qSOFA Score Research Articles

Comparison of SOFA and qSOFA Scores in Predicting Infection and Mortality in HDU and ICU Patients at a Tertiary Care Center

Objective: The objective of this study is to compare the sensitivity and specificity of the SOFA (Sequential Organ Failure Assessment) and qSOFA (Quick Sequential Organ Failure Assessment) in predicting infection and mortality in ICU (intensive care unit) and HDU (high dependency unit) patients admitted at a tertiary care center of excellence. Study Design and Setting: Prospective observational non-interventional study. Anesthesia Department of Combined Military Hospital, Rawalpindi from Jan 2023-Jun 2023. Methodology: Patients in both ICU (n=220) and HDU (n=220) setups admitted with a suspicion of sepsis were evaluated for onset of sepsis and mortality. Primary variables studied were the sensitivity and specificity for both scores for predicting infection and mortality in the ICU and HDU. Positive predictive value for both scores were calculated as secondary variable. Results: While assessing the primary variables, the sensitivity of SOFA for predicting infection in the ICU was 25.6% with a specificity of 85.3% versus a sensitivity of 76.8% and specificity of 59.0% for qSOFA. In the HDU, It showed sensitivity and specificity with PPV for SOFA being 64.7%, 95.1% and 64.7% versus 79.3%, 85.3% and 46.9% for qSOFA respectively. While assessing for mortality, SOFA values in the ICU for sensitivity, specificity and PPV were 81.8%, 93.5% and 69.2% versus 88.8%, 58.3% and 90.9% for qSOFA respectively. Conclusion: We conclude that qSOFA to be good predictor of mortality in the HDU and SOFA with good specificity for infection and mortality in the ICU

Value of modified qSOFA, glucose and lactate in predicting prognosis in children with sepsis in the PICU

The purpose was to investigate how well age-adjusted modified quick Sequential Organ Failure Assessment (qSOFA) scores paired with blood glucose and lactate levels predict the outcomes of septicemic children in the pediatric intensive care unit (PICU). One hundred children who were diagnosed with sepsis and septic shock in the PICU of Henan Children’s Hospital were eligible, and other 20 patients in the same hospital at different times were selected as a validation set. Respiratory rate (RR), heart rate (HR), capillary refill time (CRT), and Alert, Voice, Pain, Unresponsive (AVPU) scale were included in the age-adjusted modified qSOFA scoring criteria for scoring. The primary outcome was 28-day all-cause mortality. The predictive values were evaluated by the ROC curve. In the sepsis group, 50 patients were male, and 50 patients were female. The 28-day all-cause mortality rate was 52%. Fifty-one patients with age-adjusted modified qSOFA scores >1. The serum lactate level was 2.4 mmol/L, and the blood glucose level was 9.3 mmol/L. The AUCs for the age-adjusted modified qSOFA score, serum lactate and blood glucose levels for the prediction of 28-day all-cause mortality in children with sepsis were 0.719, 0.719 and 0.737, respectively. The cut-off values were one point, 3.8 mmol/L and 10 mmol/L, respectively. The AUC of the age-adjusted modified qSOFA score for the validation set of was 0.925. When the three indices were combined, the AUC was 0.817, the Hosmer–Lemeshow goodness-of-fit test showed χ 2 = 2.428 and p = .965. When children with sepsis are admitted to the ICU, we recommend performing rapid scoring and rapid bedside lactate and glucose testing to determine the early prognosis.

Association between chest X-ray score and clinical outcome in COVID-19 patients: A study on modified radiographic assessment of lung edema score (mRALE) in Indonesia.

