Prediction of mortality in adult emergency department patients with sepsis

Vorwerk, Christiane; Loryman, Ben; Coats, Timothy J; Stephenson, James A.; Gray, Lewis D; Reddy, G.; Florence, L.; Butler, N

doi:10.1136/emj.2007.053298

Cited by 89 publications

(89 citation statements)

References 21 publications

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“…20 Where the precise FiO 2 was not known, this was estimated from the inspired oxygen concentration and device, according to Data Supplement S4 (available as supporting information in the online version of this paper). For the MEDS score, neutrophil bands were excluded as described by Vorwerk et al 21 since these are not reported by our laboratory. Finally, the PIRO model was modified to use blood urea > 8 mmol/L to replace blood urea nitrogen (BUN) > 20 mg/dL, and again neutrophil bands could not be included in the score.…”

Section: Study Protocolmentioning

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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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: Study Protocolmentioning

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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“…The MEDS score also correlated well with the classification of clinical severity of sepsis [24]. The abbreviated MEDS score evaluated by Vorwerk et al was found to have a better performance as a predictor of 28-day mortality (AUC = 0.81) when compared to serum lactate (AUC = 0.62) among patients enrolled from the urban teaching centre [26]. A MEDS score of 13 and above was found to correlate well with those with severe sepsis and septic shock with a specificity of 85.3%, PPV of 70.4%, and NPV of 79.5% by Zhao et al [25].…”

Section: Outcomementioning

confidence: 84%

“…of nine (without the neutrophil bands) [26]. Zhao et al also assessed the impact on the prognostic value of the MEDS score by combining it with one of the biomarkers [25].…”

Section: Prognostic Determinant and Comparatorsmentioning

confidence: 99%

“…Three studies defined the 1-month mortality as death occurring within 28 days of ED presentation [23,25,26] while Lee et al subcategorised the outcome measure as (5-day) early and (6-to 30-day) late mortality [24]. In all four studies, the MEDS score performed better than the respective comparators in predicting mortality with an AUC ranging from 0.78 to 0.89 across the studies (Table 4).…”

Section: Outcomementioning

confidence: 99%

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The Mortality in Emergency Department Sepsis Score as a Predictor of 1-Month Mortality among Adult Patients with Sepsis: Weighing the Evidence

Putra

Tiah

2013

ISRN Emergency Medicine

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Objective. To evaluate the performance of Mortality in Emergency Department Sepsis (MEDS) score in comparison to biomarkers as a predictor of mortality in adult emergency department (ED) patients with sepsis. Methods. A literature search was performed using PubMed, ScienceDirect, SpringerLink, and Ovid databases. Studies were appraised by using the C2010 Consensus Process for Levels of Evidence for prognostic studies. The respective values for area under the curve (AUC) were obtained from the selected articles. Results. Four relevant articles met the selection process. Three studies defined the 1-month mortality as death occurring within 28 days of ED presentation, while the remaining one subcategorised the outcome measure as (5-day) early and (6-to 30-day) late mortality. In all four studies, the MEDS score performed better than the respective comparators (C-reactive protein, lactate, procalcitonin, and interleukin-6) in predicting mortality with an AUC ranging from 0.78 to 0.89 across the studies. Conclusion. The MEDS score has a better prognostic value than the respective comparators in predicting 1-month mortality in adult ED patients with suspected sepsis.

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“…We believe that this is an important consideration that should be addressed by future prospective study. Finally, this study did not address clinical changes after index lactate values (e.g., incident hypotension or organ failure) that might have altered lactate values or fluid administration practice independently of our observed variables (14,18,29,41).…”

Section: Discussionmentioning

confidence: 99%

Fluid Volume, Lactate Values, and Mortality in Sepsis Patients with Intermediate Lactate Values

et al. 2013

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Rationale: Patients with severe sepsis without shock or tissue hypoperfusion face substantial mortality; however, treatment guidelines are lacking. Hospital and 30-day mortality were 8.2 and 13.3%, respectively, for patients with lactate clearance; they were 18.7 and 24.7%, respectively, for those without lactate clearance. Each 10% increase in repeat lactate values was associated with a 9.4% (95% confidence interval [CI] = 7.8-11.1%) increase in the odds of hospital death. Within 4 hours, patients received 32 (618) ml/kg of fluid. Each 7.5 ml/kg increase was associated with a 1.3% (95% CI = 0.6-2.1%) decrease in repeat lactate. Across an unrestricted range, increased fluid was not associated with improved mortality. However, when limited to less than 45 ml/kg, additional fluid was associated with a trend toward improved survival (odds ratio = 0.92; 95% CI = 0.82-1.03) that was statistically significant among patients with highly concordant fluid records.Conclusions: Early fluid administration, below 45 ml/kg, was associated with modest improvements in lactate clearance and potential improvements in mortality. Further study is needed to define treatment strategies in this prevalent and morbid group of patients with sepsis.

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Prediction of mortality in adult emergency department patients with sepsis

Cited by 89 publications

References 21 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

The Mortality in Emergency Department Sepsis Score as a Predictor of 1-Month Mortality among Adult Patients with Sepsis: Weighing the Evidence

Fluid Volume, Lactate Values, and Mortality in Sepsis Patients with Intermediate Lactate Values

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