Quick SOFA Research Articles

SOFA and quick SOFA are more clinically useful scoring systems than SIRS in predicting mortality of patients with acute pyelonephritis associated with upper urinary tract calculi

SOFA and quick SOFA are more clinically useful scoring systems than SIRS in predicting mortality of patients with acute pyelonephritis associated with upper urinary tract calculi

Predicting complicated outcomes in spinal cord injury patients with urinary tract infection: Development and internal validation of a risk model

Context/objective: Patients with chronic SCI hospitalized for UTI can have significant morbidity. It is unclear whether SIRS criteria, SOFA score, or quick SOFA score can be used to predict complicated outcome.Design: Retrospective cohort study. A risk prediction model was developed and internally validated using bootstrapping methodology.Setting: Urban, academic hospital in St. Louis, Missouri.Participants: 402 hospitalizations for UTI between October 1, 2010 and September 30, 2015, arising from 164 patients with chronic SCI, were included in the final analysis.Outcome/measures: An a priori composite complicated outcome defined as: 30-day hospital mortality, length of hospital stay >4 days, intensive care unit (ICU) admission, and hospital revisit within 30 days of discharge.Results: Mean age of patients was 46.4 ± 12.3 years; 83.6% of patient-visits involved males. The primary outcome occurred in 278 (69.2%) hospitalizations. In multivariate analysis, male sex was protective (odds ratio [OR], 0.43; 95% confidence interval [CI], 0.18-0.99; P = 0.048) while Gram-positive urine culture (OR 3.07; 95% CI, 1.05-9.01; P = 0.041), urine culture with no growth (OR, 1.69; 95% CI, 1.02-2.80; P = 0.041), and greater SOFA score (for one-point increments, OR, 1.41; 95% CI, 1.18-1.69; P < 0.001) were predictive for complicated outcome. SIRS criteria and qSOFA score were not associated with complicated outcome. Our risk prediction model demonstrated good overall performance (Brier score, 0.19), fair discriminatory power (c-index, 0.72), and good calibration during internal validation.Conclusion: Clinical variables present on hospital admission with UTI may help identify SCI patients at risk for complicated outcomes and inform future clinical decision-making.

The Use of Quick Sofa (Qsofa) in Elderly Patients with Sepsis in the Intensive Care Unit

The Use of Quick Sofa (Qsofa) in Elderly Patients with Sepsis in the Intensive Care Unit

Prognostic accuracy of age-adapted SOFA, SIRS, PELOD-2, and qSOFA for in-hospital mortality among children with suspected infection admitted to the intensive care unit

PurposeThe Sepsis-3 consensus task force defined sepsis as life-threatening organ dysfunction caused by dysregulated host response to infection. However, the clinical criteria for this definition were neither designed for nor validated in children. We validated the performance of SIRS, age-adapted SOFA, quick SOFA and PELOD-2 scores as predictors of outcome in children.MethodsWe performed a multicentre binational cohort study of patients < 18 years admitted with infection to ICUs in Australia and New Zealand. The primary outcome was ICU mortality. SIRS, age-adapted SOFA, quick SOFA and PELOD-2 scores were compared using crude and adjusted area under the receiver operating characteristic curve (AUROC) analysis.ResultsOf 2594 paediatric ICU admissions due to infection, 151 (5.8%) children died, and 949/2594 (36.6%) patients died or experienced an ICU length of stay ≥ 3 days. A ≥ 2-point increase in the individual score was associated with a crude mortality increase from 3.1 to 6.8% for SIRS, from 1.9 to 7.6% for age-adapted SOFA, from 1.7 to 7.3% for PELOD-2, and from 3.9 to 8.1% for qSOFA (p < 0.001). The discrimination of outcomes was significantly higher for SOFA (adjusted AUROC 0.829; 0.791–0.868) and PELOD-2 (0.816; 0.777–0.854) than for qSOFA (0.739; 0.695–0.784) and SIRS (0.710; 0.664–0.756).ConclusionsSIRS criteria lack specificity to identify children with infection at substantially higher risk of mortality. We demonstrate that adapting Sepsis-3 to age-specific criteria performs better than Sepsis-2-based criteria. Our findings support the translation of Sepsis-3 into paediatric-specific sepsis definitions and highlight the importance of robust paediatric organ dysfunction characterization.

