Complementary Role of Hypothermia Identification to the Quick Sequential Organ Failure Assessment Score in Predicting Patients With Sepsis at High Risk of Mortality: A Retrospective Analysis From a Multicenter, Observational Study

Shigeki Kushimoto, Satoshi Gando, Hiroshi Ogura, Yutaka Umemura, Daizoh Saitoh, Toshihiko Mayumi, Seitaro Fujishima, Toshikazu Abe, Atsushi Shiraishi, Hiroto Ikeda, Joji Kotani, Yasuo Miki, Shin Ichiro Shiraishi, Koichiro Suzuki, Yasushi Suzuki, Naoshi Takeyama, Kiyotsugu Takuma, Ryosuke Tsuruta, Yoshihiro Yamaguchi, Norio YamashitaNaoki Aikawa

Research output: Contribution to journalArticle

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Abstract

Background: Although the quick Sequential Organ Failure Assessment (qSOFA) has been recommended for identifying patients at higher risk of hospital death, it has only a 60% sensitivity for in-hospital mortality. On the other hand, hypothermia associates with increased mortality and organ failure in patients with sepsis. This study aimed to assess the predictive validity of qSOFA for identifying patients with sepsis at higher risk of multiple organ dysfunction or death and the complementary effect of hypothermia. Methods: Patients with severe sepsis admitted to intensive care units (ICUs) were retrospectively analyzed. The predictive validities of qSOFA (≥2, positive) and the complementary effect of hypothermia (body temperature ≤36.5°C) for the identification of death or multiorgan dysfunction were evaluated. Results: Of the 624 patients, 230 (36.9%) developed multiorgan dysfunction and 144 (23.1%) died within 28 days; 527 (84.5%) had a positive qSOFA. The 28-day mortality rates of patients with positive and negative qSOFA were 25.4% and 10.3%, respectively (P =.001). The rate of positive qSOFA was higher in patients with multiorgan dysfunction (sensitivity, 0.896; specificity, 0.185) and among patients who died within 28 days (sensitivity, 0.931; specificity, 0.181); 10 (6.9%) of 144 deaths were not identified. In cases of positive qSOFA without hypothermia, positive qSOFA + hypothermia, or negative qSOFA with hypothermia, the predictive value for 28-day mortality improved (sensitivity, 0.979). Among the 144 patients who died, only 3 were not identified. Conclusion: A qSOFA score ≥2 may identify >90% of 28-day deaths among patients with severe sepsis; hypothermia may complement the predictive ability of qSOFA.

Original languageEnglish
JournalJournal of Intensive Care Medicine
DOIs
Publication statusAccepted/In press - 2018 Jan 1

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Organ Dysfunction Scores
Hypothermia
Multicenter Studies
Observational Studies
Sepsis
Mortality
Sensitivity and Specificity
Hospital Mortality
Body Temperature
Intensive Care Units

Keywords

  • body temperature
  • critical care
  • mortality
  • quick SOFA
  • sepsis

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Complementary Role of Hypothermia Identification to the Quick Sequential Organ Failure Assessment Score in Predicting Patients With Sepsis at High Risk of Mortality : A Retrospective Analysis From a Multicenter, Observational Study. / Kushimoto, Shigeki; Gando, Satoshi; Ogura, Hiroshi; Umemura, Yutaka; Saitoh, Daizoh; Mayumi, Toshihiko; Fujishima, Seitaro; Abe, Toshikazu; Shiraishi, Atsushi; Ikeda, Hiroto; Kotani, Joji; Miki, Yasuo; Shiraishi, Shin Ichiro; Suzuki, Koichiro; Suzuki, Yasushi; Takeyama, Naoshi; Takuma, Kiyotsugu; Tsuruta, Ryosuke; Yamaguchi, Yoshihiro; Yamashita, Norio; Aikawa, Naoki.

In: Journal of Intensive Care Medicine, 01.01.2018.

