Comparative prognostic accuracy of sepsis scores for hospital mortality in adults with suspected infection in non-ICU and ICU at an academic public hospital
Autoři:
Christopher P. Kovach aff001; Grant S. Fletcher aff002; Kristina E. Rudd aff001; Rosemary M. Grant aff004; David J. Carlbom aff001
Působiště autorů:
Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle, Washington, United States of America
aff001; Division of Hospital Medicine, Department of Medicine, University of Washington, Seattle, Washington, United States of America
aff002; Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
aff003; Professional Development and Nursing Excellence, Harborview Medical Center, Seattle, Washington, United States of America
aff004
Vyšlo v časopise:
PLoS ONE 14(9)
Kategorie:
Research Article
doi:
https://doi.org/10.1371/journal.pone.0222563
Souhrn
Background
Sepsis is a global healthcare challenge and reliable tools are needed to identify patients and stratify their risk. Here we compare the prognostic accuracy of the sepsis-related organ failure assessment (SOFA), quick SOFA (qSOFA), systemic inflammatory response syndrome (SIRS), and national early warning system (NEWS) scores for hospital mortality and other outcomes amongst patients with suspected infection at an academic public hospital.
Measurements and main results
10,981 adult patients with suspected infection hospitalized at a U.S. academic public hospital between 2011–2017 were retrospectively identified. Primary exposures were the maximum SIRS, qSOFA, SOFA, and NEWS scores upon inclusion. Comparative prognostic accuracy for the primary outcome of hospital mortality was assessed using the area under the receiver operating characteristic curve (AUROC). Secondary outcomes included mortality in ICU versus non-ICU settings, ICU transfer, ICU length of stay (LOS) >3 days, and hospital LOS >7 days. Adjusted analyses were performed using a model of baseline risk for hospital mortality. 774 patients (7.1%) died in hospital. Discrimination for hospital mortality was highest for SOFA (AUROC 0.90 [95% CI, 0.89–0.91]), followed by NEWS (AUROC 0.85 [95% CI, 0.84–0.86]), qSOFA (AUROC 0.84 [95% CI, 0.83–0.85]), and SIRS (AUROC 0.79 [95% CI, 0.78–0.81]; p<0.001 for all comparisons). NEWS (AUROC 0.94 [95% CI, 0.93–0.95]) outperformed other scores in predicting ICU transfer (qSOFA AUROC 0.89 [95% CI, 0.87–0.91]; SOFA AUROC, 0.84 [95% CI, 0.82–0.87]; SIRS AUROC 0.81 [95% CI, 0.79–0.83]; p<0.001 for all comparisons). NEWS (AUROC 0.86 [95% CI, 0.85–0.86]) was also superior to other scores in predicting ICU LOS >3 days (SOFA AUROC 0.84 [95% CI, 0.83–0.85; qSOFA AUROC, 0.83 [95% CI, 0.83–0.84]; SIRS AUROC, 0.75 [95% CI, 0.74–0.76]; p<0.002 for all comparisons).
Conclusions
Multivariate prediction scores, such as SOFA and NEWS, had greater prognostic accuracy than qSOFA or SIRS for hospital mortality, ICU transfer, and ICU length of stay. Complex sepsis scores may offer enhanced prognostic performance as compared to simple sepsis scores in inpatient hospital settings where more complex scores can be readily calculated.
Klíčová slova:
Medicine and health sciences – Diagnostic medicine – Signs and symptoms – Sepsis – Systemic inflammatory response syndrome – Pathology and laboratory medicine – Health care – Health care facilities – Hospitals – Intensive care units – Patients – Inpatients – Critical care and emergency medicine – Biology and life sciences – Population biology – Population metrics – Death rates – Physical sciences – Chemistry – Chemical elements – Oxygen
Zdroje
1. Paoli CJ, Reynolds MA, Sinha M, Gitlin M, Crouser E. Epidemiology and Costs of Sepsis in the United States-An Analysis Based on Timing of Diagnosis and Severity Level. Crit Care Med. 2018;46(12):1889–97. doi: 10.1097/CCM.0000000000003342 30048332
2. Liu V, Escobar GJ, Greene JD, Soule J, Whippy A, Angus DC, et al. Hospital deaths in patients with sepsis from 2 independent cohorts. Jama. 2014;312(1):90–2. doi: 10.1001/jama.2014.5804 24838355
3. Martin GS, Mannino DM, Eaton S, Moss M. The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med. 2003;348(16):1546–54. doi: 10.1056/NEJMoa022139 12700374
4. Rudd KE, Delaney A, Finfer S. Counting Sepsis, an Imprecise but Improving Science. Jama. 2017;318(13):1228–9. doi: 10.1001/jama.2017.13697 28903164
5. Fleischmann C, Scherag A, Adhikari NK, Hartog CS, Tsaganos T, Schlattmann P, et al. Assessment of Global Incidence and Mortality of Hospital-treated Sepsis. Current Estimates and Limitations. Am J Respir Crit Care Med. 2016;193(3):259–72. doi: 10.1164/rccm.201504-0781OC 26414292
6. Hatfield KM, Dantes RB, Baggs J, Sapiano MRP, Fiore AE, Jernigan JA, et al. Assessing Variability in Hospital-Level Mortality Among U.S. Medicare Beneficiaries With Hospitalizations for Severe Sepsis and Septic Shock. Crit Care Med. 2018;46(11):1753–60. doi: 10.1097/CCM.0000000000003324 30024430
7. Rhee C, Dantes R, Epstein L, Murphy DJ, Seymour CW, Iwashyna TJ, et al. Incidence and Trends of Sepsis in US Hospitals Using Clinical vs Claims Data, 2009–2014. Jama. 2017;318(13):1241–9. doi: 10.1001/jama.2017.13836 28903154
8. Yealy DM, Huang DT, Delaney A, Knight M, Randolph AG, Daniels R, et al. Recognizing and managing sepsis: what needs to be done? BMC Med. 2015;13(98):015–0335.