Radiological examinations such as chest X-rays (CXR) play a crucial role in the early diagnosis and determining disease severity in coronavirus disease 2019 (COVID-19). Various CXR scoring systems have been developed to quantitively assess lung abnormalities in COVID-19 patients, including CXR modified radiographic assessment of lung edema (mRALE). The aim of this study was to determine the relationship between mRALE scores and clinical outcome (mortality), as well as to identify the correlation between mRALE score and the severity of hypoxia (PaO2/FiO2 ratio). A retrospective cohort study was conducted among hospitalized COVID-19 patients at Dr. Soetomo General Academic Hospital Surabaya, Indonesia, from February to April 2022. All CXR data at initial admission were scored using the mRALE scoring system, and the clinical outcomes at the end of hospitalization were recorded. Of the total 178 COVID-19 patients, 62.9% survived after completing the treatment. Patients within non-survived had significantly higher quick sequential organ failure assessment (qSOFA) score (p<0.001), lower PaO2/FiO2 ratio (p=0.004), and higher blood urea nitrogen (p<0.001), serum creatinine (p<0.008) and serum glutamic oxaloacetic transaminase (p=0.001) levels. There was a significant relationship between mRALE score and clinical outcome (survived vs deceased) (p=0.024; contingency coefficient of 0.184); and mRALE score of ≥2.5 served as a risk factor for mortality among COVID-19 patients (relative risk of 1.624). There was a significant negative correlation between the mRALE score and PaO2/FiO2 ratio based on the Spearman correlation test (r=-0.346; p<0.001). The findings highlight that the initial mRALE score may serve as an independent predictor of mortality among hospitalized COVID-19 patients as well as proves its potential prognostic role in the management of COVID-19.

Are Deep Odontogenic Infections Associated With an Increased Risk for Sepsis?

Quick Sequential Organ Failure Assessment (qSOFA) is recommended to identify sepsis. Odontogenic infection (OI) can progress to sepsis, causing systematic inflammatory complications or organ failure. The purpose of the study was to measure the association between OI location and risk for sepsis at admission. This retrospective cohort study included subjects treated for OI at Baylor University Medical Center in Dallas, TX, from January 9, 2019 to July 30, 2022. Subjects > 18years old who were treated under general anesthesia were included. OI limited to periapical, vestibular, buccal, and/or canine spaces were excluded from the sample. The primary predictor variable was OI anatomic location (superficial or deep). Superficial OI infection includes submental, submandibular, sublingual, submasseteric, and/or superficial temporal spaces. Deep OI includes pterygomandibular, deep temporal, lateral pharyngeal, retropharyngeal, pretracheal, and/or prevertebral. The primary outcome variable was risk for sepsis measured using a qSOFA score (0 to 3). A higher score (>0) indicates the patient has a high risk for sepsis. Covariates were demographics, clinical, laboratory, and radiological findings, antibiotic route, postoperative endotracheal intubation, tracheostomy, intensive care unit, admission, and length of stay. Descriptive and bivariate analyses were performed. A χ2 test was used for categorical variables. The Mann-Whitney U test was used for continuous variables. Statistical significance was P<.05. The sample was composed of 168 subjects with a mean age of 42.8±21.5 and 69 (48.6%) subjects were male. There were 11 (6.5%) subjects with a qSOFA score > 0. The relative risk of a qSOFA > 0 for a deep OI is 5.4 times greater than for a superficial OI (136 (95.8) versus 21 (80.8%): RR (95% confidence interval): 5.4 (1.51 to 19.27), P=.004). After adjusting for age, sex, American Society of Anesthesiologists score, and involved anatomical spaces, there was a significant correlation between laterality and the number of involved anatomical spaces and qSOFA score (odd ratio=9.13, 95% confidence interval: 2.48 to 33.55, adjusted P= <.001). The study findings suggest that the OI location is associated with the qSOFA score >0.

