Prognostic Accuracy of Quick SOFA is different according to the severity of illness in infectious patients

Yutaka Umemura, Hiroshi Ogura, Satoshi Gando, Atsushi Shiraishi, Daizoh Saitoh, Seitaro Fujishima, Toshihiko Mayumi, Shigeki Kushimoto, Toshikazu Abe, Yasukazu Shiino, Taka aki Nakada, Takehiko Tarui, Toru Hifumi, Yasuhiro Otomo, Kohji Okamoto, Joji Kotani, Yuichiro Sakamoto, Junichi Sasaki, Shin ichiro Shiraishi, Kiyotsugu Takuma & 8 others Ryosuke Tsuruta, Akiyoshi Hagiwara, Tomohiko Masuno, Naoshi Takeyama, Norio Yamashita, Hiroto Ikeda, Masashi Ueyama, Kazuma Yamakawa

Research output: Contribution to journalArticle

Abstract

Background: Sepsis-3 proposed the quick Sequential Organ Failure Assessment (qSOFA) to identify sepsis patients likely to have poor outcome. The clinical utility of qSOFA still remains controversial because its predictive accuracy for mortality is quite different across the validation studies. We hypothesized that one of the major causes for these controversial findings was the heterogeneity in severity across the studies, and evaluated the association between severity of illness and the prognostic accuracy of qSOFA. Materials and methods: This was a post hoc analysis of a prospective nationwide cohort of consecutive adult patients with sepsis in 59 intensive care units in Japan. Regression trees analysis for survival was used to classify patients according to severity of illness as determined by SOFA score on registration. We conducted receiver operating characteristic (ROC) analyses and evaluated the differences in the area under the ROC curve (AUROC). As a subgroup analysis, we conducted the above evaluations in emergency department (ED) and non-ED patients separately. Results: We included 1114 patients fulfilling the criteria and classified them into three subsets according to severity. The AUROC for mortality was significantly different according to the severity of illness (p = 0.007), with the highest AUROC being in the low-severity subset (patients with SOFA score ≤ 7). Interestingly, our subgroup analysis revealed that a significant difference in the AUROC of qSOFA was observed only in ED patients. Conclusion: This study suggested that lower severity of illness was associated with the relatively higher prognostic accuracy of qSOFA, especially in ED patients.

Original languageEnglish
JournalJournal of Infection and Chemotherapy
DOIs
Publication statusPublished - 2019 Jan 1

Fingerprint

ROC Curve
Area Under Curve
Hospital Emergency Service
Sepsis
Mortality
Validation Studies
Intensive Care Units
Japan
Regression Analysis
Survival

Keywords

  • Diagnosis
  • Organ dysfunction scores
  • Prognosis
  • Sepsis
  • Severity of illness index

ASJC Scopus subject areas

  • Microbiology (medical)
  • Pharmacology (medical)
  • Infectious Diseases

Cite this

Prognostic Accuracy of Quick SOFA is different according to the severity of illness in infectious patients. / Umemura, Yutaka; Ogura, Hiroshi; Gando, Satoshi; Shiraishi, Atsushi; Saitoh, Daizoh; Fujishima, Seitaro; Mayumi, Toshihiko; Kushimoto, Shigeki; Abe, Toshikazu; Shiino, Yasukazu; Nakada, Taka aki; Tarui, Takehiko; Hifumi, Toru; Otomo, Yasuhiro; Okamoto, Kohji; Kotani, Joji; Sakamoto, Yuichiro; Sasaki, Junichi; Shiraishi, Shin ichiro; Takuma, Kiyotsugu; Tsuruta, Ryosuke; Hagiwara, Akiyoshi; Masuno, Tomohiko; Takeyama, Naoshi; Yamashita, Norio; Ikeda, Hiroto; Ueyama, Masashi; Yamakawa, Kazuma.

In: Journal of Infection and Chemotherapy, 01.01.2019.