9. Seymour CW, Gesten F, Prescott HC, Friedrich ME, Iwashyna TJ, Phillips GS, et al. Time to Treatment and Mortality during Mandated Emergency Care for Sepsis. N Engl J Med. 2017;376(23):2235–44. doi: 10.1056/NEJMoa1703058 28528569
10. Seymour CW, Liu VX, Iwashyna TJ, Brunkhorst FM, Rea TD, Scherag A, et al. Assessment of Clinical Criteria for Sepsis: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). Jama. 2016;315(8):762–74. doi: 10.1001/jama.2016.0288 26903335
11. Vincent JL, de Mendonca A, Cantraine F, Moreno R, Takala J, Suter PM, et al. Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Working group on "sepsis-related problems" of the European Society of Intensive Care Medicine. Crit Care Med. 1998;26(11):1793–800. doi: 10.1097/00003246-199811000-00016 9824069
12. Bone RC, Balk RA, Cerra FB, Dellinger RP, Fein AM, Knaus WA, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference Committee. American College of Chest Physicians/Society of Critical Care Medicine. Chest. 1992;101(6):1644–55. doi: 10.1378/chest.101.6.1644 1303622
13. Freund Y, Lemachatti N, Krastinova E, Van Laer M, Claessens YE, Avondo A, et al. Prognostic Accuracy of Sepsis-3 Criteria for In-Hospital Mortality Among Patients With Suspected Infection Presenting to the Emergency Department. Jama. 2017;317(3):301–8. doi: 10.1001/jama.2016.20329 28114554
14. Raith EP, Udy AA, Bailey M, McGloughlin S, MacIsaac C, Bellomo R, et al. Prognostic Accuracy of the SOFA Score, SIRS Criteria, and qSOFA Score for In-Hospital Mortality Among Adults With Suspected Infection Admitted to the Intensive Care Unit. Jama. 2017;317(3):290–300. doi: 10.1001/jama.2016.20328 28114553
15. Rudd KE, Seymour CW, Aluisio AR, Augustin ME, Bagenda DS, Beane A, et al. Association of the Quick Sequential (Sepsis-Related) Organ Failure Assessment (qSOFA) Score With Excess Hospital Mortality in Adults With Suspected Infection in Low- and Middle-Income Countries. Jama. 2018;319(21):2202–11. doi: 10.1001/jama.2018.6229 29800114
16. Minne L, Abu-Hanna A, de Jonge E. Evaluation of SOFA-based models for predicting mortality in the ICU: A systematic review. Crit Care. 2008;12(6):17.
17. Keegan MT, Gajic O, Afessa B. Severity of illness scoring systems in the intensive care unit. Crit Care Med. 2011;39(1):163–9. doi: 10.1097/CCM.0b013e3181f96f81 20838329
18. Kollef MH, Schuster DP. Predicting intensive care unit outcome with scoring systems. Underlying concepts and principles. Crit Care Clin. 1994;10(1):1–18. 8118722
19. Sbiti-Rohr D, Kutz A, Christ-Crain M, Thomann R, Zimmerli W, Hoess C, et al. The National Early Warning Score (NEWS) for outcome prediction in emergency department patients with community-acquired pneumonia: results from a 6-year prospective cohort study. BMJ Open. 2016;6(9):2015–011021.