Epidemiology of Febrile Neutropenic and Bacteremic Patients in the Extensively Drug-Resistant Era

Background: Appropriate empiric antibiotic use is of utmost importance in febrile neutropenic patients. This study analyzed positive blood culture reports from febrile neutropenic patients and provided a new empirical antibiotic treatment approach. Methods: This study retrospectively enrolled febrile neutropenic patients with hematological or solid organ malignancies who had positive blood cultures at the Bahrain Oncology Center within January 2019 to August 2021. Microbiological data were used to draw inferences for rational antimicrobial treatment. The quick sequential organ failure assessment (qSOFA) score was employed to classify the severity status. The t-test was used to compare univariate and multivariate sensitivity values for two dependent proportions. Results: A total of 73 episodes of bacteremia were detected in 53 patients. Among these, 54 episodes (74%) were caused by gram-negative organisms. The most commonly isolated organisms were Escherichia coli (30%), Klebsiella pneumonia (22%), and coagulase-negative staphylococci (11%). The rate of extensively drug-resistant strains among K. pneumoniae was 44% (n = 7). Among gram-negative microorganisms, the susceptibility rates for monotherapies were reported for ceftazidime (56%), piperacillin/tazobactam (76%), cefepime (54%), meropenem (80%), and ceftazidime-avibactam (91%). The susceptibility rates for tigecycline-based combinations exceeded 90% overall. Conclusions: Clinical severity and local epidemiological data should be considered in the management of febrile neutropenia. New antibiotics and tigecycline should be considered for combination therapy in selected cases due to the increasing resistance observed.

Comparison of Manchester, qSOFA, emergency severity index, and national early warning scores for prognostic estimation and effective triage system in geriatric patients.

Triage refers to classifying and prioritizing patients based on the severity of their injuries or illnesses in the health care setting. The increasing number of elderly patients seeking care in emergency departments (EDs) highlights the need for special attention to the unique needs of this patient population. We aimed to compare the qSOFA, Emergency Severity Index (ESI), National Early Warning Score (NEWS), and Manchester Triage System (MTS) scores to assist ED physicians in assessing the severity of elderly patients' clinical conditions and triaging them appropriately. This cross-sectional study included 1066 patients aged 65 and over who presented to our ED as outpatients or by ambulance between September 1, 2022, and August 30, 2023. Scoring systems at the time of admission to the ED were recorded separately for outpatients and arriving by ambulance. According to the qSOFA, patients with a score of 0 were 0.976 times less likely to arrive by ambulance compared to those scoring 1 and above (OR = 0.976, p = .934). According to the NEWS, patients in the moderate-risk category were 0.447 times less likely to arrive by ambulance (OR = 0.447, p = .054). According to the ESI score, patients requiring high resource use with normal vital signs were 146.758 times more likely to arrive by ambulance (OR = 146.758, p = .001). Significant differences in patients' methods of presentation to the ED were observed based on the MTS, qSOFA, NEWS, and ESI scores.

Deficits in blood culture collection in the emergency department if sepsis is suspected: results of a retrospective cohort study

PurposeBlood cultures (BCs) are key for pathogen detection in septic patients. We investigated the extent to which sampling was performed and what factors were associated with the absence of general or inadequate BC sampling.MethodsWe conducted a retrospective cohort study of hospitalized patients with sepsis admitted to one of three EDs in 2018. Primary outcome was the extent of general BC collection of at least 1 set. Secondary outcome was the extent of adequate BC sampling, defined as ≥ 2 sets before antibiotic therapy (AT). Multivariable logistic regression analysis was performed to identify factors associated with deficits in both outcomes.Results1143 patients were analyzed. BCs were collected from 946 patients. Single BCs were taken from 520 patients, ≥ 2 sets from 426 patients. Overall, ≥ 2 BCs were taken from 349 patients before AT. BC sampling before AT occurred significantly more frequently when ≥ 2 BC sets were taken rather than a single one (81.9%, versus 68.4%, p < 0.001) and this also led to the highest pathogen detection rate in our cohort (65.6%). A body temperature of ≥ 38 °C was the a supporting factor for general and adequate BC collection in all three EDs. Retrospective analysis of 533 patients showed that the qSOFA score had no influence on general or adequate BC collection.ConclusionData on everyday clinical practice in the pre-analytical phase of microbiological diagnostics shows considerable deficits and indicates the need for more implementation of best practice. The variations identified in BC sampling between EDs should be further investigated.

Role of SFGSI, microbial culture and qSOFA as predictive factors in determining the survival rate in Fournier Gangrene patient.

