: The incidence in-hospital mortality was 20 (22.7%) out of 88 and 3 (3.8%) out of 80 in patients whose serum lactate levels on admission were &gt;36 mg/dL and ≤36 mg/dL, respectively (p-value=0.002). The median duration of ICU stay was six and three days in patients whose serum lactate levels on admission were &gt;36 mg/dL and ≤36 mg/dL, respectively (p-value=0.001). A 87 (98.9%) patients whose serum lactate levels &gt;36 mg/dL on admission had the higher requirement of inotropes as compared to 35 (50.7%) patients whose serum lactate levels were ≤36 mg/dL. The percentage of patients whose serum lactate level &gt;36 mg/dL, had a significantly higher Quick Sequential Organ Failure Assessment (qSOFA) scores and higher Shock Index (SI). There was a statistically significant positive correlation between serum lactate levels and qSOFA score (r=0.555) and SI (r=0.559). Conclusion: Initial serum lactate level was associated with higher in-hospital mortality, the higher requirement of inotropic support and longer duration of ICU stay.

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.)

The role of qSOFA score and biomarkers in assessing severity of community-acquired pneumonia in adults

Abstract Introduction: Community-acquired pneumonia (CAP) is the primary cause of severe sepsis. Severity assessment scores have been created, in order to help physicians decide the proper management of CAP. The purpose of this study was to examine the correlations between different CAP severity scores, including qSOFA, several biomarkers and their predictive value in the 30 day follow-up period, regarding adverse outcome. Materials and methods: One hundred and thirty nine adult patients with CAP, admitted in the Teaching Hospital of Infectious Diseases, Cluj-Napoca, Romania from December 2015 to February 2017, were enrolled in this study. Pneumonia Severity Index (PSI), CURB-65, SMART-COP and the qSOFA scores were calculated at admittance. Also, C-reactive protein (CRP), procalcitonin (PCT) and albumin levels were used to determine severity. Results: The mean PSI of all patients was 93.30±41.135 points, for CURB-65 it was 1.91±0.928 points, for SMART-COP it was 1.69±1.937 points. The mean qSOFA was 1.06±0.522 points, 21 (14.9%) were at high risk of in-hospital mortality. In the group of patients with qSOFA of ≥2, all pneumonia severity scores and all biomarkers tested were higher than those with scores &lt;2. We found significant correlations between biomarkers and severity scores, but none regarding adverse outcome. Conclusion: The qSOFA score is easier to use and it is able to accurately evaluate the severity of CAP, similar to other scores. Biomarkers are useful in determining the severity of the CAP. Several studies are needed to assess the prediction of these biomarkers and severity scores in pneumonia regarding adverse outcome.

Predictors of mortality and the need of mechanical ventilation in confirmed COVID-19 patients presenting to the emergency department in North India.

Background and Objectives:As the number of COVID-19 cases keeps on rising, a better awareness of the nature and severity of the disease will aid in clinical decision-making and management. Hence, this study was conducted to find the predictors of mortality and the need for mechanical ventilation in COVID-19 patients.Methods:This was a single centre, prospective observational study conducted in a tertiary care centre in north India. We included patients with influenza like illness who tested positive for COVID-19. Information regarding patient demography, symptoms, and vital signs on presentation, laboratory values, chest imaging findings, and disease severity was collected by the emergency physician. QSOFA score and National early warning score (NEWS) score were calculated using initial vital signs. Each patient was followed up till discharge or death.Results:We included 116 COVID-19 patients with 33 patients having mild, 46 patients with severe and 37 patients with critical disease. The median age of our patients was 47 years (39–59) with 63% males. About 58% of patients had at least one comorbidity and shortness of breath was the most common presenting feature. The patients with severe and critical disease had a significantly higher respiratory rate and heart rate as compared to mild disease (p < 0.05). SpO2 of those with critical disease was significantly lower as compared to those with mild disease. Mechanical ventilation was required in around 36% of patients which included 67% of patients with critical disease. The overall mortality was 51% with 90% among critical disease. Lower SpO2 and GCS were the only parameters that showed a significant association with mortality and need for mechanical ventilation. The receiver operating characteristics analysis showed NEWS score as a better predictor of mortality and need for mechanical ventilation as compared to qSOFA score.Conclusion:NEWS and qSOFA scores are useful tools in predicting fatal outcomes in COVID patients with NEWS score being a better score than qSOFA.

