serval:BIB_A63A222AF0CB
Prognostic Accuracy of Sepsis-3 Criteria for In-Hospital Mortality Among Patients With Suspected Infection Presenting to the Emergency Department.
10.1001/jama.2016.20329
28114554
Freund
Y.
author
Lemachatti
N.
author
Krastinova
E.
author
Van Laer
M.
author
Claessens
Y.E.
author
Avondo
A.
author
Occelli
C.
author
Feral-Pierssens
A.L.
author
Truchot
J.
author
Ortega
M.
author
Carneiro
B.
author
Pernet
J.
author
Claret
P.G.
author
Dami
F.
author
Bloom
B.
author
Riou
B.
author
Beaune
S.
author
French Society of Emergency Medicine Collaborators Group
contributor
article
2017-01-17
JAMA
1538-3598
0098-7484
journal
317
3
301-308
An international task force recently redefined the concept of sepsis. This task force recommended the use of the quick Sequential Organ Failure Assessment (qSOFA) score instead of systemic inflammatory response syndrome (SIRS) criteria to identify patients at high risk of mortality. However, these new criteria have not been prospectively validated in some settings, and their added value in the emergency department remains unknown.
To prospectively validate qSOFA as a mortality predictor and compare the performances of the new sepsis criteria to the previous ones.
International prospective cohort study, conducted in France, Spain, Belgium, and Switzerland between May and June 2016. In the 30 participating emergency departments, for a 4-week period, consecutive patients who visited the emergency departments with suspected infection were included. All variables from previous and new definitions of sepsis were collected. Patients were followed up until hospital discharge or death.
Measurement of qSOFA, SOFA, and SIRS.
In-hospital mortality.
Of 1088 patients screened, 879 were included in the analysis. Median age was 67 years (interquartile range, 47-81 years), 414 (47%) were women, and 379 (43%) had respiratory tract infection. Overall in-hospital mortality was 8%: 3% for patients with a qSOFA score lower than 2 vs 24% for those with qSOFA score of 2 or higher (absolute difference, 21%; 95% CI, 15%-26%). The qSOFA performed better than both SIRS and severe sepsis in predicting in-hospital mortality, with an area under the receiver operating curve (AUROC) of 0.80 (95% CI, 0.74-0.85) vs 0.65 (95% CI, 0.59-0.70) for both SIRS and severe sepsis (Pā<ā.001; incremental AUROC, 0.15; 95% CI, 0.09-0.22). The hazard ratio of qSOFA score for death was 6.2 (95% CI, 3.8-10.3) vs 3.5 (95% CI, 2.2-5.5) for severe sepsis.
Among patients presenting to the emergency department with suspected infection, the use of qSOFA resulted in greater prognostic accuracy for in-hospital mortality than did either SIRS or severe sepsis. These findings provide support for the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) criteria in the emergency department setting.
clinicaltrials.gov Identifier: NCT02738164.
eng
60_published
true
peer-reviewed
Publication types: Journal Article
Publication Status: ppublish
University of Lausanne
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