New Sepsis Definition (Sepsis-3) and Community-acquired Pneumonia Mortality. A Validation and Clinical Decision-Making Study.

The Sepsis-3 Task Force updated the clinical criteria for sepsis, excluding the need for systemic inflammatory response syndrome (SIRS) criteria. The clinical implications of the proposed flowchart including the quick Sequential (Sepsis-related) Organ Failure Assessment (qSOFA) and SOFA scores are unknown. To perform a clinical decision-making analysis of Sepsis-3 in patients with community-acquired pneumonia. This was a cohort study including adult patients with community-acquired pneumonia from two Spanish university hospitals. SIRS, qSOFA, the Confusion, Respiratory Rate and Blood Pressure (CRB) score, modified SOFA (mSOFA), the Confusion, Urea, Respiratory Rate, Blood Pressure and Age (CURB-65) score, and Pneumonia Severity Index (PSI) were calculated with data from the emergency department. We used decision-curve analysis to evaluate the clinical usefulness of each score and the primary outcome was in-hospital mortality. Of 6,874 patients, 442 (6.4%) died in-hospital. SIRS presented the worst discrimination, followed by qSOFA, CRB, mSOFA, CURB-65, and PSI. Overall, overestimation of in-hospital mortality and miscalibration was more evident for qSOFA and mSOFA. SIRS had lower net benefit than qSOFA and CRB, significantly increasing the risk of over-treatment and being comparable with the "treat-all" strategy. PSI had higher net benefit than mSOFA and CURB-65 for mortality, whereas mSOFA seemed more applicable when considering mortality/intensive care unit admission. Sepsis-3 flowchart resulted in better identification of patients at high risk of mortality. qSOFA and CRB outperformed SIRS and presented better clinical usefulness as prompt tools for patients with community-acquired pneumonia in the emergency department. Among the tools for a comprehensive patient assessment, PSI had the best decision-aid tool profile.

Low sensitivity of qSOFA, SIRS criteria and sepsis definition to identify infected patients at risk of complication in the prehospital setting and at the emergency department triage

BackgroundSepsis is defined as life-threatening organ dysfunction caused by a host response to infection. The quick SOFA (qSOFA) score has been recently proposed as a new bedside clinical score to identify patients with suspected infection at risk of complication (intensive care unit (ICU) admission, in-hospital mortality). The aim of this study was to measure the sensitivity of the qSOFA score, SIRS criteria and sepsis definitions to identify the most serious sepsis cases in the prehospital setting and at the emergency department (ED) triage.MethodsWe performed a retrospective study of all patients transported by emergency medical services (EMS) to the Lausanne University Hospital (CHUV) over twelve months. All patients with a suspected or proven infection after the ED workup were included. We retrospectively analysed the sensitivity of the qSOFA score (≥2 criteria), SIRS criteria (≥2 clinical criteria) and sepsis definition (SIRS criteria + one sign of organ dysfunction or hypoperfusion) in the pre-hospital setting and at the ED triage as predictors of ICU admission, ICU stay of ≥3 days and early (i.e. 48 h) mortality. No direct comparison between the three tools was attempted.ResultsAmong 11,411 patients transported to the University hospital, 886 (7.8%) were included. In the pre-hospital setting, the sensitivity of qSOFA reached 36.3% for ICU admission, 17.4% for ICU stay of three days or more and 68.0% for 48 h mortality. The sensitivity of SIRS criteria reached 68.8% for ICU admission, 74.6% for ICU stay of three days or more and 64.0% for 48 h mortality. The sensitivity of sepsis definition did not reach 60% for any outcome. At ED triage, the sensitivity of qSOFA reached 31.2% for ICU admission, 30.5% for ICU stay of ≥3 days and 60.0% for mortality at 48 h. The sensitivity of SIRS criteria reached 58.8% for ICU admission, 57.6% for ICU stay of ≥3 days 80.0% for mortality at 48 h. The sensitivity of sepsis definition reached 60.0% for 48 h mortality.DiscussionIncidence of sepsis in the ED among patients transported by ambulance was 3.8 percent. This rate, associated to the mortality of sepsis, confirms the necessity to dispose of a test to early identify those patients.ConclusionThe sensitivity performance of all three tools was suboptimal. The qSOFA score, SIRS criteria and sepsis definition have low identification sensitivity in selecting septic patients in the pre-hospital setting or upon arrival in the ED at risk of complication.

