Critical Care: Sepsis Diagnosis and Resuscitation |

Validation of the Recently Proposed qSOFA Score in the Weill Cornell Medicine Registry of Critical Illness FREE TO VIEW

Eli Finkelsztein, MD; Daniel Jones, MD; Kevin Ma, MD; Maria Pabón, MD; Edward Schenck, MD; David Berlin, MD; Ilias Siempos, MD; Augustine Choi, MD
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Department of Medicine, Division of Pulmonary and Critical Care Medicine, New York-Presbyterian Hospital-Weill Cornell Medical Center, Weill Cornell Medical College, New York, NY

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):347A. doi:10.1016/j.chest.2016.08.360
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SESSION TITLE: Sepsis Diagnosis and Resuscitation

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Tuesday, October 25, 2016 at 11:00 AM - 12:15 PM

PURPOSE: The Third International Consensus Definitions for Sepsis and Septic Shock (SEPSIS-3) Task Force recently introduced a new clinical score termed quick Sequential [Sepsis-related] Organ Failure Assessment (qSOFA) for identification of patients at risk for sepsis outside of the intensive care unit (ICU). Introduction of the score was based on a large retrospective study which found that, among encounters with suspected infection outside of the ICU, the predictive validity for in-hospital mortality of qSOFA was greater than systemic inflammatory response syndrome (SIRS). The Task Force encouraged validation of the new qSOFA score in other cohorts. Thus, we attempted to examine the robustness of qSOFA score in our healthcare setting.

METHODS: The Weill Cornell Medicine Registry of Critical Illness is an ongoing prospective observational cohort of medical ICU patients, for whom clinical information (including vital signs before ICU admission) and biological samples are prospectively collected. Using such information, we calculated qSOFA and SIRS scores outside of the ICU (specifically, within 8 hours before ICU admission). Patients were categorized according to whether they had signs meeting two or more (qSOFA-positive) or less than two (qSOFA-negative) qSOFA criteria. They were also categorized according to whether they met two or more (SIRS-positive) or less than two (SIRS-negative) SIRS criteria. The outcome of this study was in-hospital mortality.

RESULTS: One hundred nineteen patients (69% from the emergency department, 31% form hospital wards) had suspected infection and were included in this study. Twenty-two (19%) of those patients died in the hospital, 56% had positive cultures and 20% had microbiologically confirmed bacteremia. Of the included patients, 40% were qSOFA-negative and 11% were SIRS-negative before ICU admission. Patients with positive qSOFA had higher in-hospital mortality compared to those with negative qSOFA (25% vs 8%, p = 0.03). There was no difference between SIRS-positive and SIRS-negative patients in terms of in-hospital mortality (p = 0.45). The discrimination of hospital mortality using qSOFA was adequate [area under the receiver operating characteristic curve (AUROC) = 0.70; 95% confidence intervals (CI), 0.58-0.82]. The discrimination of hospital mortality using SIRS was poor (AUROC = 0.58; 95% CI, 0.45-0.70).

CONCLUSIONS: In a selected population of patients at risk for sepsis who were eventually admitted in the ICU, qSOFA score calculated within 8 hours before ICU admission could adequately predict in-hospital mortality.

CLINICAL IMPLICATIONS: The qSOFA score might be useful for identifying patients with suspected infections outside of the ICU, who are likely to have poor outcomes.

DISCLOSURE: The following authors have nothing to disclose: Eli Finkelsztein, Daniel Jones, Kevin Ma, Maria Pabón, Edward Schenck, David Berlin, Ilias Siempos, Augustine Choi

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