TY - JOUR
T1 - Assessment of mortality by qSOFA in patients with sepsis outside ICU
T2 - A post hoc subgroup analysis by the Japanese Association for Acute Medicine Sepsis Registry Study Group
AU - JAAM Sepsis Registry (JAAMSR) Study Group
AU - Umemura, Yutaka
AU - Ogura, Hiroshi
AU - Gando, Satoshi
AU - Kushimoto, Shigeki
AU - Saitoh, Daizoh
AU - Mayumi, Toshihiko
AU - Fujishima, Seitaro
AU - Abe, Toshikazu
AU - Ikeda, Hiroto
AU - Kotani, Joji
AU - Miki, Yasuo
AU - Shiraishi, Shin ichiro
AU - Shiraishi, Atsushi
AU - Suzuki, Koichiro
AU - Suzuki, Yasushi
AU - Takeyama, Naoshi
AU - Takuma, Kiyotsugu
AU - Tsuruta, Ryosuke
AU - Yamaguchi, Yoshihiro
AU - Yamashita, Norio
AU - Aikawa, Naoki
N1 - Publisher Copyright:
© 2017 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases
PY - 2017/11
Y1 - 2017/11
N2 - Quick sequential organ failure assessment (qSOFA) was proposed in the new sepsis definition (Sepsis-3). Although qSOFA was created to identify patients with suspected infection and likely to have poor outcomes, the clinical utility of qSOFA to screen sepsis has not been fully evaluated. We investigated the number of patients diagnosed as having severe sepsis who could not be identified by the qSOFA criteria and what clinical signs could complement the qSOFA score. This retrospective analysis of a multicenter prospective registry included adult patients with severe sepsis diagnosed outside the intensive care unit (ICU) by conventional criteria proposed in 2003. We conducted receiver operating characteristic (ROC) analyses to assess the predictive value for in-hospital mortality and compared clinical characteristics between survivors and non-survivors with qSOFA score ≤ 1 point (qSOFA-negative). Among 387 eligible patients, 63 (16.3%) patients were categorized as qSOFA-negative, and 10 (15.9%) of these patients died. The area under the ROC curve for the qSOFA score was 0.615, which was superior to that for the systemic inflammatory response syndrome score (0.531, P = 0.019) but inferior to that for the SOFA score (0.702, P = 0.005). Multivariate logistic regression analysis showed that hypothermia might be associated with poor outcome independently of qSOFA criteria. Our findings suggested that qSOFA had a suboptimal level of predictive value outside the ICU and could not identify 16.3% of patients who were once actually diagnosed with sepsis. Hypothermia might be associated with an increased risk of death that cannot be identified by qSOFA.
AB - Quick sequential organ failure assessment (qSOFA) was proposed in the new sepsis definition (Sepsis-3). Although qSOFA was created to identify patients with suspected infection and likely to have poor outcomes, the clinical utility of qSOFA to screen sepsis has not been fully evaluated. We investigated the number of patients diagnosed as having severe sepsis who could not be identified by the qSOFA criteria and what clinical signs could complement the qSOFA score. This retrospective analysis of a multicenter prospective registry included adult patients with severe sepsis diagnosed outside the intensive care unit (ICU) by conventional criteria proposed in 2003. We conducted receiver operating characteristic (ROC) analyses to assess the predictive value for in-hospital mortality and compared clinical characteristics between survivors and non-survivors with qSOFA score ≤ 1 point (qSOFA-negative). Among 387 eligible patients, 63 (16.3%) patients were categorized as qSOFA-negative, and 10 (15.9%) of these patients died. The area under the ROC curve for the qSOFA score was 0.615, which was superior to that for the systemic inflammatory response syndrome score (0.531, P = 0.019) but inferior to that for the SOFA score (0.702, P = 0.005). Multivariate logistic regression analysis showed that hypothermia might be associated with poor outcome independently of qSOFA criteria. Our findings suggested that qSOFA had a suboptimal level of predictive value outside the ICU and could not identify 16.3% of patients who were once actually diagnosed with sepsis. Hypothermia might be associated with an increased risk of death that cannot be identified by qSOFA.
KW - Criteria
KW - Hypothermia
KW - Organ dysfunction scores
KW - Registries
KW - Sepsis
UR - http://www.scopus.com/inward/record.url?scp=85028360139&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85028360139&partnerID=8YFLogxK
U2 - 10.1016/j.jiac.2017.07.005
DO - 10.1016/j.jiac.2017.07.005
M3 - Article
C2 - 28847586
AN - SCOPUS:85028360139
VL - 23
SP - 757
EP - 762
JO - Journal of Infection and Chemotherapy
JF - Journal of Infection and Chemotherapy
SN - 1341-321X
IS - 11
ER -