To examine the simplified Fournier Gangrene Severe Index Score (SFGSI) and the number of species in culture findings for predicting death in Fournier Gangrene (FG) patients in terms of their predictive power. From January 2017 to July 2022, the medical records of individuals undergoing emergency surgery for FG were obtained. A total of 80 patients were examined for clinical data such as age, gender, laboratory parameters, etiology, isolated bacteria, and mortality rate. We identified a statistically significant mean difference between SFGSI (p<0.0001) and quickSOFA (qSOFA) scores (p=0.002) in determining the survival rate of FG patients. The sensitivity and specificity of the SFGSI score in predicting mortality were 90.1% and 88.3% respectively, whereas the sensitivity and specificity of the qSOFA score were 88.2% and 86.2%. E. Coli comprised 56.2% of the bacteria, followed by S. Haemolyticus, S. Aureus, P. Aeruginosa, and K. Pneumoniae. On the basis of bacterial culture results, P. Aeruginosa had the highest fatality rate (100%) followed by S. Aureus (75%), S. Haemolyticus (30%), and E. Coli (20%), in that order. The survival rate of FG patients can be predicted using the sensitivity and specificity of the SFGSI and qSOFA scores together. P. Aeruginosa-infected patients have the greatest mortality rate (100%) compared to the other groups.

Modification of qSOFA Increases Mortality Prediction Accuracy in Sepsis Patients

The Quick Sequential Organ Failure Assessment (qSOFA) is a simple parameter, however, its sensitivity as a mortality predictor is low. This study aimed to improve the predictor performance of qSOFA for in-hospital mortality. This study was a retrospective single-centered cohort using medical record data. This study included 150 patients aged 18-80 years old, who experienced sepsis and received ICU care between September 2021 and August 2022. qSOFA and modified ROX index (mROX) were calculated based on the most severe condition recorded in the emergency department (ED). Each variable's area under the receiver operating characteristic (AUROC) curve, sensitivity, and specificity were compared to predict in-hospital mortality. qSOFA scores ≥2 and mROX values ≤3.20 were independent factors that increased the risk of in-hospital mortality (OR 3.69 and 21.50; p 0.004 and 0.005, respectively). The combination of qSOFA scores ≥2 and mROX value ≤3.20 as in-hospital mortality predictors resulted in AUROC 0.791 with a sensitivity of 71.7% and specificity of 75.7%. The AUROC, sensitivity, and specificity of the combination of qSOFA and mROX were higher than qSOFA (0.766, 70.8%, 70.3%) or mROX (0.760, 68.1%, 67.6%) alone. In conclusion, the combination of qSOFA scores ≥2 and mROX values ≤3.20 increase the sensitivity and specificity for predicting in-hospital mortality in sepsis patients.

Biomarkers Improve Diagnostics of Sepsis in Adult Patients With Suspected Organ Dysfunction Based on the Quick Sepsis-Related Organ Failure Assessment (qSOFA) Score in the Emergency Department.

Consensus regarding biomarkers for detection of infection-related organ dysfunction in the emergency department is lacking. We aimed to identify and validate biomarkers that could improve risk prediction for overt or incipient organ dysfunction when added to quick Sepsis-related Organ Failure Assessment (qSOFA) as a screening tool. In a large prospective multicenter cohort of adult patients presenting to the emergency department with a qSOFA score greater than or equal to 1, admission plasma levels of C-reactive protein, procalcitonin, adrenomedullin (either bioavailable adrenomedullin or midregional fragment of proadrenomedullin), proenkephalin, and dipeptidyl peptidase 3 were assessed. Least absolute shrinkage and selection operator regression was applied to assess the impact of these biomarkers alone or in combination to detect the primary endpoint of prediction of sepsis within 96 hours of admission. Three tertiary emergency departments at German University Hospitals (Jena University Hospital and two sites of the Charité University Hospital, Berlin). One thousand four hundred seventy-seven adult patients presenting with suspected organ dysfunction based on qSOFA score greater than or equal to 1. None. The cohort was of moderate severity with 81% presenting with qSOFA = 1; 29.2% of these patients developed sepsis. Procalcitonin outperformed all other biomarkers regarding the primary endpoint (area under the curve for receiver operating characteristic [AUC-ROC], 0.86 [0.79-0.93]). Adding other biomarkers failed to further improve the AUC-ROC for the primary endpoint; however, they improved the model regarding several secondary endpoints, such as mortality, need for vasopressors, or dialysis. Addition of procalcitonin with a cutoff level of 0.25 ng/mL improved net (re)classification by 35.2% compared with qSOFA alone, with positive and negative predictive values of 60.7% and 88.7%, respectively. Biomarkers of infection and organ dysfunction, most notably procalcitonin, substantially improve early prediction of sepsis with added value to qSOFA alone as a simple screening tool on emergency department admission.

