The Utility of the Rapid Emergency Medicine Score (REMS) compared with SIRS, qSOFA and NEWS for predicting in-Hospital Mortality Among Patients with Suspicion of Sepsis in an Emergency Department

Abstract

Background Many early warning scores (EWSs) have been validated to prognosticate adverse outcomes secondary to sepsis in the Emergency Department (ED). These EWSs include the Systemic Inflammatory Response Syndrome criteria (SIRS), the quick Sequential Organ Failure Assessment (qSOFA) and the National Early Warning Score (NEWS). However, the Rapid Emergency Medicine Score (REMS) has never been validated for this purpose. We aimed to assess and compare the prognostic utility of REMS with that of SIRS, qSOFA and NEWS for predicting mortality in patients with suspicion of sepsis in the ED.Methods We conducted a retrospective study at the ED of Siriraj Hospital Mahidol University, Thailand. Adult patients suspected of having sepsis in the ED between August 2018 and July 2019 were included. Their EWSs were calculated. The primary outcome was all-cause in-hospital mortality. The secondary outcome was 7-day mortality.Results A total of 1622 patients were included in the study; 574 (28.2%) died at hospital discharge. REMS yielded the highest discrimination capacity for in-hospital mortality (the area under the receiver operator characteristics curves (AUROC) 0.62 (95% confidence interval (CI) 0.59, 0.65)), which was significantly higher than qSOFA (AUROC 0.58 (95%CI 0.55, 0.60); p=0.005) and SIRS (AUROC 0.52 (95%CI 0.49, 0.55); p<0.001) but not significantly superior to NEWS (AUROC 0.61 (95%CI 0.58, 0.64); p=0.27). REMS was the best EWS in terms of calibration and association with the outcome. It could also provide the highest net benefit from the decision curve analysis. Comparison of EWSs plus baseline risk model showed similar results. REMS also performed better than other EWSs for 7-day mortality.ConclusionREMS was an early warning score with higher accuracy than sepsis-related scores (qSOFA and SIRS) and had the highest utility in terms of net benefit compared to SIRS, qSOFA and NEWS in predicting in-hospital mortality in patients presenting to the ED with suspected sepsis.

Comparison of REMS, NEWS, qSOFA scales and SIRS criteria in sepsis prediction for patients with confirmed SARS-CoV-2 infection: retrospective observational study

“…Выборка пациентов в исследовании Omar et al была больше (n = 115,734). В исследовании R. Onlak et al сравнивалась эффективность шкал REMS, NEWS, qSOFA и критериев SIRS в прогнозе летальности у пациентов с подозрением на сепсис [16]. Дизайн работы отличается от дизайна нашей статьи разделением пациентов на группы и конечной точкой.…”

A Transcriptomic Severity Metric that Predicts Clinical Outcomes in Critically Ill Surgical Sepsis Patients

“…The quick (q)SOFA assessment associated with the Sepsis-3 criteria has been recommended to identify patients at high risk of death, but its value is still controversial. 9,10 Other less common metrics such as procalcitonin, IL-6 and monocyte distribution width (MDW) have all been promulgated as being predictive of sepsis severity, 11,12 although their predictive ability to either diagnose sepsis or its severity remains controversial. 13 A rapid and clinically applicable diagnostic that can both diagnose infection and predict sepsis severity will be required to alter clinical management of the individual patient.…”