The predictive value of qSOFA and CURB-65 scores in predicting the hospitalization need and mortality in patients with acute exacerbation of chronic obstructive pulmonary disease

article: The predictive value of qSOFA and CURB-65 scores in predicting the hospitalization need and mortality in patients with acute exacerbation of chronic obstructive pulmonary disease - Italian Journal of Emergency Medicine 2020 December;9(3):169-77 - Minerva Medica - Journals

Use of quick sequential organ failure assessment score-based sepsis clinical decision support system may be helpful to predict sepsis development

Objectives: A sepsis clinical decision support system (CDSS) can facilitate quicker sepsis detection and treatment and consequently improve outcomes. We developed a qSOFA-based sepsis CDSS and evaluated its impact on compliance with a 3-hour resuscitation bundle for patients with sepsis. Methods: This before-and-after study included consecutive adult patients with suspected infection and qSOFA scores of ≥ 2 at their emergency department (ED) presentation of a tertiary care hospital. Sepsis was defined according to the Sepsis-3 criteria. We evaluated the 3-hour resuscitation bundle compliance rate for control patients from July through August 2016, for patients using the qSOFA-based sepsis CDSS from September through December 2016, and the impact of the system using multivariable logistic regression analysis. Results: Of 306 patients with suspected infection and positive qSOFA scores at presentation, 265 patients (86.6%) developed sepsis (including 71 patients with septic shock). The 3-hour resuscitation bundle compliance rate did not differ significantly between the patients before and after the routine implementation of the qSOFA-based sepsis CDSS (63.7% vs. 52.6%; P = 0.071). Multivariate analysis showed that age (AOR [adjusted odds ratio], 1.033; P = 0.002) and body temperature (AOR, 1.677; P &lt; 0.001) were associated with bundle compliance. Conclusions: Among patients with a positive qSOFA score at presentation, sepsis developed in 86.6%, which means the qSOFA-based sepsis CDSS may be helpful; however, it was not associated with improved bundle compliance. Future quality improvement studies with multifactorial, hospital-wide approaches using sepsis CDSS tools are warranted.

Severity of illness scores at presentation predict ICU admission and mortality in COVID-19.

Background:The COVID-19 pandemic has overwhelmed hospital systems in multiple countries and necessitated caring for patients in atypical healthcare settings. The goal of this study was to ascertain if the conventional critical care severity scores qSOFA, SOFA, APACHE-II, and SAPS-II could predict which patients admitted to the hospital from an emergency department would eventually require intensive care.Methods:This single-center, retrospective cohort study enrolled patients admitted to Vanderbilt University Hospital from the emergency room with symptomatic, confirmed COVID-19 infection between March 8, 2020 through May 15, 2020. Clinical phenotyping was performed by chart abstraction, and the correlation of the qSOFA, SOFA, APACHE-II, and SAPS-II scores for the primary endpoint of ICU admission and secondary endpoint of in-hospital mortality was evaluated.Results:During the study period, 128 patients were admitted to Vanderbilt University Hospital from the emergency room with COVID-19. Of these, 39 patients eventually required intensive care; the remaining 89 were discharged from the medical ward. All severity of illness scores demonstrated at least moderate ability to identify patients who would die or require ICU admission. Of the three severity of illness scores assessed, the APACHE-II score performed best with an AUC of 0.851 (95% CI: 0.786 to 0.917) for identifying patient that would require ICU admission. No patient with an APACHE-II score at the time of presentation less than 8 or qSOFA of 0 required intensive care unit (ICU) admission. All patients with an APACHE-II score less than 10 or qSOFA score of 0 survived to hospital discharge.Conclusions:The APACHE-II score accurately predicts the eventual need for ICU admission. This may allow for risk-stratification of patients safe to treat in alternative health care settings and prognostic enrichment to accelerate clinical trials of COVID-19 therapies.