ミノサイクリンによる薬剤性肺障害とダニ媒介性感染症の鑑別にダニの同定と媒介能評価が有効であった1例(A difficult distinction: a case of drug–induced pneumonitis or a tick–borne infection with lung involvement?)

要旨今回，ダニ媒介性感染症による肺病変と薬剤性肺障害の鑑別に難渋し，刺咬したダニの形態学的評価と媒介能を検討し診断の一助とした症例を経験した。症例は50歳の男性。マダニ刺咬後にミノサイクリンの経口投与を開始された。2週間後に発熱，呼吸困難感を認め当院受診。紅斑はなく，好酸球の軽度増多を伴う白血球数の上昇とCRPの上昇，両側肺に非区域性のすりガラス陰影を認め，ミノサイクリンによる薬剤性肺障害とダニ媒介性感染症による肺病変が考えられた。画像上，両者の鑑別は困難であったため，ダニの同定とその媒介能の評価を各種検査と並行して行い，診断することとした。患者が持参したダニはタカサゴキララマダニであり，その媒介能から重症熱性血小板減少症候群（severe fever with thrombocytopenia syndrome，以下SFTS）と日本紅斑熱による急性呼吸窮迫症候群の可能性は否定できないため，精査を行った。SFTSウイルス，Rickettsia japonicaはいずれも陰性であり，薬剤性障害と判断し薬剤を中止したところ，症状と肺病変の消失を認めた。臨床医と研究者との緊密な連携による，ダニの同定とその媒介能の評価がダニ媒介性感染症の鑑別に有用であった。今後は両者による知見の集積を行い，より正確な媒介能の評価を行うことが重要である。

Is the Sepsis-3 definition useful in the management of patients with complicated intra-abdominal infections?

Sepsis-3 definition introduces Quick SOFA (qSOFA) as a tool for identifying patients at risk of sepsis with a higher risk of hospital death both inside and outside critical care units. However qSOFA does not define sepsis and the new sepsis definitions recommend using an increase in the SOFA score of 2 points or more to represent organ dysfunction. The SOFA score, is potentially not accessible everywhere, especially for PaO2, which would require an arterial blood gas measurement. In order to validate a new practical sepsis severity score for patients with complicated intra-abdominal infections (cIAIs) including the clinical conditions at the admission (severe sepsis/septic shock), the origin of the cIAIs, the delay in source control, the setting of acquisition and any risk factors such as age and immunosuppression a prospective study was conducted around the world from October 2014 to February 2015. The WISS study (WSES cIAIs Score Study) is a multicenter observational study underwent in 132 medical institutions worldwide during a four-month study period. The data from WISS study showed that mortality was significantly affected by the old sepsis definition. Mortality by sepsis status was: no sepsis 1.2%, sepsis only 4.4%, severe sepsis 27.8% and septic shock 67.8%. Early detection and timely therapeutic intervention improved the prognosis and overall clinical outcome of patients. Severe sepsis represented a reasonable approximation of the tipping point between stable and critical clinical conditions in management of patients with intra-abdominal infections. In patients with complicated intra-abdominal infections, SIRS signs associated with abdominal signs screened patients needing immediate acute care surgery and old sepsis definition better recognized patients at earlier stages when the infective process is most treatable.

