Combining quick Sequential Organ Failure Assessment with plasma lactate concentration is comparable to standard Sequential Organ Failure Assessment score in predicting mortality of patients with and without suspected infection

Ho, Kwok M.; Lan, Norris S H

doi:10.1016/j.jcrc.2016.10.005

Cited by 58 publications

(67 citation statements)

References 18 publications

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“…qSOFA outperformed other single predictors (CURB65, CRB65, PSI, SOFA, and lactate) in predicting 28-day mortality, although the AUROC of qSOFA was not significantly different from SOFA. Similar to previous studies, the combination of qSOFA + lactate was proved comparable to full version of SOFA in predicting primary and secondary outcomes in our research [25,26]. Moreover, qSO-FA + lactate was not statistically significant from SOFA + lactate (Z � 1.187, P � 0.235).…”

Section: Emergency Medicine Internationalsupporting

confidence: 88%

Prognostic Prediction Value of qSOFA, SOFA, and Admission Lactate in Septic Patients with Community-Acquired Pneumonia in Emergency Department

Zhou

Lan

Guo

2020

Emergency Medicine International

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Background. Community-acquired pneumonia (CAP) is a leading cause of sepsis and common presentation to emergency department (ED) with a high mortality rate. The prognostic prediction value of sequential organ failure assessment (SOFA) and quick SOFA (qSOFA) scores in CAP in ED has not been validated in detail. The aim of this research is to investigate the prognostic prediction value of SOFA, qSOFA, and admission lactate compared with that of other commonly used severity scores (CURB65, CRB65, and PSI) in septic patients with CAP in ED. Methods. Adult septic patients with CAP admitted between Jan. 2017 and Jan. 2019 with increased admission SOFA ≥ 2 from baseline were enrolled. The primary outcome was 28-day mortality. The secondary outcome included intensive care unit (ICU) admission, mechanical ventilation, and vasopressor use. Prognostic prediction performance of the parameters above was compared using receiver operating characteristic (ROC) curves. Kaplan–Meier survival curves were compared using optimal cutoff values of qSOFA and admission lactate. Results. Among the 336 enrolled septic patients with CAP, 89 patients died and 247 patients survived after 28-day follow-up. The CURB65, CRB65, PSI, SOFA, qSOFA, and admission lactate levels were statistically significantly higher in the death group (P<0.001). qSOFA and SOFA were superior and the combination of qSOFA + lactate and SOFA + lactate outperformed other combinations of severity score and admission lactate in predicting both primary and secondary outcomes. Patients with admission qSOFA < 2 or lactate ≤ 2 mmol/L showed significantly prolonged survival than those patients with qSOFA ≥ 2 or lactate > 2 mmol/L (log-rank χ2 = 59.825, P<0.001). The prognostic prediction performance of the combination of qSOFA and admission lactate was comparable to the full version of SOFA (AUROC 0.833 vs. 0.795, Z = 1.378, P=0.168 in predicting 28-day mortality; AUROC 0.868 vs. 0.895, Z = 1.022, P=0.307 in predicting ICU admission; AUROC 0.868 vs. 0.845, Z = 0.921, P=0.357 in predicting mechanical ventilation; AUROC 0.875 vs. 0.821, Z = 2.12, P=0.034 in predicting vasopressor use). Conclusion. qSOFA and SOFA were superior to CURB65, CRB65, and PSI in predicting 28-day mortality, ICU admission, mechanical ventilation, and vasopressor use for septic patients with CAP in ED. Admission qSOFA with lactate is a convenient and useful predictor. Admission qSOFA ≥ 2 or lactate > 2 mmol/L would be very helpful in discriminating high-risk patients with a higher mortality rate.

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Section: Emergency Medicine Internationalsupporting

confidence: 88%

Prognostic Prediction Value of qSOFA, SOFA, and Admission Lactate in Septic Patients with Community-Acquired Pneumonia in Emergency Department

Zhou

Lan

Guo

2020

Emergency Medicine International

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“…In the present study, the prognostic accuracies between SIRS and qSOFA were equivalent. Although there have been certain studies that compared the prognostic effectiveness between SIRS and qSOFA, the results are controversial and contradictory (14,15,17,27,28). It is possible that neither are superior for predicting the prognosis of patients with suspected sepsis.…”

Section: Discussionmentioning

confidence: 99%

The prognostic performance of Sepsis‑3 and SIRS criteria for patients with urolithiasis‑associated sepsis transferred to ICU following surgical interventions

