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

Abstract

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

Role of serum lactate as prognostic marker of mortality among emergency department patients with multiple conditions: A systematic review

“…Also, after Bonferroni’s correction, MqSOFA outperformed qSOFA in respiratory and urinary etiologies. 28 Another study determined the detection rate of PCT, sequential organ failure assessment (SOFA), and qSOFA in estimating sepsis and in-hospital mortality in 65-year-old patients referred to the ED. It was found that the PCT test possesses a higher prognostic and predictive capacity for the diagnosis of sepsis than qSOFA and SOFA, with AUC = 0.883 at 95% confidence interval (CI): 0.835–0.931 and p < 0.0001.…”

Construction of a predictive model for the risk of sepsis-related liver injury in the intensive care unit: a retrospective cohort study over 10 years

“…We verified by LASSO and multifactorial logistic regression that an increase in RDW was also significantly associated with the development of SALI ( P < 0.001). Lactate is a reliable biomarker for predicting organ failure and death in sepsis patients [25,26] . Increased lactate production in sepsis due to enhanced glycolysis, altered pyruvate dehydrogenase activity, and other factors [27] .…”

Defining sepsis in small animals

“…It should be noted that qSOFA is a rapid screen for predictors of mortality rather than a means to identify sepsis specifically and has limited prognostic utility in human studies. [97][98][99] Several studies have evaluated modified qSOFA criteria in dogs with variable results. In a critically ill population of dogs, qSOFA was not predictive of mortality in contrast to plasma lactate concentration, but that population had few dogs with sepsis.…”

“…To identify organ dysfunction, the qSOFA score requires 2 or more of altered mentation (a diminished Glasgow Coma Scale score), hypotension (systolic blood pressure ≤100 mm Hg), or tachypnea (respiratory rate ≥22/min). It should be noted that qSOFA is a rapid screen for predictors of mortality rather than a means to identify sepsis specifically and has limited prognostic utility in human studies 97–99 . Several studies have evaluated modified qSOFA criteria in dogs with variable results.…”