A Study on Quick Sofa Score as a Predictive Tool of Severity in Emergency Department Patients

A Study on Quick Sofa Score as a Predictive Tool of Severity in Emergency Department Patients

A comparison of pre ICU admission SIRS, EWS and q SOFA scores for predicting mortality and length of stay in ICU

IntroductionThe 2015 sepsis definitions suggest using the quick SOFA score for risk stratification of sepsis patients among other changes in sepsis definition. Our aim was to validate the q sofa score for diagnosing sepsis and comparing it to traditional scores of pre ICU admission sepsis outcome prediction such as EWS and SIRS in our setting in order to predict mortality and length of stay. MethodsThis was a retrospective cohort study. We retrospectively calculated the q sofa, SIRS and EWS scores of all ICU patients admitted with the diagnosis of sepsis at our center in 2015. This was analysed using STATA 12. Logistic regression and ROC curves were used for analysis in addition to descriptive analysis. Results58 patients were included in the study. Based on our one year results we have shown that although q SOFA is more sensitive in predicting LOS in ICU of sepsis patients, the EWS score is more sensitive and specific in predicting mortality in the ICU of such patients when compared to q SOFA and SIRS scores. ConclusionIn conclusion, we find that in our setting, EWS is better than SIRS and q SOFA for predicting mortality and perhaps length of stay as well. The q Sofa score remains validated for diagnosis of sepsis.

Sa1334 - Quick Sofa: An Accurate Predictor of Mortality and Need for Advanced Organ Support in Severe Acute Pancreatitis

Sa1334 - Quick Sofa: An Accurate Predictor of Mortality and Need for Advanced Organ Support in Severe Acute Pancreatitis

81 - Quick SOFA score might be inadequate as initial sepsis screening system in UTI patients

81 - Quick SOFA score might be inadequate as initial sepsis screening system in UTI patients

Quick SOFA Scores Predict Mortality in Adult Emergency Department Patients With and Without Suspected Infection

The Quick Sequential Organ Failure Assessment (qSOFA) score (composed of respiratory rate ≥22 breaths/min, systolic blood pressure ≤100 mm Hg, and altered mental status) may identify patients with infection who are at risk of complications. We determined the association between qSOFA scores and outcomes in adult emergency department (ED) patients with and without suspected infection. We performed a single-site, retrospective review of adult ED patients between January 2014 and March 2015. Patients triaged to fast-track, dentistry, psychiatry, and labor and delivery were excluded. qSOFA scores were calculated with simultaneous vital signs and Modified Early Warning System scores. Patients receiving intravenous antibiotics were presumed to have suspected infection. Univariate and multivariate analyses were performed to explore the association between qSOFA scores and inpatient mortality, admission, and length of stay. Receiver operating characteristics curve analysis and c statistics were also calculated for ICU admission and mortality. We included 22,530 patients. Mean age was 54 years (SD 21 years), 53% were women, 45% were admitted, and mortality rate was 1.6%. qSOFA scores were associated with mortality (0 [0.6%], 1 [2.8%], 2 [12.8%], and 3 [25.0%]), ICU admission (0 [5.1%], 1 [10.5%], 2 [20.8%], and 3 [27.4%]), and hospital length of stay (0 [123 hours], 1 [163 hours], 2 [225 hours], and 3 [237 hours]). Adjusted rates were also associated with qSOFA. The c statistics for mortality in patients with and without suspected infection were similarly high (0.75 [95% confidence interval 0.71 to 0.78) and 0.70 (95% confidence interval 0.65 to 0.74), respectively. qSOFA scores were associated with inpatient mortality, admission, ICU admission, and hospital length of stay in adult ED patients likely to be admitted both with and without suspected infection and may be useful in predicting outcomes.

FRI-028 - The Quick SOFA, a simple bedside score, identifies hospitalized cirrhotic patients with poor outcomes

FRI-028 - The Quick SOFA, a simple bedside score, identifies hospitalized cirrhotic patients with poor outcomes

32 Quick SOFA Scores Predict Mortality in Emergency Department Patients With and Without Suspected Infection

32 Quick SOFA Scores Predict Mortality in Emergency Department Patients With and Without Suspected Infection