Comparison of Predisposition, Insult/Infection, Response, and Organ dysfunction, Acute Physiology And Chronic Health Evaluation II, and Mortality in Emergency Department Sepsis in patients meeting criteria for early goal-directed therapy and the severe sepsis resuscitation bundle

Nguyen, H. Bryant; Ginkel, Chad Van; Batech, Michael; Banta, Jim E.; Corbett, Stephen W.

doi:10.1016/j.jcrc.2011.08.013

Cited by 54 publications

(30 citation statements)

References 35 publications

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“…This is in contrast to Jones et al 14 who found the MEDS score to have an AUC of 0.61 among ED patients with septic shock. Similarly Nguyen et al 27 found MEDS to have an AUC of 0.63 in a registry database of patients undergoing EGDT in the ED. Our results are similar to the AUC of 0.78 found among "allcomers" with sepsis in the original MEDS score validation study.…”

Section: Discussionmentioning

confidence: 80%

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Comparison of PIRO, SOFA, and MEDS Scores for Predicting Mortality in Emergency Department Patients With Severe Sepsis and Septic Shock

Macdonald

Arendts

Fatovich

et al. 2014

Academic Emergency Medicine

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Objectives: The Predisposition Insult Response and Organ failure (PIRO) scoring system has been developed for use in the emergency department (ED) to risk stratify sepsis cases, but has not been well studied among high-risk patients with severe sepsis and septic shock. The PIRO score was compared with the Sequential Organ Failure Assessment (SOFA) and Mortality in ED Sepsis (MEDS) scores to predict mortality in ED patients with features suggesting severe sepsis or septic shock in the ED. Methods:This was an analysis of sepsis patients enrolled in a prospective observational ED study of patients presenting with evidence of shock, hypoxemia, or other organ failure. PIRO, MEDS, and SOFA scores were calculated from ED data. Analysis compared areas under the receiver operator characteristic (ROC) curves for 30-day mortality.Results: Of 240 enrolled patients, final diagnoses were septic shock in 128 (53%), severe sepsis without shock in 70 (29%), and infection with no organ dysfunction in 42 (18%). Forty-eight (20%) patients died within 30 days of presentation. Area under the ROC curve (AUC) for mortality was 0.86 (95% confidence interval [CI] = 0.80 to 0.92) for PIRO, 0.81 (95% CI = 0.74 to 0.88) for MEDS, and 0.78 (95% CI = 0.71 to 0.87) for SOFA scores. Pairwise comparisons of the AUC were as follows: PIRO versus SOFA, p = 0.01; PIRO versus MEDS, p = 0.064; and MEDS versus SOFA; p = 0.37. Mortality increased with increasing PIRO scores: PIRO < 5, 0%; PIRO 5 to 9, 5%; PIRO 10 to 14, 5%; PIRO 15 to 19, 37%; and PIRO ≥ 20, 80% (p < 0.001). The MEDS score also showed increasing mortality with higher scores: MEDS < 5, 0%; MEDS 5 to 7, 12%; MEDS 8 to 11, 15%; MEDS 12 to 14, 48%; and MEDS > 15, 65% (p < 0.001).Conclusions: The PIRO model, taking into account comorbidities and septic source as well as physiologic status, performed better than the SOFA score and similarly to the MEDS score for predicting mortality in ED patients with severe sepsis and septic shock. These findings have implications for identifying and managing high-risk patients and for the design of clinical trials in sepsis.

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Section: Discussionmentioning

confidence: 80%

“…Nguyen et al 27 evaluated the original PIRO model 15 among sepsis patients undergoing EGDT in the ED. They found that PIRO performed similarly to APACHE II and outperformed the MEDS score; however, the PIRO model tended to overestimate mortality and the AUC was 0.71.…”

Section: Discussionmentioning

confidence: 99%

Comparison of PIRO, SOFA, and MEDS Scores for Predicting Mortality in Emergency Department Patients With Severe Sepsis and Septic Shock

Macdonald

Arendts

Fatovich

et al. 2014

Academic Emergency Medicine

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“…This is a secondary data analysis of hospital discharges based on International Classification of Diseases-9 codes. It is noteworthy though that our combined model including demographic, health status, and hospital characteristics had an AUC of 0.781, whereas Acute Physiology and Chronic Health Evaluation II had a lower AUC of 0.7052 in predicting mortality in severe sepsis (32). We were unable to source-verify from the medical records for each case and may have missed sepsis cases, which did not have an International Classification of Diseases-9 diagnosis consistent with severe sepsis.…”

Section: Discussionmentioning

confidence: 84%

Patient and hospital characteristics associated with inpatient severe sepsis mortality in California, 2005–2010

Banta

Beeson

et al. 2012

Critical Care Medicine

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“…The PIRO system indeed outperformed the SOFA score in predicting mortality (AUC: 0.86; 95% CI: 0.80 to 0.92 vs. 0.78; 95% CI: 0.71 to 0.87) of patients with severe sepsis and of septic shock patients in the emergency department (18). However, inferior results were obtained from other studies with AUCs ranging between 0.68 and 0.744, from various emergency department cohorts (18)(19)(20)(21). To date, no randomized controlled trials (RCT) have explored how patient-important outcomes (e.g., mortality, long term physical and cognitive behavior, return to previously normal function etc.)…”

Section: Classification and Staging Of Sepsismentioning

confidence: 87%

AME evidence series 001—The Society for Translational Medicine: clinical practice guidelines for diagnosis and early identification of sepsis in the hospital

Zhang¹,

Smischney²,

Zhang³

et al. 2016

J. Thorac. Dis.

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Sepsis is a heterogeneous disease caused by an infection stimulus that triggers several complex local and systemic immuno-inflammatory reactions, which results in multiple organ dysfunction and significant morbidity and mortality. The diagnosis of sepsis is challenging because there is no gold standard for diagnosis. As a result, the clinical diagnosis of sepsis is ever changing to meet the clinical and research requirements. Moreover, although there are many novel biomarkers and screening tools for predicting the risk of sepsis, the diagnostic performance and effectiveness of these measures are less than satisfactory, and there is insufficient evidence to recommend clinical use of these new techniques. As a consequence, diagnostic criteria for sepsis need regular revision to cope with emerging evidence. This review aims to present the most updated information on diagnosis and early recognition of sepsis. Recommendations for

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Comparison of Predisposition, Insult/Infection, Response, and Organ dysfunction, Acute Physiology And Chronic Health Evaluation II, and Mortality in Emergency Department Sepsis in patients meeting criteria for early goal-directed therapy and the severe sepsis resuscitation bundle

Cited by 54 publications

References 35 publications

Comparison of PIRO, SOFA, and MEDS Scores for Predicting Mortality in Emergency Department Patients With Severe Sepsis and Septic Shock

Comparison of PIRO, SOFA, and MEDS Scores for Predicting Mortality in Emergency Department Patients With Severe Sepsis and Septic Shock

Patient and hospital characteristics associated with inpatient severe sepsis mortality in California, 2005–2010

AME evidence series 001—The Society for Translational Medicine: clinical practice guidelines for diagnosis and early identification of sepsis in the hospital

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