Shi

et al. 2019

Exp Ther Med

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The aim of the present study was to validate the prognostic effectiveness of Sepsis-3 criteria, including sequential organ failure assessment (SOFA) and quick SOFA (qSOFA), with systemic inflammatory response syndrome (SIRS) criteria among patients with urolithiasis associated sepsis that were transferred to intensive care unit (ICU) facilities following surgical interventions. To achieve this, the records of all patients transferred to ICU following surgical interventions with urolithiasis-associated sepsis between January 2010 to July 2017 at Xin Hua Hospital Affiliated to Shanghai Jiao Tong University were retrospectively reviewed. A total of 107 patients were enrolled. The prognostic performances of SOFA, qSOFA and SIRS for predicting in-hospital mortality (sepsis-related mortality during patients' hospitalizations) or prolonged length of ICU stay (>3 days) were compared using the area under the receiver operating characteristic curve (AUROC) and Z statistic values. The results revealed that the overall in-hospital mortality rate was 8.4% and the percentage of in-hospital mortality or prolonged length of ICU stay (>3 days) was 72.0% among the 107 patients. The favorable outcome group exhibited significantly decreased white blood cell counts, and levels of C-reactive protein and procalcitonin and increased systolic blood pressure and mean arterial pressure. The AUROC of qSOFA, SIRS and SOFA were 0.615, 0.625 and 0.860, respectively. SOFA was significantly more effective at predicting adverse outcomes when compared with SIRS and qSOFA criteria. Following adjustments for patient age and comorbidities, the AUROC values of qSOFA, SIRS and SOFA were 0.713, 0.722 and 0.940. In conclusion, the results of the present study indicate that the prognostic performance of SOFA for predicting in-hospital mortality or prolonged ICU stay among patients with urolithiasis-associated sepsis following surgical interventions was significantly improved when compared with qSOFA or SIRS criteria. Based on these results it is recommended that urologists use the SOFA score for patients with urolithiasis-associated sepsis.

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“…Besides using vital signs, there have been several attempts to predict the prognosis of patients with infectious conditions using biomarkers like lactate and other inflammatory markers [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]. When evaluating the prognostic value of biomarkers, the interest is in the value that can be added to already available clinical information (e.g., history and physical examination) [29].…”

Section: Introductionmentioning

confidence: 99%

“…Thus, in patients suspected of acute severe infection, the prognostic performance of biomarkers should be assessed in addition to at least vital signs, which are parameters commonly used for the screening of those patients, as discussed above [6][7][8][9][10]. Although the added value of lactate to qSOFA has been often evaluated [20,26,27], most inflammatory markers have not been adequately assessed in a sequential process in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Added value of inflammatory markers to vital signs to predict mortality in patients suspected of severe infection

Takada

Hoogland

Yano

et al. 2020

The American Journal of Emergency Medicine

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To evaluate the added value of inflammatory markers to vital signs to predict mortality in patients suspected of severe infection. Methods: This study was conducted at an acute care hospital (471-bed capacity). Consecutive adult patients suspected of severe infection who presented to either ambulatory care or the emergency department from April 2015 to March 2017 were retrospectively evaluated. A prognostic model for predicting 30-day inhospital mortality based on previously established vital signs (systolic blood pressure, respiratory rate, and mental status) was compared with an extended model that also included four inflammatory markers (C-reactive protein, neutrophil-lymphocyte ratio, mean platelet volume, and red cell distribution width). Measures of interest were model fit, discrimination, and the net percentage of correctly reclassified individuals at the pre-specified threshold of 10% risk. Results: Of the 1015 patients included, 66 (6.5%) died. The extended model including inflammatory markers performed significantly better than the vital sign model (likelihood ratio test: p b 0.001), and the c-index increased from 0.69 (range 0.67-0.70) to 0.76 (range 0.75-0.77) (p = 0.01). All included markers except C-reactive protein showed significant contribution to the model improvement. Among those who died, 9.1% (95% CI −2.8-21.8) were correctly reclassified by the extended model at the 10% threshold. Conclusions: The inflammatory markers except C-reactive protein showed added predictive value to vital signs. Future studies should focus on developing and validating prediction models for use in individualized predictions including both vital signs and the significant markers.

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Combining quick Sequential Organ Failure Assessment with plasma lactate concentration is comparable to standard Sequential Organ Failure Assessment score in predicting mortality of patients with and without suspected infection

Cited by 58 publications

References 18 publications

Prognostic Prediction Value of qSOFA, SOFA, and Admission Lactate in Septic Patients with Community-Acquired Pneumonia in Emergency Department

Prognostic Prediction Value of qSOFA, SOFA, and Admission Lactate in Septic Patients with Community-Acquired Pneumonia in Emergency Department

The prognostic performance of Sepsis‑3 and SIRS criteria for patients with urolithiasis‑associated sepsis transferred to ICU following surgical interventions

Added value of inflammatory markers to vital signs to predict mortality in patients suspected of severe infection

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