Predictive Value of 3 Clinical Criteria for Sepsis (Quick Sequential Organ Failure Assessment, Systemic Inflammatory Response Syndrome, and National Early Warning Score) With Respect to Short-term Mortality in Allogeneic Hematopoietic Cell Transplant Recipients With Suspected Infections

Abstract

Background Sepsis, a life-threatening immunological response to an infection, disproportionality affects allogeneic hematopoietic cell transplant (HCT) recipients and is challenging to define. Clinical criteria that predict mortality and intensive care unit endpoints in patients with suspected infections (SI) have been adopted in sepsis definitions, but their predictive value among immunocompromised populations is largely unknown. Here, we evaluate three criteria among allogeneic HCT recipients. Methods We evaluated Systemic Inflammatory Response Syndrome (SIRS), quick-Sequential Organ Failure Assessment (qSOFA), and National Early Warning Score (NEWS) criteria in relation to short-term mortality among HCT recipients with SIs. Data from the first 100-days post-transplant were analyzed for patients transplanted between September 2010 - July 2017. We used the following cut-points (qSOFA/SIRS: 2+; NEWS: 7+) and restricted to first SI per hospital encounter. Results Of the 880 HCT recipients who experienced ≥ 1 SI, 58 (6.6%) died within 28 days and 22 (2.5%) within 10 days of a SI. In relation to 10-day mortality, SIRS was the most sensitive: 91.3% (95% CI:72.0 – 98.9%) but least specific: 35.0% (32.6 – 37.5%) whereas qSOFA was the most specific: 90.5% (88.9 – 91.9%) but least sensitive: 47.8% (26.8 – 69.4%). NEWS was moderately sensitive 78.3% (56.3 – 92.5%) and specific 70.2% (67.8 – 72.4%). Conclusion NEWS outperformed qSOFA and SIRS, but all three criteria had low to moderate predictive accuracy and the magnitude of the known predictive limitations of qSOFA and SIRS were at least as large as in general populations. Our data suggest that population-specific sepsis criteria are needed for immunocompromised patients.

Development and Validation of a Machine Learning Model to Estimate Bacterial Sepsis Among Immunocompromised Recipients of Stem Cell Transplant

“…11 This difference is likely driven by our decision to evaluate potential infections (ie, all blood cultures) instead of the commonly used suspected infections (ie, body fluid cultures collected within a specific antibiotic time epoch) as well as missingness frequency differences (suspected infection study temperature missingness, 6%; temperature missingness in this study, 35%). 11,18 While examining PBIs likely contributed to our large amount of missingness and meant we included some cultures in the absence of clinical suspicion of infection (ie, surveillance cultures), we evaluated PBIs rather than suspected infections because our primary end point required blood culture confirmation, and we wanted our tools to inform antibiotic treatment use rather than estimate disease escalation among patients already receiving antibiotic treatment. 34,37 To ensure our tools were not biased toward surveillance cultures, we performed a sensitivity analysis excluding surveillance cultures and found that neither C-SHBSL nor SHBSL performed meaningfully different.…”

“…FHCRC guidelines during the study have been described elsewhere. 11 Briefly, cultures were recommended for patients with fevers, and surveillance cultures were recommended weekly or biweekly for patients receiving high-dose glucocorticoids (ie, >0.5 mg/kg). Levofloxacin was used as the primary antibiotic prophylaxis agent during neutropenic periods while patients with neutropenic fever received empirical therapy with ceftazidime, cefepime, or meropenem.…”

National Early Warning Score in Predicting Severe Adverse Outcomes of Emergency Medicine Patients: A Retrospective Cohort Study

“…[20][21][22] Systemic inflammatory response syndrome (SIRS) is often used to predict infection or septic shock. [23][24][25][26][27] However, many of these scores include laboratory results and are used primarily for specific patients, limiting their value in emergency triage. However, general early warning scores, such as the MEWS and NEWS, are based only on readily available parameters, and thus have a good range of applicability.…”

CRB-65: Predictor for Intensive Care Unit Admission in Patients with Biliary Tract Infection Presenting to An Emergency Department

“…The early recognition of sepsis and its severity are important for appropriate treatment, improving outcomes, and reducing costs [4]. Therefore, many screening tools have been proposed to identify disease severity, including the SOFA, qSOFA, Acute Physiology and Chronic Health Evaluation, Multiple Organ Dysfunction Score (MODS), National Early Warning Score (NEWS), and CURB-65 (confusion, urea > 7 mmol/L, respiratory rate ≥ 30/minute, low systolic [< 90 mmHg] or diastolic [≤ 60 mmHg] blood pressure, and age ≥ 65 years) [9][10][11].…”