External validation of the quick Sequential Organ Failure Assessment score for mortality and bacteraemia risk evaluation in Japanese patients undergoing haemodialysis: a retrospective multicentre cohort study

Abstract

ObjectivesWe aimed to examine the validity of the quick Sequential Organ Failure Assessment (qSOFA) score for mortality and bacteraemia risk assessment in Japanese haemodialysis patients.DesignThis is a retrospective multicentre cohort study.SettingThe six participating hospitals are tertiary-care institutions that receive patients on an emergency basis and provide primary, secondary and tertiary care. The other participating hospital is a secondary-care institution that receives patients on an emergency basis and provides both primary and secondary care.ParticipantsThis study included haemodialysis outpatients admitted for bacteraemia suspicion, who had blood drawn for cultures within 48 hours of their initial admission.Primary and secondary outcome measuresThe primary outcome measure was overall in-hospital mortality. Secondary outcomes included 28-day in-hospital mortality and the incidence of bacteraemia diagnosed based on blood culture findings. The discrimination, calibration and test performance of the qSOFA score were assessed. Missing data were handled using multiple imputation.ResultsAmong the 507 haemodialysis patients admitted with bacteraemia suspicion between August 2011 and July 2013, the overall in-hospital mortality was 14.6% (74/507), the 28-day in-hospital mortality was 11.1% (56/507) and the incidence of bacteraemia, defined as a positive blood culture, was 13.4% (68/507). For predicting in-hospital mortality among haemodialysis patients, the area under the receiver operating characteristic curve was 0.61 (95% CI 0.56–0.67) for a qSOFA score ≥2. The Hosmer-Lemeshow χ2statistics for the qSOFA score as a predictor of overall and 28-day in-hospital mortality were 5.72 (p=0.02) and 7.40 (p<0.01), respectively.ConclusionOn external validation, the qSOFA score exhibited low diagnostic accuracy and miscalibration for in-hospital mortality and bacteraemia among haemodialysis patients.

Added value of clinical prediction rules for bacteremia in hemodialysis patients: An external validation study

“…This is consistent with our previous studies showing that the systemic inflammatory response syndrome (SIRS) criteria [ 31 ] and the quick Sequential (Sepsis-Related) Organ Failure Assessment (qSOFA) score [ 32 , 33 ] were not useful in predicting bacteremia in HD patients. Second, the clinical information of patients on maintenance HD such as body weight, vital signs [ 34 ], electrolytes, blood urea nitrogen, and creatinine vary greatly between dialysis and non-dialysis days.…”

The Use of the Initial National Early Warning Score 2 at the Emergency Department as a Predictive Tool of In-Hospital Mortality in Hemodialysis Patients

“…Hemodialysis patients have been observed to experience significantly higher annual mortality rates due to sepsis compared to the general population, with estimates ranging from 100 to 300 times higher [ 3 ]. While epidemiological studies of sepsis in Saudi Arabia are limited, a recent study conducted at Buraidah Central Hospital in Al-Qassim highlighted the prevalence of sepsis among intensive care patients, reporting a mortality rate of 40.3% among those diagnosed with sepsis [ 4 , 5 ]. By focusing on hemodialysis patients, this study seeks to explore the utility of the initial National Early Warning Score 2 (NEWS-2) as a predictive tool for in-hospital mortality, providing valuable insights specific to this vulnerable patient population.…”