Quick Sequential Organ Failure Assessment Versus Systemic Inflammatory Response System in Early Detection of Sepsis in Emergency Department

Background: Sepsis is a life threating medical condition where infection leads to massive inflammatory response and eventually lead to organ dysfunction. It continues to pose a significant health threat despite remarkable developments in critical care medicine and extensive study of septic patients. Early recognition and treatment of sepsis in emergency department (ED) is important to reduce mortality, hospital length of stay and morbidity. Objective: This study was aimed to validate the performance of qSOFA scoring system and SIRS criteria in early sepsis diagnosis in the Emergency Department. Patient and method: This prospective observational clinical study was carried out in Emergency Department (ED) on 100 patients with suspected infection presented and admitted at o Mansoura University Emergency Hospital from February 2019 to February 2020. Patients were divided into two groups: infection group with qSOFA –ve criteria and sepsis group with qSOFA +ve group. We compare between qSOFA and SIRS scores in both groups. Results: The study demonstrated that organ dysfunction >2, 2ry to infection (according to sepsis definition by sepsis-3 task force) was more frequently reported among qSOFA + SIRS + group, compared to qSOFA - SIR – group. Moreover, both qSOFA and SIRS had comparable sensitivity (100%) in prediction of mortality within 1 week, while qSOFA demonstrated higher specificity (53.3%) in comparison with SIRS (20%). Both scores had comparable sensitivity for prediction ICU admission and of mechanical ventilation (86.67 and 88.9) whereas qSOFA demonstrated higher specificity than SIRS for ICU admission (94.29 versus 71.43) as well as mechanical ventilation (82.9 versus 63.41). Conclusion: It could be concluded that qSOFA is considered as specific not sensitive tool, while SIRS is more sensitive but not specific score for sepsis detection in emergency room.

The difficulty in distinguishing the type of occlusive coronary artery disease among patients with sepsis in the emergency department: a multicenter retrospective cohort study

Purpose: Distinguishing true obstructive coronary artery disease (OCAD) from myocardial infarction (MI) resulting from a mismatch between oxygen supply and demand (T2MI) in patients with sepsis is difficult. This study aimed to assess the clinical presentation and laboratory biomarkers of OCAD in patients with sepsis in the emergency department. Materials and Methods: This was a multicenter retrospective cohort study. We included patients diagnosed with sepsis or septic shock in the emergency department between January 2010 and December 2017 and who underwent coronary angiography in the emergency department for suspected concomitant MI. The patients were categorized into the mixed MI group, for those who had significant coronary occlusion superimposed on type 2 MI or the pure type 2 MI (T2MI) group. Results: A total of 71 patients were included after exclusion. Forty patients (56.3%) had OCAD (mixed MI). Fever (25% vs. 15%) and high scores of quick sequential organ failure assessment (qSOFA score) (35.5% vs. 27.5%) were more frequent in the T2MI group, and the troponin-I level was more elevated in the mixed MI group, but the difference was not significant. The most common focus of infection was pulmonary. Sepsis patients with OCAD tended to have longer admissions in the intensive care unit and ward admission days. However, the proportion of mortality and shock events was similar to T2MI group after percutaneous coronary artery intervention (PCI) treatment. Conclusions: Differentiating between mixed MI from pure T2MI through clinical presentation or laboratory results in patients with sepsis with suspected myocardial infarctions remains difficult. Lowering the threshold of coronary artery angiography may play a critical role in differentiating OCAD from T2MI.

Sepsis outcomes in patients with pre-existing liver disease.

Aim of the studyTo determine the characteristics, including the use of various diagnostic criteria, outcomes and treatment strategies in septic patients treated outside of the critical care area with pre-existing liver disease (LD).Material and methodsThe study population included patients recruited into two annual 24-hour prospective point-prevalence studies on the general wards and emergency departments across all Welsh acute hospitals in 2016 and 2017. Data were collected on patient demographics, observations and SIRS, SOFA and qSOFA scores.ResultsOut of 839 recruited patients, 24 (2.9%) had a past medical history of LD. 12/24 (50%) had a SIRS score ≥ 2, 21/24 (87.5%) a SOFA score ≥ 2 and 3/24 (12.5%) a qSOFA score ≥ 2. Patients with LD had 2.4 times higher odds (95% CI = 1.07-5.53, p = 0.03) of mortality after the sepsis episode. LD patients were younger than non-LD patients (p = 0.04) but not significantly different in frailty, do not attempt cardiopulmonary resuscitation (DNA-CPR) status or ceiling of care (p = 0.78, p = 0.54, p = 0.06, respectively).ConclusionsThe 90-day mortality was greater in patients with LD than the rest of the population. Management of sepsis in LD patients poses a challenge with current therapeutic bundles being underused and of unclear significance in improving patient outcome.