Research output: Contribution to journalArticle

Kushimoto, S, Gando, S, Ogura, H, Umemura, Y, Saitoh, D, Mayumi, T, Fujishima, S, Abe, T, Shiraishi, A, Ikeda, H, Kotani, J, Miki, Y, Shiraishi, SI, Suzuki, K, Suzuki, Y, Takeyama, N, Takuma, K, Tsuruta, R, Yamaguchi, Y, Yamashita, N & Aikawa, N 2018, 'Complementary Role of Hypothermia Identification to the Quick Sequential Organ Failure Assessment Score in Predicting Patients With Sepsis at High Risk of Mortality: A Retrospective Analysis From a Multicenter, Observational Study', Journal of Intensive Care Medicine. https://doi.org/10.1177/0885066618761637
Kushimoto, Shigeki ; Gando, Satoshi ; Ogura, Hiroshi ; Umemura, Yutaka ; Saitoh, Daizoh ; Mayumi, Toshihiko ; Fujishima, Seitaro ; Abe, Toshikazu ; Shiraishi, Atsushi ; Ikeda, Hiroto ; Kotani, Joji ; Miki, Yasuo ; Shiraishi, Shin Ichiro ; Suzuki, Koichiro ; Suzuki, Yasushi ; Takeyama, Naoshi ; Takuma, Kiyotsugu ; Tsuruta, Ryosuke ; Yamaguchi, Yoshihiro ; Yamashita, Norio ; Aikawa, Naoki. / Complementary Role of Hypothermia Identification to the Quick Sequential Organ Failure Assessment Score in Predicting Patients With Sepsis at High Risk of Mortality : A Retrospective Analysis From a Multicenter, Observational Study. In: Journal of Intensive Care Medicine. 2018.
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abstract = "Background: Although the quick Sequential Organ Failure Assessment (qSOFA) has been recommended for identifying patients at higher risk of hospital death, it has only a 60{\%} sensitivity for in-hospital mortality. On the other hand, hypothermia associates with increased mortality and organ failure in patients with sepsis. This study aimed to assess the predictive validity of qSOFA for identifying patients with sepsis at higher risk of multiple organ dysfunction or death and the complementary effect of hypothermia. Methods: Patients with severe sepsis admitted to intensive care units (ICUs) were retrospectively analyzed. The predictive validities of qSOFA (≥2, positive) and the complementary effect of hypothermia (body temperature ≤36.5°C) for the identification of death or multiorgan dysfunction were evaluated. Results: Of the 624 patients, 230 (36.9{\%}) developed multiorgan dysfunction and 144 (23.1{\%}) died within 28 days; 527 (84.5{\%}) had a positive qSOFA. The 28-day mortality rates of patients with positive and negative qSOFA were 25.4{\%} and 10.3{\%}, respectively (P =.001). The rate of positive qSOFA was higher in patients with multiorgan dysfunction (sensitivity, 0.896; specificity, 0.185) and among patients who died within 28 days (sensitivity, 0.931; specificity, 0.181); 10 (6.9{\%}) of 144 deaths were not identified. In cases of positive qSOFA without hypothermia, positive qSOFA + hypothermia, or negative qSOFA with hypothermia, the predictive value for 28-day mortality improved (sensitivity, 0.979). Among the 144 patients who died, only 3 were not identified. Conclusion: A qSOFA score ≥2 may identify >90{\%} of 28-day deaths among patients with severe sepsis; hypothermia may complement the predictive ability of qSOFA.",
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T2 - A Retrospective Analysis From a Multicenter, Observational Study