Supplementary Contribution of Eastern Cooperative Oncology Group-Performance Status to Quick Sequential Organ Failure Assessment in the Detection of Bacteremia Among Older Patients With Suspected Infections.

Background The Quick Sequential Organ Failure Assessment (qSOFA) is a simple method for identifying patients with bacteremia; however, it is not accurate for predicting it. Performance status assessment involves the evaluation of daily activities and could be beneficial in predicting bacteremia. We aimed to evaluate whether adding Eastern Cooperative Oncology Group-Performance Status (ECOG-PS) to qSOFA could improve the prediction of bacteremia diagnosis in older patients admitted with suspected infections. Methods Data were gathered from individuals aged ≥65 years who were hospitalized with suspected bacteremia from 2018 to 2019. Two prediction models were contrasted employing logistic regression. The initial model exclusively incorporated the qSOFA score, while the second model integrated the Eastern Cooperative Oncology Group-Performance Status (ECOG-PS) alongside the qSOFA score. Results Among 1,114 enrolled patients, 221 (19.8%) had true bacteremia. The area under the curve of the qSOFA+ECOG-PS model did not show a statistically significant improvement in predictive capacity compared with that of the qSOFA model (0.544 vs. 0.554, p=0.162). Conclusions Adding the ECOG-PS score did not improve the performance of qSOFA for predicting bacteremia in older patients with suspected infection.

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.

Comparison of modified quick Sequential Organ Failure Assessment models as triage tools for febrile patients.

Effective triage of febrile patients in the emergency department is crucial during times of overcrowding to prioritize care and allocate resources, especially during pandemics. However, available triage tools often require laboratory data and lack accuracy. We aimed to develop a simple and accurate triage tool for febrile patients by modifying the quick Sequential Organ Failure Assessment (qSOFA) score. We retrospectively analyzed data from 7,303 febrile patients and created modified versions of qSOFA using factors identified through multivariable analysis. The performance of these modified qSOFAs in predicting in-hospital mortality and intensive care unit (ICU) admission was compared using the area under the receiver operating characteristic curve (AUROC). Through multivariable analysis, the identified factors were age ("A" factor), male sex ("M" factor), oxygen saturation measured by pulse oximetry (SpO2; "S" factor), and lactate level ("L" factor). The AUROCs of ASqSOFA (in-hospital mortality: 0.812 [95% confidence interval, 0.789-0.835]; ICU admission: 0.794 [95% confidence interval, 0.771-0.817]) were simple and not inferior to those of other more complex models (e.g., ASMqSOFA, ASLqSOFA, and ASMLqSOFA). ASqSOFA also displayed significantly higher AUROC than other triage scales, such as the Modified Early Warning Score and Korean Triage and Acuity Scale. The optimal cutoff score of ASqSOFA for the outcome was 2, and the score for redistribution to a lower level emergency department was 0. We demonstrated that ASqSOFA can be employed as a simple and efficient triage tool for emergency febrile patients to aid in resource distribution during overcrowding. It also may be applicable in prehospital settings for febrile patient triage.

Comparison of NEWS, SIRS, and qSOFA Score as Predictors of Mortality and Length of Stay in Patients Pneumonia with Sepsis

Comparison of NEWS, SIRS, and qSOFA Score as Predictors of Mortality and Length of Stay in Patients Pneumonia with Sepsis

Identifying critically ill children in Malawi: A modified qSOFA score for low-resource settings.