Research output: Contribution to journalArticle

Umemura, Y, Ogura, H, Gando, S, Shiraishi, A, Saitoh, D, Fujishima, S, Mayumi, T, Kushimoto, S, Abe, T, Shiino, Y, Nakada, TA, Tarui, T, Hifumi, T, Otomo, Y, Okamoto, K, Kotani, J, Sakamoto, Y, Sasaki, J, Shiraishi, SI, Takuma, K, Tsuruta, R, Hagiwara, A, Masuno, T, Takeyama, N, Yamashita, N, Ikeda, H, Ueyama, M & Yamakawa, K 2019, 'Prognostic Accuracy of Quick SOFA is different according to the severity of illness in infectious patients', Journal of Infection and Chemotherapy. https://doi.org/10.1016/j.jiac.2019.05.010
Umemura, Yutaka ; Ogura, Hiroshi ; Gando, Satoshi ; Shiraishi, Atsushi ; Saitoh, Daizoh ; Fujishima, Seitaro ; Mayumi, Toshihiko ; Kushimoto, Shigeki ; Abe, Toshikazu ; Shiino, Yasukazu ; Nakada, Taka aki ; Tarui, Takehiko ; Hifumi, Toru ; Otomo, Yasuhiro ; Okamoto, Kohji ; Kotani, Joji ; Sakamoto, Yuichiro ; Sasaki, Junichi ; Shiraishi, Shin ichiro ; Takuma, Kiyotsugu ; Tsuruta, Ryosuke ; Hagiwara, Akiyoshi ; Masuno, Tomohiko ; Takeyama, Naoshi ; Yamashita, Norio ; Ikeda, Hiroto ; Ueyama, Masashi ; Yamakawa, Kazuma. / Prognostic Accuracy of Quick SOFA is different according to the severity of illness in infectious patients. In: Journal of Infection and Chemotherapy. 2019.
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abstract = "Background: Sepsis-3 proposed the quick Sequential Organ Failure Assessment (qSOFA) to identify sepsis patients likely to have poor outcome. The clinical utility of qSOFA still remains controversial because its predictive accuracy for mortality is quite different across the validation studies. We hypothesized that one of the major causes for these controversial findings was the heterogeneity in severity across the studies, and evaluated the association between severity of illness and the prognostic accuracy of qSOFA. Materials and methods: This was a post hoc analysis of a prospective nationwide cohort of consecutive adult patients with sepsis in 59 intensive care units in Japan. Regression trees analysis for survival was used to classify patients according to severity of illness as determined by SOFA score on registration. We conducted receiver operating characteristic (ROC) analyses and evaluated the differences in the area under the ROC curve (AUROC). As a subgroup analysis, we conducted the above evaluations in emergency department (ED) and non-ED patients separately. Results: We included 1114 patients fulfilling the criteria and classified them into three subsets according to severity. The AUROC for mortality was significantly different according to the severity of illness (p = 0.007), with the highest AUROC being in the low-severity subset (patients with SOFA score ≤ 7). Interestingly, our subgroup analysis revealed that a significant difference in the AUROC of qSOFA was observed only in ED patients. Conclusion: This study suggested that lower severity of illness was associated with the relatively higher prognostic accuracy of qSOFA, especially in ED patients.",
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T1 - Prognostic Accuracy of Quick SOFA is different according to the severity of illness in infectious patients

AU - Umemura, Yutaka

AU - Ogura, Hiroshi

AU - Gando, Satoshi

AU - Shiraishi, Atsushi

AU - Saitoh, Daizoh

AU - Fujishima, Seitaro

AU - Mayumi, Toshihiko

AU - Kushimoto, Shigeki

AU - Abe, Toshikazu

AU - Shiino, Yasukazu

AU - Nakada, Taka aki

AU - Tarui, Takehiko

AU - Hifumi, Toru

AU - Otomo, Yasuhiro

AU - Okamoto, Kohji

AU - Kotani, Joji

AU - Sakamoto, Yuichiro

AU - Sasaki, Junichi

AU - Shiraishi, Shin ichiro

AU - Takuma, Kiyotsugu

AU - Tsuruta, Ryosuke

AU - Hagiwara, Akiyoshi

AU - Masuno, Tomohiko

AU - Takeyama, Naoshi

AU - Yamashita, Norio

AU - Ikeda, Hiroto

AU - Ueyama, Masashi

AU - Yamakawa, Kazuma

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Sepsis-3 proposed the quick Sequential Organ Failure Assessment (qSOFA) to identify sepsis patients likely to have poor outcome. The clinical utility of qSOFA still remains controversial because its predictive accuracy for mortality is quite different across the validation studies. We hypothesized that one of the major causes for these controversial findings was the heterogeneity in severity across the studies, and evaluated the association between severity of illness and the prognostic accuracy of qSOFA. Materials and methods: This was a post hoc analysis of a prospective nationwide cohort of consecutive adult patients with sepsis in 59 intensive care units in Japan. Regression trees analysis for survival was used to classify patients according to severity of illness as determined by SOFA score on registration. We conducted receiver operating characteristic (ROC) analyses and evaluated the differences in the area under the ROC curve (AUROC). As a subgroup analysis, we conducted the above evaluations in emergency department (ED) and non-ED patients separately. Results: We included 1114 patients fulfilling the criteria and classified them into three subsets according to severity. The AUROC for mortality was significantly different according to the severity of illness (p = 0.007), with the highest AUROC being in the low-severity subset (patients with SOFA score ≤ 7). Interestingly, our subgroup analysis revealed that a significant difference in the AUROC of qSOFA was observed only in ED patients. Conclusion: This study suggested that lower severity of illness was associated with the relatively higher prognostic accuracy of qSOFA, especially in ED patients.

AB - Background: Sepsis-3 proposed the quick Sequential Organ Failure Assessment (qSOFA) to identify sepsis patients likely to have poor outcome. The clinical utility of qSOFA still remains controversial because its predictive accuracy for mortality is quite different across the validation studies. We hypothesized that one of the major causes for these controversial findings was the heterogeneity in severity across the studies, and evaluated the association between severity of illness and the prognostic accuracy of qSOFA. Materials and methods: This was a post hoc analysis of a prospective nationwide cohort of consecutive adult patients with sepsis in 59 intensive care units in Japan. Regression trees analysis for survival was used to classify patients according to severity of illness as determined by SOFA score on registration. We conducted receiver operating characteristic (ROC) analyses and evaluated the differences in the area under the ROC curve (AUROC). As a subgroup analysis, we conducted the above evaluations in emergency department (ED) and non-ED patients separately. Results: We included 1114 patients fulfilling the criteria and classified them into three subsets according to severity. The AUROC for mortality was significantly different according to the severity of illness (p = 0.007), with the highest AUROC being in the low-severity subset (patients with SOFA score ≤ 7). Interestingly, our subgroup analysis revealed that a significant difference in the AUROC of qSOFA was observed only in ED patients. Conclusion: This study suggested that lower severity of illness was associated with the relatively higher prognostic accuracy of qSOFA, especially in ED patients.

KW - Diagnosis

KW - Organ dysfunction scores

KW - Prognosis

KW - Sepsis

KW - Severity of illness index

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