20. Goulden R, Hoyle MC, Monis J, Railton D, Riley V, Martin P, et al. qSOFA, SIRS and NEWS for predicting inhospital mortality and ICU admission in emergency admissions treated as sepsis. Emerg Med J. 2018;35(6):345–9. doi: 10.1136/emermed-2017-207120 29467173
21. Churpek MM, Snyder A, Sokol S, Pettit NN, Edelson DP. Investigating the Impact of Different Suspicion of Infection Criteria on the Accuracy of Quick Sepsis-Related Organ Failure Assessment, Systemic Inflammatory Response Syndrome, and Early Warning Scores. Crit Care Med. 2017;45(11):1805–12. doi: 10.1097/CCM.0000000000002648 28737573
22. Fernando SM, Tran A, Taljaard M, Cheng W, Rochwerg B, Seely AJE, et al. Prognostic Accuracy of the Quick Sequential Organ Failure Assessment for Mortality in Patients With Suspected Infection: A Systematic Review and Meta-analysis. Ann Intern Med. 2018;168(4):266–75. doi: 10.7326/M17-2820 29404582
23. Churpek MM, Snyder A, Han X, Sokol S, Pettit N, Howell MD, et al. Quick Sepsis-related Organ Failure Assessment, Systemic Inflammatory Response Syndrome, and Early Warning Scores for Detecting Clinical Deterioration in Infected Patients outside the Intensive Care Unit. Am J Respir Crit Care Med. 2017;195(7):906–11. doi: 10.1164/rccm.201604-0854OC 27649072
24. Szakmany T, Pugh R, Kopczynska M, Lundin RM, Sharif B, Morgan P, et al. Defining sepsis on the wards: results of a multi-centre point-prevalence study comparing two sepsis definitions. Anaesthesia. 2018;73(2):195–204. doi: 10.1111/anae.14062 29150856
25. Prytherch DR, Smith GB, Schmidt PE, Featherstone PI. ViEWS—Towards a national early warning score for detecting adult inpatient deterioration. Resuscitation. 2010;81(8):932–7. doi: 10.1016/j.resuscitation.2010.04.014 20637974
26. Redfern OC, Smith GB, Prytherch DR, Meredith P, Inada-Kim M, Schmidt PE. A Comparison of the Quick Sequential (Sepsis-Related) Organ Failure Assessment Score and the National Early Warning Score in Non-ICU Patients With/Without Infection. Crit Care Med. 2018;46(12):1923–33. doi: 10.1097/CCM.0000000000003359 30130262
27. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). Jama. 2016;315(8):801–10. doi: 10.1001/jama.2016.0287 26903338
28. Teasdale G, Jennett B. Assessment of coma and impaired consciousness. A practical scale. Lancet. 1974;2(7872):81–4. doi: 10.1016/s0140-6736(74)91639-0 4136544
29. Nasa P, Juneja D, Singh O, Dang R, Arora V. Severe sepsis and its impact on outcome in elderly and very elderly patients admitted in intensive care unit. J Intensive Care Med. 2012;27(3):179–83. doi: 10.1177/0885066610397116 21436163
30. Pietropaoli AP, Glance LG, Oakes D, Fisher SG. Gender differences in mortality in patients with severe sepsis or septic shock. Gend Med. 2010;7(5):422–37. doi: 10.1016/j.genm.2010.09.005 21056869
31. Chaudhary NS, Donnelly JP, Wang HE. Racial Differences in Sepsis Mortality at U.S. Academic Medical Center-Affiliated Hospitals. Crit Care Med. 2018;46(6):878–83. doi: 10.1097/CCM.0000000000003020 29438109
32. Bland JM, Altman DG. Multiple significance tests: the Bonferroni method. Bmj. 1995;310(6973):170. doi: 10.1136/bmj.310.6973.170 7833759
33. Kaukonen KM, Bailey M, Pilcher D, Cooper DJ, Bellomo R. Systemic inflammatory response syndrome criteria in defining severe sepsis. N Engl J Med. 2015;372(17):1629–38. doi: 10.1056/NEJMoa1415236 25776936
34. Liao MM, Lezotte D, Lowenstein SR, Howard K, Finley Z, Feng Z, et al. Sensitivity of systemic inflammatory response syndrome for critical illness among ED patients. Am J Emerg Med. 2014;32(11):1319–25. doi: 10.1016/j.ajem.2014.07.035 25205616
35. Rubenfeld GD, Caldwell E, Peabody E, Weaver J, Martin DP, Neff M, et al. Incidence and outcomes of acute lung injury. N Engl J Med. 2005;353(16):1685–93. doi: 10.1056/NEJMoa050333 16236739
Článek vyšel v časopise
PLOS One
2019 Číslo 9
- Proč jsou nemocnice nepřítelem spánku? A jak to změnit?
- Dlouhodobá ketodieta může poškozovat naše orgány
- „Jednohubky“ z klinického výzkumu – 2024/42
- Metamizol jako analgetikum první volby: kdy, pro koho, jak a proč?
- MUDr. Jana Horáková: Remise již dosahujeme u více než 80 % pacientů s myastenií