Prognostic accuracy of SIRS criteria, qSOFA score and GYM score for 30-day-mortality in older non-severely dependent infected patients attended in the emergency department

Abstract

The aim of this study was to determine the accuracy of systemic inflammatory response syndrome (SIRS), quick Sepsis-related Organ Failure Assessment (qSOFA) score and GYM score to predict 30-day mortality in older non-severely dependent patients attended for an episode of infection in the emergency department (ED). We performed an analytical, observational, prospective cohort study including patients 75 years of age or older, without severe functional dependence, attended for an infectious process in 69 Spanish EDs for 2-day three-seasonal periods. Demographic, clinical and analytical data were collected. The primary outcome was 30-day mortality after the index event. We included 1071 patients, with a mean age of 83.6 [standard deviation (SD) 5.6] years; 544 (50.8%) were men. Seventy-two patients (6.5%) died within 30 days. SIRS criteria ≥ 2 had a sensitivity of 65% [95% confidence interval (CI) 53.1-75.9] and a specificity of 49% (95% CI 46.0-52.3), a qSOFA score ≥ 2 had a sensitivity of 28% (95% CI 18.2-39.8) and a specificity of 94% (95% CI 91.9-95.1), and a GYM score ≥ 1 had a sensitivity of 81% (95% CI 69.2-88.6) and a specificity of 45% (95% CI 41.6-47.9). A GYM score ≥ 1 and a qSOFA score ≥ 2 were the cut-offs with the highest sensitivity (p < 0.001) and specificity (p < 0.001), respectively. The area under the curve (AUC) was 0.73 (95% CI 0.66-0.79; p < 0.001) for the GYM score, 0.69 (95% CI 0.61-0.76; p < 0.001) for the qSOFA score and 0.65 (95% CI 0.59-0.72; p < 0.001) for SIRS. A GYM score ≥ 1 may be the most sensitive score and a qSOFA score ≥ 2 the most specific score to predict 30-day mortality in non-severely dependent older patients attended for acute infection in EDs.

Sepsis in the older person: The ravages of time and bacteria

“…A number of tools have been suggested to risk‐stratify patients with sepsis (Table ); however, their prognostic performance is lower in older age groups . In older persons, Systemic Inflammatory Response Syndrome (SIRS) criteria and the quick Sepsis‐related Organ Failure Assessment (qSOFA) demonstrate a sensitivity for prediction of 30 day mortality of only 65% and 28%, respectively, using cut‐points of ≥2 . However, qSOFA has a significantly higher specificity than SIRS, at 94% and 49% for 30 day mortality, respectively .…”

“…In older persons, Systemic Inflammatory Response Syndrome (SIRS) criteria and the quick Sepsis‐related Organ Failure Assessment (qSOFA) demonstrate a sensitivity for prediction of 30 day mortality of only 65% and 28%, respectively, using cut‐points of ≥2 . However, qSOFA has a significantly higher specificity than SIRS, at 94% and 49% for 30 day mortality, respectively . The Glasgow tachYpnoea Morbidity score has recently been suggested as a measure to improve prognostic capacity in older people with sepsis, with a sensitivity of 80% for 30 day mortality when using a cut‐point of ≥1 .…”

“…However, qSOFA has a significantly higher specificity than SIRS, at 94% and 49% for 30 day mortality, respectively . The Glasgow tachYpnoea Morbidity score has recently been suggested as a measure to improve prognostic capacity in older people with sepsis, with a sensitivity of 80% for 30 day mortality when using a cut‐point of ≥1 . However, this score has been assessed at only a single centre and requires external validation.…”

“…31 The Glasgow tachYpnoea Morbidity score has recently been suggested as a measure to improve prognostic capacity in older people with sepsis, with a sensitivity of 80% for 30 day mortality when using a cut-point of ≥1. 31 However, this score has been assessed at only a single centre and requires external validation. Scoring systems incorporating age and comorbid illness burden such as the Mortality in ED Sepsis (MEDS) and Predisposition Insult Response Organ failure (PIRO) scores have better predictive value in the ED than SOFA, which addresses only physiological derangements.…”

Comparison of Prognostic Accuracy of the quick Sepsis-Related Organ Failure Assessment between Short- & Long-term Mortality in Patients Presenting Outside of The Intensive Care Unit - A Systematic Review & Meta-analysis

“…In this meta-analysis, 35 studies with 269,544 patients reported on the prognostic accuracy of the qSOFA and short-term mortality, including 27 retrospective studies [5][6][7][8]10,11,[13][14][15][16]18,20,22,[24][25][26][27]29,[32][33][34][35][37][38][39][40] , while 8 studies were prospective studies 9,12,17,19,21,23,28,30,36 . Due to the heterogeneity of the inclusion criteria, a random-effects model was used to calculate the pooled sensitivity and specificity of the included studies.…”