In low-resource settings, a reliable bedside score for timely identification of children at risk of dying, could help focus resources and improve survival. The rapid bedside Liverpool quick Sequential Organ Failure Assessment (LqSOFA) uses clinical parameters only and performed well in United Kingdom cohorts. A similarly quick clinical assessment-only score has however not yet been developed for paediatric populations in sub-Saharan Africa. In a development cohort of critically ill children in Malawi, we calculated the LqSOFA scores using age-adjusted heart rate and respiratory rate, capillary refill time and Blantyre Coma Scale, and evaluated its prognostic performance for mortality. An improved score, the Blantyre qSOFA (BqSOFA), was developed (omitting heart rate, adjusting respiratory rate cut-off values and adding pallor), subsequently validated in a second cohort of Malawian children, and compared with an existing score (FEAST-PET). Prognostic performance for mortality was evaluated using area under the receiver operating characteristic curve (AUC). Mortality was 15.4% in the development (N = 493) and 22.0% in the validation cohort (N = 377). In the development cohort, discriminative ability (AUC) of the LqSOFA to predict mortality was 0.68 (95%-CI: 0.60-0.76). The BqSOFA and FEAST-PET yielded AUCs of 0.84 (95%-CI:0.79-0.89) and 0.83 (95%-CI:0.77-0.89) in the development cohort, and 0.74 (95%-CI:0.68-0.79) and 0.76 (95%-CI:0.70-0.82) in the validation cohort, respectively. We developed a simple prognostic score for Malawian children based on four clinical parameters which performed as well as a more complex score. The BqSOFA might be used to promptly identify critically ill children at risk of dying and prioritize hospital care in low-resource settings.

Utility of emergency department triage tools in predicting the need for intensive respiratory or vasopressor support in adult patients with COVID-19

BackgroundSerum and radiological parameters used to predict prognosis in COVID patients are not feasible in the Emergency Department. Due to its damaging effect on multiple organs and lungs, scores used to assess multiorgan damage and pneumonia such as Pandemic Medical Early Warning Score (PMEWS), National Early Warning Score 2 (NEWS2), WHO score, quick Sequential Organ Failure Assessment (qSOFA), and DS-CRB 65 can be used to triage patients in the Emergency Department. They can be used to predict patients with the highest risk of seven-day mortality and need for intensive respiratory or vasopressor support (IRVS). PurposeThe primary purpose was to find the score with the highest AUC in predicting IRVS and mortality at seven days. Additional objective was to find out any independent factors associated with IRVS and mortality. MethodsThe data of adult patients who presented to the Emergency Department (ED) between April 1, 2021 and June 30, 2021 were collected. The WHO score, CRB-65, DS-CRB 65, PMEWS, NEWS2, and qSOFA score were calculated for all patients. Statistical analysis was done and an ROC curve was calculated for all the tools for mortality and need for IRVS at seven days. Findings677 patients presented to the Emergency Department with COVID-19 during the period above. Presence of Diabetes Mellitus (p = 0.001), Hypertension (p = 0.001), and chronic kidney disease(CKD) (p = 0.04) was significantly associated with need for IRVS. Age, duration of symptoms, pulse rate, respiratory rate, room air saturation, mental status at admission, and time to IRVS need were identified as independent predictors of in-hospital mortality. The longer the time to IRVS need from ED arrival, the higher the likelihood of mortality. PMEWS (0.830) had the highest AUC, followed by NEWS2 (0.805). A PMEWS cut-off of 6.5 was 74.2% sensitive and 78.3% specific in predicting the need for IRVS. ROC analysis to predict 7-day mortality showed that PMEWS had an AUC of 0.802 (0.766–0.839). QSOFA performed poorly in predicting IRVS (AUC 0.645) and 7-day mortality (AUC 0.677). ConclusionPMEWS may be used for triaging patients presenting to the Emergency Department with COVID-19 and accurately predicts the need for IRVS and seven day mortality.

