Prognostic Accuracy of the Quick Sequential Organ Failure Assessment for Mortality in Patients With Suspected Infection

Swartz, Andrew W.

doi:10.7326/l18-0290

Cited by 3 publications

(3 citation statements)

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“…In a Norwegian study of patients admitted to the ED of a university hospital, the mortality after seven days was 7% [14]. The ability of qSOFA to predict in-hospital mortality was limited, with sensitivity and speci city comparable to previous studies [14][15][16][17].…”

Section: Discussionmentioning

confidence: 76%

“…Thus, evaluation of cognitive function is a core component of emergency medicine. However, previous studies have demonstrated a relatively poor ability of qSOFA performed in the ED to predict sepsis and sepsisrelated mortality [14][15][16][17], and qSOFA only offers a crude evaluation of cognitive function. The 4 'A's Test (4AT) is a rapid bedside delirium screening tool that assesses the major features of delirium; disturbed alertness, cognition and attention, and acute change or uctuation in symptoms [18].…”

Section: Introductionmentioning

confidence: 99%

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Delirium screening with 4AT in patients aged 65 years and older admitted to the Emergency Department with suspected sepsis – a prospective cohort study

Myrstad

Kuwelker

Haakonsen

et al. 2021

Preprint

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Background Cognitive impairment is common among acutely ill older patients admitted to hospital. The quick Sequential Organ Failure Assessment (qSOFA) is recommended as a tool to predict poor outcome in patients with suspected sepsis, but assesses cognitive function crudely. We aimed to study the feasibility of The 4 'A's test (4AT), a rapid delirium screening tool, performed upon Emergency Department (ED) admission by nurses and doctors inexperienced with this tool, and to characterize patients aged ≥ 65 years admitted to the ED with suspected sepsis. Methods In this prospective cohort study, we included patients aged ≥ 65 years, admitted to the EDs of two Norwegian general hospitals, with suspected sepsis. ED nurses and doctors performed delirium screening with 4AT within two hours after ED admission, and registered the time spent on the screening in each case. Sepsis and delirium during the hospital stay were diagnosed retrospectively, according to recommended diagnosis criteria. Results Out of the 196 patients included (mean age 81 years), 100 patients fulfilled the sepsis diagnosis criteria. Mean 4AT screening time was 2.5 minutes (median two minutes). While qSOFA identified 48 patients (24%) with altered mental status, 114 patients (58%) had a 4AT score ≥ 1, indicating cognitive impairment, upon ED admission. Sepsis patients more often had a 4AT score ≥ 4, indicating delirium, than patients without sepsis (40% vs. 26%, p < 0.05). The prevalence of delirium any time during the hospital stay was 44% in patients aged 65–80 years, 57% in patients aged ≥ 80 years, and 76% in patients aged ≥ 80 years with sepsis. Conclusions Delirium screening upon ED admission, with 4AT performed by nurses and doctors inexperienced with this tool, was feasible among patients aged ≥ 65 years admitted with suspected sepsis. Features of delirium were common upon ED admission, particularly in patients with sepsis. The prevalence of delirium anytime during the hospital stay was highest among patients aged 80 years and older with sepsis. Our findings suggest increased awareness of delirium in older patients admitted to the ED with suspected sepsis, but the added value of systematic delirium screening with 4AT needs to be addressed in future studies.

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Section: Discussionmentioning

confidence: 76%

Section: Introductionmentioning

confidence: 99%

Delirium screening with 4AT in patients aged 65 years and older admitted to the Emergency Department with suspected sepsis – a prospective cohort study

Myrstad

Kuwelker

Haakonsen

et al. 2021

Preprint

View full text Add to dashboard Cite

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“…This tool can be an invaluable adjunct to the current clinical and pathological parameters in identifying patients with higher mortality risk. 9 Biomarkers associated with the magnitude of the inflammatory response, like IL-6 and CXCL10, were correlated with sepsis patients' clinical outcomes in populationbased studies. 10,11 However, such biomarkers' ability to predict outcome in an individual is limited, primarily due to the lack of specificity of the biomarkers and their similarity to the early inflammatory response.…”

Section: Introductionmentioning

confidence: 99%

Identification of Potential Prognosticators for Sepsis through Expression Analysis of Transcriptomic Data from Sepsis Survivors and Nonsurvivors

