qSOFA Score is useful to predict in-hospital mortality and long-term outcomes in patients with acute coronary syndrome

Abstract

Funding Acknowledgements Type of funding sources: None. Introduction Quick Sequential Organ Failure Assessment (qSOFA) is a bedside score widely used to identify patients at greater risk for a poor outcome outside the intensive care unit. Initially applied in patients with suspected infection, the score has recently emerged as a marker for poor prognosis or mortality across various patient groups. Aim To validate the qSOFA score as a predictor of in-hospital mortality and long-term outcomes in acute coronary syndrome (ACS) patients. Methods A retrospective analysis of 1296 patients admitted for ACS was performed. qSOFA score evaluates the presence of 3 variables: systolic blood pressure <120mmHg (1 point), respiratory rate ≥22 breaths per min (1 point), and Glasgow coma scale <15 (1 point). The score derived from these variables allowed the classification of patients into two risk categories: low risk (LR) (<2 points) and high risk (HR) (≥2 points). The Mann-Whitney U test was used for median comparison between groups. In addition, Kaplan-Meier survival plot was used to evaluate the predictive power of qSOFA score on in-hospital mortality and 12-month mortality (12MM). Results Mean age 69,1±13years; 70% were male. The mean time of hospitalization was 7,4±5days. 34% had a diagnosis of ST-elevation myocardial infarction (STEMI). Mean left ventricular ejection fraction (LVEF) was 56,4±14,6%. Global in-hospital mortality was 8%. qSOFA was calculated, and the population was divided into 2 groups: 78% had low risk (qSOFA <2) and 6% had high risk (qSOFA ≥2). HR group defined by qSOFA was significantly associated with in-hospital mortality (28% vs 8%; p<0,01, OR: 3,8 CI 95% 2,4;6,2). Kaplan-Meier survival analysis revealed that HR qSOFA was significantly associated with 12MM (p<0,01; 24% vs 7%; 260 vs 321 days until event, χ2 8,2). In logistic regression analysis, LVEF and diagnosis of STEMI did not increase the risk of a higher qSOFA score and in-hospital mortality (p=0,06 and p=0,94). HR group is significantly associated with left main coronary artery disease (12% vs 9%; p<0,01; OR 2,4; CI 95% 1,2;4,9) and in-hospital complications, including arrhythmia, mechanical complications, hemorrhagic events, acute kidney disease and hematological disorders (54% vs 28%; p<0,01; OR 3,0; CI 95% 1,9;4,6). Conclusion qSOFA score is associated with higher in-hospital mortality and 12 month-mortality in patients with ACS. Its use may identify patients with an increased risk of mortality, needing specialized care, and a close follow-up.