Prognostic evaluation of quick sequential organ failure assessment score in ICU patients with sepsis across different income settings

BackgroundThere is conflicting evidence on association between quick sequential organ failure assessment (qSOFA) and sepsis mortality in ICU patients. The primary aim of this study was to determine the association between qSOFA and 28-day mortality in ICU patients admitted for sepsis. Association of qSOFA with early (3-day), medium (28-day), late (90-day) mortality was assessed in low and lower middle income (LLMIC), upper middle income (UMIC) and high income (HIC) countries/regions. MethodsThis was a secondary analysis of the MOSAICS II study, an international prospective observational study on sepsis epidemiology in Asian ICUs. Associations between qSOFA at ICU admission and mortality were separately assessed in LLMIC, UMIC and HIC countries/regions. Modified Poisson regression was used to determine the adjusted relative risk (RR) of qSOFA score on mortality at 28 days with adjustments for confounders identified in the MOSAICS II study.ResultsAmong the MOSAICS II study cohort of 4980 patients, 4826 patients from 343 ICUs and 22 countries were included in this secondary analysis. Higher qSOFA was associated with increasing 28-day mortality, but this was only observed in LLMIC (p < 0.001) and UMIC (p < 0.001) and not HIC (p = 0.220) countries/regions. Similarly, higher 90-day mortality was associated with increased qSOFA in LLMIC (p < 0.001) and UMIC (p < 0.001) only. In contrast, higher 3-day mortality with increasing qSOFA score was observed across all income countries/regions (p < 0.001). Multivariate analysis showed that qSOFA remained associated with 28-day mortality (adjusted RR 1.09 (1.00–1.18), p = 0.038) even after adjustments for covariates including APACHE II, SOFA, income country/region and administration of antibiotics within 3 h.ConclusionsqSOFA was independently associated with 28-day mortality in ICU patients admitted for sepsis. In LLMIC and UMIC countries/regions, qSOFA was associated with early to late mortality but only early mortality in HIC countries/regions.Graphical

The Predictive Value of Sepsis Scores for In-Hospital Mortality in Patients with Left-Sided Infective Endocarditis.

As infective endocarditis has particular characteristics compared to other infectious diseases, it is not clear if sepsis scores are reported with good accuracy in these patients. The aim of this study is to evaluate the accuracy of the qSOFA and SOFA scores to predict mortality in patients with infective endocarditis. Between January 2010 and June 2019, 867 patients with suspected left-sided endocarditis were evaluated; 517 were included with left-sided infective endocarditis defined as "possible" or "definite" endocarditis, according to the Modified Duke Criteria. ROC curves were constructed to assess the accuracy of qSOFA and SOFA sepsis scores for the prediction of in-hospital mortality. The median age was 57 years, 65% were male, 435 (84%) had pre-existing heart valve disease, and the overall mortality was 28%. The most frequent etiologies were Streptococcus spp. (36%), Enterococcus spp. (10%), and Staphylococcus aureus (9%). The sepsis scores from the ROC curves used to predict in-hospital mortality were qSOFA 0.601 (CI95% 0.522-0.681) and SOFA score 0.679 (CI95% 0.602-0.756). A sub-group analysis in patients with and without pre-existing valve disease for SOFA ≥ 2 showed ROC curves of 0.627 (CI95% 0.563-0.690) and 0.775 (CI95% 0.594-0.956), respectively. qSOFA and SOFA scores were associated with increased in-hospital mortality in patients with infective endocarditis. However, as accuracy was relatively lower compared to other sites of bacterial infections, we believe that this score may have lower accuracy when predicting the prognosis of patients with IE, because, in this disease, the patient's death may be more frequently linked to valvular and cardiac dysfunction, as well as embolic events, and less frequently directly associated with sepsis.

