Comparison of qSOFA, SIRS, NEWS and REWS Scores in Predicting Severity and 28-day Mortality of older Suspected Sepsis Cases; a Prognostic Accuracy Study
Archives of Academic Emergency Medicine,
Vol. 12 No. 1 (2024),
1 January 2024
,
Page e3
https://doi.org/10.22037/aaem.v12i1.2148
Abstract
Introduction: Various scores have been developed to predict sepsis mortality. This Study aimed to evaluate the accuracy of the quick Sequential Organ Failure Assessment (qSOFA), Systemic Inflammatory Response Syndrome (SIRS), National Early Warning Score (NEWS) and Ramathibodi Early Warning Score (REWS) for predicting severity and 28-day mortality of elderly suspected sepsis cases in emergency department (ED).
Methods: This prognostic accuracy study was performed using data obtained from patients aged ≥ 60 years with suspected sepsis who visited the Ramathibodi Hospital ED between May and December 2019. The accuracy of NEWS, SIRS, REWS, and qSOFA in predicting the studied outcomes were evaluated using the receiver operating characteristic (ROC) curve analysis.
Results: A total of 531 cases with the mean age of 77.6 ± 9.39 (range: 60-101) years were evaluated (45% male). The overall 28-day mortality was 11.6%. The area under ROC curve of qSOFA scores ≥2 showed moderate discrimination (0.66, 95% confidence interval [CI]: 0.59–0.73) in predicting mortality, which was significantly higher than SIRS ≥2 (ROC: 0.56, 95% CI: 0.50–0.63; p=0.04), NEWS ≥5 (ROC: 0.56, 95% CI: 0.50–0.63; p=0.01), and REWS ≥4 (ROC: 0.56, 95% CI: 0.50–0.63; p<0.01).
Conclusions: qSOFA score ≥2 was superior to SIRS ≥2, NEWS ≥5, and REWS ≥4 in predicting 28-day mortality and septic shock in elderly patients with suspected sepsis in the ED. However, the predictive performance of qSOFA ≥2 was only moderate (AUC<0.8). Therefore, to reduce mortality and improve outcomes, we suggest the use of qSOFA ≥2 combined with clinical or other early warning scores, or the development of new prediction scores for screening, triage, and prediction of mortality and of severity of sepsis in elderly patients with suspected sepsis in the ED.
- Aged
- Sepsis
- Mortality
- Emergency service, hospital
- Clinical decision rules
How to Cite
References
Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):801-10.
Harris RL, Musher DM, Bloom K, Gathe J, Rice L, Sugarman B, et al. Manifestations of sepsis. Arch Intern Med. 1987;147(11):1895-906.
Fleischmann C, Scherag A, Adhikari NK, Hartog CS, Tsaganos T, Schlattmann P, et al. Assessment of Global Incidence and Mortality of Hospital-treated Sepsis. Current Estimates and Limitations. Am J Respir Crit Care Med. 2016;193(3):259-72.
Khwannimit B, Bhurayanontachai R, Vattanavanit V. Comparison of the performance of SOFA, qSOFA and SIRS for predicting mortality and organ failure among sepsis patients admitted to the intensive care unit in a middle-income country. J Crit Care. 2018;44:156-60.
Global Sepsis Alliance. What is sepsis? – Definition of sepsis [Internet]. 2021 [cited 2022 December 28] Available from: https://www.global-sepsis-alliance.org/sepsis.
Boonmee P, Ruangsomboon O, Limsuwat C, Chakorn T. Predictors of Mortality in Elderly and Very Elderly Emergency Patients with Sepsis: A Retrospective Study. West J Emerg Med. 2020;21(6):210-8.
Ittisanyakorn M, Ruchichanantakul S, Vanichkulbodee A, Sri-On J. Prevalence and factors associated with one-year mortality of infectious diseases among elderly emergency department patients in a middle-income country. BMC Infect Dis. 2019;19(1):662.
Nasa P, Juneja D, Singh O. Severe sepsis and septic shock in the elderly: An overview. World J Crit Care Med. 2012;1(1):23-30.
Martin-Loeches I, Guia MC, Vallecoccia MS, Suarez D, Ibarz M, Irazabal M, et al. Risk factors for mortality in elderly and very elderly critically ill patients with sepsis: a prospective, observational, multicenter cohort study. Ann Intensive Care. 2019;9(1):26.
Evans L, Rhodes A, Alhazzani W, Antonelli M, Coopersmith CM, French C, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med. 2021;47(11):1181-247.
Abdullah SMOB, Sørensen RH, Nielsen FE. Prognostic Accuracy of SOFA, qSOFA, and SIRS for Mortality Among Emergency Department Patients with Infections. Infect Drug Resist. 2021;14:2763-75.
Brink A, Alsma J, Verdonschot RJCG, Rood PPM, Zietse R, Lingsma HF, et al. Predicting mortality in patients with suspected sepsis at the Emergency Department; A retrospective cohort study comparing qSOFA, SIRS and National Early Warning Score. PLoS One. 2019;14(1):e0211133.
Churpek MM, Snyder A, Han X, Sokol S, Pettit N, Howell MD, et al. Quick Sepsis-related Organ Failure Assessment, Systemic Inflammatory Response Syndrome, and Early Warning Scores for Detecting Clinical Deterioration in Infected Patients outside the Intensive Care Unit. Am J Respir Crit Care Med. 2017;195(7):906-11.
Alhmoud B, Bonnici T, Patel R, Melley D, Williams B, Banerjee A. Performance of universal early warning scores in different patient subgroups and clinical settings: a systematic review. BMJ Open. 2021;11(4):e045849.
Holland M, Kellett J. A systematic review of the discrimination and absolute mortality predicted by the National Early Warning Scores according to different cut-off values and prediction windows. European Journal of Internal Medicine. 2022;98:15-26.
Lie KC, Lau C-Y, Van Vinh Chau N, West TE, Limmathurotsakul D, Sudarmono P, et al. Utility of SOFA score, management and outcomes of sepsis in Southeast Asia: a multinational multicenter prospective observational study. J Intensive Care. 2018;6(1):9.
Tan TL, Tang YJ, Ching LJ, Abdullah N, Neoh H-M. 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. Sci Rep. 2018;8(1):16698.
de Groot B, Stolwijk F, Warmerdam M, Lucke JA, Singh GK, Abbas M, et al. The most commonly used disease severity scores are inappropriate for risk stratification of older emergency department sepsis patients: an observational multi-centre study. Scand J Trauma Resusc Emerg Med. 2017;25(1):91.
Weng J, Hou R, Zhou X, Xu Z, Zhou Z, Wang P, et al. Development and validation of a score to predict mortality in ICU patients with sepsis: a multicenter retrospective study. J Transl Med. 2021;19(1):322.
- Abstract Viewed: 518 times
- pdf Downloaded: 1122 times