Combining quick sequential organ failure assessment score with heart rate variability may improve predictive ability for mortality in septic patients at the emergency department

Prabhakar, Sumanth Madhusudan; Tagami, Takashi; Liu, Nan; Samsudin, Mas’uud Ibnu; Ng, Janson Cheng Ji; Koh, Zhi Xiong; Ong, Marcus Eng Hock

doi:10.1371/journal.pone.0213445

Cited by 15 publications

(24 citation statements)

References 41 publications

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“…In the literature AUROCs were found for SOFA and qSOFA for in-hospital mortality in a large validation dataset: AUC = 0.74 (all) and 0.79 (non-ICU) for SOFA and 0.66 (all) and 0.81 (non-ICU) for qSOFA [ 27 ]. Similar results are observed for recent studies outside the ICU with AUROC ranging from 0.77–0.83 for SOFA [ 28 – 32 ] and 0.63–0.77 for qSOFA [ 29 , 30 , 33 – 35 ]. MEDS is also a predictor of mortality.It had an AUC of 0.82 and 0.76 for its derivation and validation cohorts, respectively [ 11 ], although significant variability has been seen in the literature with AUC ranging from 0.67–0.77 in five recent studies [ 36 – 41 ].…”

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confidence: 90%

A comparison of predictors for mortality and bacteraemia in patients suspected of infection

et al. 2021

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Background Stratification by clinical scores of patients suspected of infection can be used to support decisions on treatment and diagnostic workup. Seven clinical scores, SepsisFinder (SF), National Early Warning Score (NEWS), Sequential Orgen Failure Assessment (SOFA), Mortality in Emergency Department Sepsis (MEDS), quick SOFA (qSOFA), Shapiro Decision Rule (SDR) and Systemic Inflammatory Response Syndrome (SIRS), were evaluated for their ability to predict 30-day mortality and bacteraemia and for their ability to identify a low risk group, where blood culture may not be cost-effective and a high risk group where direct-from-blood PCR (dfbPCR) may be cost effective. Methods Retrospective data from two Danish and an Israeli hospital with a total of 1816 patients were used to calculate the seven scores. Results SF had higher Area Under the Receiver Operating curve than the clinical scores for prediction of mortality and bacteraemia, significantly so for MEDS, qSOFA and SIRS. For mortality predictions SF also had significantly higher area under the curve than SDR. In a low risk group identified by SF, consisting of 33% of the patients only 1.7% had bacteraemia and mortality was 4.2%, giving a cost of € 1976 for one positive result by blood culture. This was higher than the cost of € 502 of one positive dfbPCR from a high risk group consisting of 10% of the patients, where 25.3% had bacteraemia and mortality was 24.2%. Conclusion This may motivate a health economic study of whether resources spent on low risk blood cultures might be better spent on high risk dfbPCR.

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Section: Discussionsupporting

confidence: 90%

A comparison of predictors for mortality and bacteraemia in patients suspected of infection

et al. 2021

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“…A study that employed time-series monitoring at the intensive care unit found that a rise in heart rate was a predictor of sepsis four hours before clinical detection, and that the sensitivity of the heart rate model was 85% combined with other clinical factors [9]. Additionally, a previous study found heart rate variability (HRV) to be an indicator for mortality in sepsis patients [10], being significantly higher in patients who died than in those who survived (31.8 s vs. 23.7 s; p -value = 0.02). In this study, for each 10-beat increase in pulse rate, the risk of inappropriate antibiotic administration went up by 19% (Table 3).…”