AU - Kushimoto, Shigeki

AU - Gando, Satoshi

AU - Ogura, Hiroshi

AU - Umemura, Yutaka

AU - Saitoh, Daizoh

AU - Mayumi, Toshihiko

AU - Fujishima, Seitaro

AU - Abe, Toshikazu

AU - Shiraishi, Atsushi

AU - Ikeda, Hiroto

AU - Kotani, Joji

AU - Miki, Yasuo

AU - Shiraishi, Shin Ichiro

AU - Suzuki, Koichiro

AU - Suzuki, Yasushi

AU - Takeyama, Naoshi

AU - Takuma, Kiyotsugu

AU - Tsuruta, Ryosuke

AU - Yamaguchi, Yoshihiro

AU - Yamashita, Norio

AU - Aikawa, Naoki

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: Although the quick Sequential Organ Failure Assessment (qSOFA) has been recommended for identifying patients at higher risk of hospital death, it has only a 60% sensitivity for in-hospital mortality. On the other hand, hypothermia associates with increased mortality and organ failure in patients with sepsis. This study aimed to assess the predictive validity of qSOFA for identifying patients with sepsis at higher risk of multiple organ dysfunction or death and the complementary effect of hypothermia. Methods: Patients with severe sepsis admitted to intensive care units (ICUs) were retrospectively analyzed. The predictive validities of qSOFA (≥2, positive) and the complementary effect of hypothermia (body temperature ≤36.5°C) for the identification of death or multiorgan dysfunction were evaluated. Results: Of the 624 patients, 230 (36.9%) developed multiorgan dysfunction and 144 (23.1%) died within 28 days; 527 (84.5%) had a positive qSOFA. The 28-day mortality rates of patients with positive and negative qSOFA were 25.4% and 10.3%, respectively (P =.001). The rate of positive qSOFA was higher in patients with multiorgan dysfunction (sensitivity, 0.896; specificity, 0.185) and among patients who died within 28 days (sensitivity, 0.931; specificity, 0.181); 10 (6.9%) of 144 deaths were not identified. In cases of positive qSOFA without hypothermia, positive qSOFA + hypothermia, or negative qSOFA with hypothermia, the predictive value for 28-day mortality improved (sensitivity, 0.979). Among the 144 patients who died, only 3 were not identified. Conclusion: A qSOFA score ≥2 may identify >90% of 28-day deaths among patients with severe sepsis; hypothermia may complement the predictive ability of qSOFA.

AB - Background: Although the quick Sequential Organ Failure Assessment (qSOFA) has been recommended for identifying patients at higher risk of hospital death, it has only a 60% sensitivity for in-hospital mortality. On the other hand, hypothermia associates with increased mortality and organ failure in patients with sepsis. This study aimed to assess the predictive validity of qSOFA for identifying patients with sepsis at higher risk of multiple organ dysfunction or death and the complementary effect of hypothermia. Methods: Patients with severe sepsis admitted to intensive care units (ICUs) were retrospectively analyzed. The predictive validities of qSOFA (≥2, positive) and the complementary effect of hypothermia (body temperature ≤36.5°C) for the identification of death or multiorgan dysfunction were evaluated. Results: Of the 624 patients, 230 (36.9%) developed multiorgan dysfunction and 144 (23.1%) died within 28 days; 527 (84.5%) had a positive qSOFA. The 28-day mortality rates of patients with positive and negative qSOFA were 25.4% and 10.3%, respectively (P =.001). The rate of positive qSOFA was higher in patients with multiorgan dysfunction (sensitivity, 0.896; specificity, 0.185) and among patients who died within 28 days (sensitivity, 0.931; specificity, 0.181); 10 (6.9%) of 144 deaths were not identified. In cases of positive qSOFA without hypothermia, positive qSOFA + hypothermia, or negative qSOFA with hypothermia, the predictive value for 28-day mortality improved (sensitivity, 0.979). Among the 144 patients who died, only 3 were not identified. Conclusion: A qSOFA score ≥2 may identify >90% of 28-day deaths among patients with severe sepsis; hypothermia may complement the predictive ability of qSOFA.

KW - body temperature

KW - critical care

KW - mortality

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KW - sepsis

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