Comparison of early warning and sepsis scores for mortality prediction in patients with suspected infection admitted to medical intensive care units

Aims: To compare the mortality prediction efficiency of the Modified Early Warning Score (MEWS), Systemic Inflammatory Response Syndrome (SIRS), Sepsis Related Organ Failure Assessment (SOFA), and Quick Sepsis Related Organ Failure Assessment (qSOFA) calculated within 48 hours before ICU admission. Methods: A prospective, noninterventional, observational cohort study enrolled adult patients admitted to medical intensive care units (ICU) with suspected infection in a tertiary care medical center. MEWS SIRS, SOFA, and qSOFA scores were calculated at four different time points: 48, 24, and 8 hours before and at the time of the ICU admission (0. hour). The scores were analyzed for hospital mortality. Results: A total of 120 patients were included. The median age was 68 (IQR 59.8-79) years, and 44.2% of patients were male. Of the study population, 75.8% were admitted to the medical ICU from the emergency department, while the remaining were from the medical wards. Considering the scores observed 48 hours before ICU admission, Odds Ratio (OR) of SIRS≥2 and SOFA≥2 showed a value of 7.6 (95% CI: 1.5-38.0) and 13.2 (95% CI: 2.3-74.3), respectively, while no increase in risk was observed for MEWS and the qSOFA score. Receiver operating characteristic analysis (ROC) performed with the highest scores observed at any time within 48 hours before ICU admission (ICU admission values were omitted) regarding hospital mortality yielded area under the curve (AUC) values (95% CI) of 0.80 (0.72-0.89) for SOFA, 0.66 (0.54-0.76) for MEWS, 0.63 (0.51-0.74) for qSOFA, and 0.61 (0.49-0.73) for SIRS. SOFA had the highest sensitivity of 92.6% (82.7-100.0), whereas qSOFA had the highest specificity of 63.0% (49.1-77.0) for hospital mortality. Conclusion: SOFA score is the most sensitive scoring system to predict hospital mortality in patients admitted to the medical ICU with suspected infection compared to MEWS, SIRS, and qSOFA. Nevertheless, the sepsis and early warning scores should be combined in clinical practice whenever possible.

Predictive value of white blood cell to hemoglobin ratio for 30-day mortality in patients with severe intracerebral hemorrhage.

To explore the predictive value of white blood cell to hemoglobin ratio (WHR) for 30-day mortality in patients with intracerebral hemorrhage (ICH). In this cohort study, 2,848 patients with ICH were identified in the Medical Information Mart for Intensive Care (MIMIC)-III and MIMIC-IV. Least absolute shrinkage and selection operator (LASSO) regression screened covariates of 30-day mortality of ICH patients. COX regression analysis was used to study the association of different levels of WHR, white blood cell (WBC), and hemoglobin (Hb) with 30-day mortality. The median follow-up time was 30 (20.28, 30.00) days. In total, 2,068 participants survived at the end of the follow-up. WHR was negatively correlated with the Glasgow Coma Score (GCS) (spearman correlation coefficient = -0.143, p < 0.001), and positively associated with the Sepsis-related Organ Failure Assessment (SOFA) score (spearman correlation coefficient = 0.156, p < 0.001), quick SOFA (qSOFA) score (spearman correlation coefficient = 0.156, p < 0.001), and Simplified Acute Physiology Score II (SAPS-II) (spearman correlation coefficient = 0.213, p < 0.001). After adjusting for confounders, WHR >0.833 (HR = 1.64, 95%CI: 1.39-1.92) and WBC >10.9 K/uL (HR = 1.49, 95%CI: 1.28-1.73) were associated with increased risk of 30-day mortality of patients with ICH. The area under the curve (AUC) value of the prediction model based on WHR and other predictors was 0.78 (95%CI: 0.77-0.79), which was higher than SAPSII (AUC = 0.75, 95%CI: 0.74-0.76), SOFA score (AUC = 0.69, 95%CI: 0.68-0.70) and GCS (AUC = 0.59, 95%CI: 0.57-0.60). The level of WHR was associated with 30-day mortality in patients with severe ICH, and the WHR-based prediction model might provide a tool to quickly predict 30-day mortality in patients with ICH.