Section: Discussionmentioning

confidence: 99%

Predictors of Appropriate Antibiotic Use in Bacteremia Patients Presenting at the Emergency Department

et al. 2019

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Sepsis is a condition that requires appropriate antibiotic treatment at the emergency department (ED). Most previous studies conducted on inappropriate antibiotic use at the ED were conducted in developed countries with a low percentage of sepsis. This study aimed to find additional clinical predictors for appropriate antibiotic use in bacteremia patients presenting at the ED from a developing country, in which there is a higher proportion of patients with sepsis. We included adult patients who presented at the ED with clinical suspicion of infection and bacteremia. Patients allocated to the appropriate antibiotic group were those in whom the prescribed antibiotic was sensitive to the pathogen. Predictors and outcomes of appropriate antibiotic use were analyzed. A total of 3133 patients who met the study criteria presented at the ED during the study period. Of those, 271 patients were diagnosed with bacteremia, 48 of whom (17.71%) received inappropriate antibiotic prescriptions. Only pulse rate was an independent factor for appropriate antibiotic treatment, with an adjusted odds ratio of 1.019 (95% CI of 1.001, 1.036). In terms of clinical outcomes, the inappropriate antibiotic group had higher proportions of 28-day mortality (29.17% vs. 25.25%; p-value = 0.022) and longer hospitalization (14 vs. 9 days; p-value = 0.003). This study found that inappropriate antibiotics were prescribed in 17% of bacteremia patients presenting at the ED and that high pulse rate was an indicator for appropriate antibiotic prescription. Patients with inappropriate antibiotic administration had longer hospitalization and higher 28-day mortality than those who received appropriate antibiotic treatment.

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“…This provides a quick and non-invasive method of evaluating the autonomic modulation of the cardiovascular system, which has been shown to be dysregulated in sepsis [18]. Abnormalities in HRV parameters present themselves far before clinical signs become apparent [19,20] and have been found to correlate well with subsequent patient deterioration and mortality [13,21,22,23,24,25,26]. HRV analysis may thus represent a potentially useful method for the early risk-stratification of septic patients presenting at the ED and can be considered as a standalone predictor or as an augmentation of the other disease severity scores.…”

Section: Introductionmentioning

confidence: 99%

Combining Heart Rate Variability with Disease Severity Score Variables for Mortality Risk Stratification in Septic Patients Presenting at the Emergency Department

Pong

Fook‐Chong

Koh

et al. 2019

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The emergency department (ED) serves as the first point of hospital contact for many septic patients, where risk-stratification would be invaluable. We devised a combination model incorporating demographic, clinical, and heart rate variability (HRV) parameters, alongside individual variables of the Sequential Organ Failure Assessment (SOFA), Acute Physiology and Chronic Health Evaluation II (APACHE II), and Mortality in Emergency Department Sepsis (MEDS) scores for mortality risk-stratification. ED patients fulfilling systemic inflammatory response syndrome criteria were recruited. National Early Warning Score (NEWS), Modified Early Warning Score (MEWS), quick SOFA (qSOFA), SOFA, APACHE II, and MEDS scores were calculated. For the prediction of 30-day in-hospital mortality, combination model performed with an area under the receiver operating characteristic curve of 0.91 (95% confidence interval (CI): 0.88–0.95), outperforming NEWS (0.70, 95% CI: 0.63–0.77), MEWS (0.61, 95% CI 0.53–0.69), qSOFA (0.70, 95% CI 0.63–0.77), SOFA (0.74, 95% CI: 0.67–0.80), APACHE II (0.76, 95% CI: 0.69–0.82), and MEDS scores (0.86, 95% CI: 0.81–0.90). The combination model had an optimal sensitivity and specificity of 91.4% (95% CI: 81.6–96.5%) and 77.9% (95% CI: 72.6–82.4%), respectively. A combination model incorporating clinical, HRV, and disease severity score variables showed superior predictive ability for the mortality risk-stratification of septic patients presenting at the ED.

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Combining quick sequential organ failure assessment score with heart rate variability may improve predictive ability for mortality in septic patients at the emergency department

Cited by 15 publications

References 41 publications

A comparison of predictors for mortality and bacteraemia in patients suspected of infection

A comparison of predictors for mortality and bacteraemia in patients suspected of infection

Predictors of Appropriate Antibiotic Use in Bacteremia Patients Presenting at the Emergency Department

Combining Heart Rate Variability with Disease Severity Score Variables for Mortality Risk Stratification in Septic Patients Presenting at the Emergency Department

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