Prognostic Accuracy of Sepsis-3 Criteria for In-Hospital Mortality Among Patients With Suspected Infection Presenting to the Emergency Department.
- Freund Y Sorbonne Universités, UPMC Paris Univ-06, Paris, France2Emergency Department, Hôpital Pitie-Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France.
- Lemachatti N Emergency Department, Hôpital Pitie-Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France.
- Krastinova E Plateforme de recherche clinique de l'est parisien (URCEST-CRCEST), Hôpital St Antoine, APHP, Paris, France.
- Van Laer M Emergency Department, Cliniques Universitaires St Luc, Bruxelles, Belgium.
- Claessens YE Emergency Department, Princess Grace Hospital, Monte-Carlo, Monaco.
- Avondo A Emergency Department, Centre hospitalo-universitaire, Dijon, France.
- Occelli C Emergency Department, Hôpital Pasteur, Nice, France.
- Feral-Pierssens AL Emergency Department, Hôpital Européen Georges Pompidou, Paris, France.
- Truchot J Emergency Department, Hôpital Lariboisière, APHP, Paris, France.
- Ortega M Emergency Department, Hospital Clinic, Barcelona, Spain.
- Carneiro B Emergency Department, Centre hospitalo-universitaire, Angers, France.
- Pernet J Emergency Department, Hôpital Tenon, APHP, Paris, France.
- Claret PG Emergency Department, Centre hospitalo-universitaire, Nîmes, France.
- Dami F Emergency Department, CHUV, Lausanne, Switzerland.
- Bloom B Emergency Department, Barts Health NHS trust, London, United Kingdom.
- Riou B Sorbonne Universités, UPMC Paris Univ-06, Paris, France2Emergency Department, Hôpital Pitie-Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France.
- Beaune S Emergency Department, Hôpital Ambroise-Paré, Boulogne, France, and Paris Diderot University, INSERM UMRS 1144, Paris, France.
- 2017-01-24
Published in:
- JAMA. - 2017
Aged
Aged, 80 and over
Area Under Curve
Belgium
Emergency Service, Hospital
Female
France
Hospital Mortality
Humans
Infections
Male
Middle Aged
Normal Distribution
Organ Dysfunction Scores
Prognosis
Prospective Studies
ROC Curve
Respiratory Tract Infections
Sepsis
Sex Distribution
Spain
Switzerland
English
Importance
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.
Objective
To prospectively validate qSOFA as a mortality predictor and compare the performances of the new sepsis criteria to the previous ones.
Design, Settings, and Participants
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.
Exposures
Measurement of qSOFA, SOFA, and SIRS.
Main Outcomes and Measures
In-hospital mortality.
Results
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 (P < .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.
Conclusions and Relevance
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.
Trial Registration
clinicaltrials.gov Identifier: NCT02738164.
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.
Objective
To prospectively validate qSOFA as a mortality predictor and compare the performances of the new sepsis criteria to the previous ones.
Design, Settings, and Participants
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.
Exposures
Measurement of qSOFA, SOFA, and SIRS.
Main Outcomes and Measures
In-hospital mortality.
Results
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 (P < .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.
Conclusions and Relevance
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.
Trial Registration
clinicaltrials.gov Identifier: NCT02738164.
- Language
-
- English
- Open access status
- green
- Identifiers
-
- DOI 10.1001/jama.2016.20329
- PMID 28114554
- Persistent URL
- https://sonar.ch/global/documents/140951
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