Role of Sepsis-3 Criteria and C-Reactive Protein in the Diagnosis of Sepsis in Critically ill Patients

Introduction: In the recent days, large proportion of the Intensive Care Unit (ICU) admissions ending in poor outcomes is impacted by pathological conditions like sepsis and septic shock. Hence, early diagnosis and appropriate therapy within the first hours of hospital admission plays a major role. Simple markers like C-Reactive Protein (CRP), Erythrocyte Sedimentation Rate (ESR), blood counts are still relied upon for suspected sepsis cases. Aim: To study the prevalence of sepsis and to evaluate the utility of the simple ideal markers like CRP, ESR, and blood counts for early diagnosis of sepsis in critically ill patients. Materials and Methods: This was a prospective observational study performed in the ICU of KMCH Institute of Allied Health Sciences, Coimbatore, Tamil Nadu, India, using 112 blood samples collected from patients admitted with clinical suspicion of sepsis. The samples were subjected to CRP estimation using turbidimetric immunoassay and blood culture. The data obtained were analysed using Statistical Package for the Social Sciences (SPSS) software version 21.0. The sensitivity, specificity, negative and positive predictive values were calculated. Results: Among a total of 112, the number of patients who abided the sepsis-3 definitions with positive qSOFA (quick Sepsis related Organ Failure Assessment) score was 50%. The most common co- morbid condition among the sepsis patients were diabetes mellitus (39.2%). The most frequent site of infection was respiratory tract (37.5%). Majority of infections were by gram-negative organisms (82%), the commonly isolated gram negative organisms were Klebsiella pneumoniae (25.9%) and Escherichia coli (25.9%). The sensitivity of CRP was 81% and specificity was 49% while the Positive Predictive Value (PPV) and Negative Predictive Value (NPV) was 60% and 56%, respectively. The prevalence of sepsis in present study was 50%. Conclusion: The study highlights the usefulness of CRP in identifying patients with sepsis in those who present with positive qSOFA score. Also, CRP could be very useful in resource-limited places, where newer biomarkers and guidance of an intensivist or sepsis expert are not available.

Underlying Diseases and in-Hospital Mortality of Acute Respiratory Failure Patients: Indonesian Prospective Cohort Study

Background: Epidemiologic data of acute respiratory failure (ARF) are limited. This study aims to investigate the underlying diseases and in-hospital mortality of patients with ARF in Indonesia. Materials and Methods: An observational prospective cohort study involving patients with ARF in six hospitals was conducted. Data were collected between January and December 2017. Data on the type of ARF, quick sepsis-related organ failure assessment (qSOFA) score, underlying diseases, and in-hospital mortality were documented. Proportions were compared using Chi-square or Fisher exact tests. Multivariable regression models with variable selection based on a stepwise backward elimination were run to analyze the risk factors for in-hospital mortality. Results: A total of 412 patients (median age: 56-years-old) were included. Most of the subjects were male (66.9%), hypoxemic (55.3%), and acute onset (86.4%). The most commonly encountered underlying diseases were pneumonia (58.7%), chronic obstructive pulmonary disease (25.5%), lung tuberculosis (25.2%), lung cancer (16.5%), noncystic fibrosis bronchiectasis (11.9%), congestive heart failure (10.2%), and chronic kidney disease (CKD) (3.2%). There were 65% of patients received only oxygen therapy, invasive mechanical ventilation was utilized for 30.8% of patients, and 4.1% of patients underwent noninvasive mechanical ventilation. There were 201 (48.79%) in-hospital mortality cases. The risk factors of in-hospital mortality were qSOFA ≥2 (odds ratio [OR]: 2.420, 95% confidence interval [CI] 1.599–3.662; P = 0.000) and CKD (OR: 3.871, 95% CI 1.024–14.631; P = 0.046). Conclusions: Most of the underlying diseases of ARF in Indonesia are communicable diseases. Patients with qSOFA ≥2 and CKD have a higher risk of death during hospitality.