2022

Acta Med Philipp

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Background. Infection can be severely complicated by a dysregulated, whole-body inflammatory response known as sepsis. While previous research showed that genetic predisposition is linked to outcome differences, current patient characterization fails to determine which septic patients have greater tendencies to develop into severe sepsis or go into septic shock. As such, the identification of prognostic biomarkers may assist in identifying these high-risk patients and help improve the clinical management of the disease.Objective. In this study, we aimed to identify molecular patterns involved in sepsis. We also aimed to identify essential genes associated with the disease's survival which could serve as potential prognosticators for the disease.Methods. We used weighted gene co-expression analysis (WGCNA) to analyze GSE63042, an RNA expression dataset from 129 patients with systemic inflammatory response syndrome or sepsis, including 78 sepsis survivors and 28 sepsis nonsurvivors. This analysis included identifying gene modules that differentiate sepsis survivors from nonsurvivors and qualitatively assessing differentially expressed genes. We then used STRING's protein-protein interaction and gene ontology analysis to determine the functional and pathway relationships of the genes in the top modules. Lastly, we assessed the prognosticator abilities of the hub genes using ROC analysis.Results. We found four diverse co-expression gene modules significantly associated with sepsis survival. Our differential gene expression analysis, combined with protein-protein interaction and gene ontology analysis, revealed that the hub genes of these modules -TAF10, SNAPIN, PSME2, PSMB9, JUNB, and CEBPD -may serve as candidate markers for sepsis prognosis. These markers were significantly downregulated in sepsis nonsurvivors compared with sepsis survivors. Conclusion.Weighted gene co-expression analysis, gene ontology enrichment analysis, and protein-protein network interaction analysis of transcriptomic data from sepsis survivors and nonsurvivors revealed TAF10, SNAPIN, PSME2, PSMB9, JUNB, and CEBPD as potential biomarkers for sepsis prognosis. These genes are associated with functions related to proper immune response, and their downregulation in sepsis nonsurvivors suggests eventual immune exhaustion in late sepsis. Further analyses, however, are necessary to validate their roles in sepsis progression and patient survival.

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The value of IL-6, PCT, qSOFA, NEWS, and SIRS to predict septic shock after Percutaneous nephrolithotomy

Liu,

Sun,

Long

et al. 2024

BMC Urol

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Background There are numerous methods available for predicting sepsis following Percutaneous Nephrolithotomy. This study aims to compare the predictive value of Quick Sequential Organ Failure Assessment (qSOFA), Systemic Inflammatory Response Syndrome (SISR), National Early Warning Score (NEWS), interleukin-6 (IL-6), and procalcitonin (PCT) for septicemia. Methods Patients who underwent percutaneous nephrolithotomy were included in the study and divided into a control group and a septic shock group. The effectiveness of qSOFA, SIRS, NEWS, Interleukin-6, and Procalcitonin was assessed, with Receiver Operating Characteristic curves and Area Under the Curve used to compare the predictive accuracy of these four indicators. Results Among the 401 patients, 16 cases (3.99%) developed septic shock. Females, elderly individuals, and patients with positive urine culture and positive nitrite in urine were found to be more susceptible to septic shock. PCT, IL-6, SIRS, NEWS, qSOFA, and surgical time were identified as independent risk factors for septic shock. The cutoff values are as follows: qSOFA score > 0.50, SIRS score > 2.50, NEWS score > 2.50, and IL-6 > 264.00 pg/ml. Among the 29 patients identified by IL-6 as having sepsis, 16 were confirmed to have developed sepsis. The qSOFA identified 63 septicemia cases, with 16 confirmed to have developed septicemia; NEWS identified 122 septicemia cases, of which 14 cases actually developed septicemia; SIRS identified 128 septicemia patients, with 16 confirmed to have developed septicemia. In terms of predictive ability, IL-6 (AUC 0.993, 95% CI 0.985 ~ 1) demonstrated a higher predictive accuracy compared to qSOFA (AUC 0.952, 95% CI 0.928 ~ 0.977), NEWS (AUC 0.824, 95% CI 0.720 ~ 0.929) and SIRS (AUC 0.928, 95% CI 0.888 ~ 0.969). Conclusions IL-6 has higher accuracy in predicting septic shock after PCNL compared to qSOFA, SIRS, and NEWS.

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Prognostic Accuracy of the Quick Sequential Organ Failure Assessment for Mortality in Patients With Suspected Infection

Cited by 3 publications

References 1 publication

Delirium screening with 4AT in patients aged 65 years and older admitted to the Emergency Department with suspected sepsis – a prospective cohort study

Delirium screening with 4AT in patients aged 65 years and older admitted to the Emergency Department with suspected sepsis – a prospective cohort study

Identification of Potential Prognosticators for Sepsis through Expression Analysis of Transcriptomic Data from Sepsis Survivors and Nonsurvivors

The value of IL-6, PCT, qSOFA, NEWS, and SIRS to predict septic shock after Percutaneous nephrolithotomy

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