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Prognostic performance of disease severity scores in patients with septic shock presenting to the emergency department

Published:August 22, 2018DOI:https://doi.org/10.1016/j.ajem.2018.08.046

      Abstract

      Background

      An accurate disease severity score that can quickly predict the prognosis of patients with sepsis in the emergency department (ED) can aid clinicians in distributing resources appropriately or making decisions for active resuscitation measures. This study aimed to compare the prognostic performance of quick sequential organ failure assessment (qSOFA) with that of other disease severity scores in patients with septic shock presenting to an ED.

      Methods

      We performed a prospective, observational, registry-based study. The discriminative ability of each disease severity score to predict 28-day mortality was evaluated in the overall cohort (which included patients who fulfilled previously defined criteria for septic shock), the newly defined sepsis subgroup, and the newly defined septic shock subgroup.

      Results

      A total of 991 patients were included. All disease severity scores had poor discriminative ability for 28-day mortality. The sequential organ failure assessment and acute physiology and chronic health evaluation II scores had the highest area under the receiver-operating characteristic curve (AUC) values, which were significantly higher than the AUC values of other disease severity scores in the overall cohort and the sepsis and septic shock subgroups. The discriminative ability of each disease severity score decreased as the mortality rate of each subgroup increased.

      Conclusions

      All disease severity scores, including qSOFA, did not display good discrimination for 28-day mortality in patients with serious infection and refractory hypotension or hypoperfusion; additionally, none of the included scoring tools in this study could consistently predict 28-day mortality in the newly defined sepsis and septic shock subgroups.

      Abbreviations:

      SIRS (systemic inflammatory response syndrome), SOFA (sequential organ failure assessment), MAP (mean arterial pressure), qSOFA (quick sequential organ failure assessment), SBP (systolic blood pressure), ED (emergency department), MEDS (Mortality in Emergency Department Sepsis), KoSS (Korean Shock Society), APACHE (acute physiology and chronic health evaluation), MISSED (mortality in severe sepsis in the emergency department), SD (standard deviation), AUC (area under the curve), CI (confidence interval), ICU (intensive care unit)

      Keywords

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