Presepsin and Procalcitonin as Potential Biomarkers for Early Diagnosis and Prognosis of Sepsis in Critically Ill Patients

Background: Sepsis has a poor prognosis for critically ill patients, even with intensive management. Early diagnosis of sepsis and detection of patients with worsening prognosis are important for immediate intervention to improve the clinical outcome. Objective: To investigate serum presepsin (PS) and procalcitonin (PCT) as early diagnostic and prognostic biomarkers for sepsis in critically ill patients. Methods: 60 critically ill patients with sepsis were subdivided into three groups of sepsis, severe sepsis and septic shock according to Acute Physiology and Chronic Health Evaluation II (APACHEII) and quick Sequential Organ Failure Assessment (qSOFA) scores. Patients were compared with 20 age and sex matched controls. Serum PS and PCT were measured by enzyme linked immunosorbent assay (ELISA). Results: Serum PS and PCT levels were significantly increased in septic patients than controls, and their increase was positively correlated with progression of sepsis severity till reached the highest levels in septic shock. Receiver operating characteristic (ROC) curve for predicting sepsis revealed that PS has the highest area under curve (AUC) (0.967) with 97.5% sensitivity, 85% specificity and cut-off of >635.5 pg/mL, followed by PCT that has AUC (0.946), 97.5% sensitivity, 95% specificity and cut-off of >319.7 pg/mL. C-reactive protein (CRP) showed the lowest AUC (0.902) with 75% sensitivity, 100% specificity and cut-off of >7 mg/L. ROC curve for predicting septic shock showed that PS has the highest AUC (0.969) with 90% sensitivity, 97.5% specificity and cut-off of >5500.6 pg/mL, followed by CRP that has AUC (0.945), 90% sensitivity, 87.5% specificity and cut-off of >63 mg/L. PCT showed the lowest AUC (0.889) with 90% sensitivity, 97.5% specificity and cut-off of >822.1 pg/mL. Conclusions: Serum PS and PCT were promising biomarkers for early diagnosis and prognosis of sepsis in critically ill patients, but PS was superior to PCT.

Combined suPAR and qSOFA for the prediction of 28-day mortality in sepsis patients

To determine the prognostic performance of soluble urokinase-type plasminogen activator receptor (suPAR) and quick Sequential Organ Failure Assessment (qSOFA) in predicting the 28-day mortality of sepsis patients admitted to the emergency department (ED). A prospective, single-center observational study was conducted between June 2018 and June 2019. In total, 175 patients with sepsis and septic shock admitted to the ED were enrolled based on the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). We assessed the qSOFA score on ED admission and measured serum suPAR levels by quantitative enzyme-linked immunosorbent assay. Univariate and multivariate analysis was performed to identify predictors of prognosis. Kaplan–Meier survival curves and areas under the receiver operating characteristic (ROC) curve for 28-day mortality were calculated. We estimated category-free net reclassification improvement (NRI) when suPAR was added to qSOFA. Increased suPAR levels were significantly associated with 28-day mortality [1.74 (1.24–2.51) ng/mL in survivors vs. 1.34 (0.96–2.00) ng/mL in non-survivors, p = 0.011] and with sepsis severity [1.34 (0.99–1.98) ng/mL in sepsis vs. 1.74 (1.22–2.65) ng/mL in septic shock, p = 0.039]. The area under the curve (AUC) for the prediction of 28-day mortality was 0.646 (95% confidence interval (CI): 0.553–0.740) for suPAR, 0.832 (95% CI: 0.692–0.923) for qSOFA and 0.864 (95% CI: 0.802–0.928) for combined suPAR and qSOFA. Serum suPAR did not significantly increase the AUC of the basic qSOFA, but a model containing suPAR and qSOFA had a continuous NRI of 11% (95% CI: 3.5–18.5%; p = 0.004). Serum suPAR was associated with sepsis severity and 28-day mortality. Adding suPAR to qSOFA increased the ROC curve area and improved its discrimination, suggesting that this might be a useful tool in sepsis mortality prediction models.