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Development and validation of a modified quick SOFA scale for risk assessment in sepsis syndrome
Sepsis is a severe clinical syndrome owing to its high mortality. Quick Sequential Organ Failure Assessment (qSOFA) score has been proposed for the prediction of fatal outcomes in sepsis syndrome in emergency departments. Due to the low predictive performance of the qSOFA score, we propose a modific...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6157867/ https://www.ncbi.nlm.nih.gov/pubmed/30256855 http://dx.doi.org/10.1371/journal.pone.0204608 |
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author | Cag, Yasemin Karabay, Oguz Sipahi, Oguz Resat Aksoy, Firdevs Durmus, Gul Batirel, Ayse Ak, Oznur Kocak-Tufan, Zeliha Atilla, Aynur Piskin, Nihal Akbas, Turkay Erol, Serpil Ozturk-Engin, Derya Caskurlu, Hulya Onal, Ugur Erdogan, Haluk Demirel, Aslıhan Dogru, Arzu Harman, Rezan Hamidi, Aziz Ahmad Karasu, Derya Korkmaz, Fatime Korkmaz, Pınar Civelek Eser, Fatma Onem, Yalcin Cesur, Sinem Salmanoglu, Musa Erdem, İlknur Diktas, Hüsrev Vahaboglu, Haluk |
author_facet | Cag, Yasemin Karabay, Oguz Sipahi, Oguz Resat Aksoy, Firdevs Durmus, Gul Batirel, Ayse Ak, Oznur Kocak-Tufan, Zeliha Atilla, Aynur Piskin, Nihal Akbas, Turkay Erol, Serpil Ozturk-Engin, Derya Caskurlu, Hulya Onal, Ugur Erdogan, Haluk Demirel, Aslıhan Dogru, Arzu Harman, Rezan Hamidi, Aziz Ahmad Karasu, Derya Korkmaz, Fatime Korkmaz, Pınar Civelek Eser, Fatma Onem, Yalcin Cesur, Sinem Salmanoglu, Musa Erdem, İlknur Diktas, Hüsrev Vahaboglu, Haluk |
author_sort | Cag, Yasemin |
collection | PubMed |
description | Sepsis is a severe clinical syndrome owing to its high mortality. Quick Sequential Organ Failure Assessment (qSOFA) score has been proposed for the prediction of fatal outcomes in sepsis syndrome in emergency departments. Due to the low predictive performance of the qSOFA score, we propose a modification to the score by adding age. We conducted a multicenter, retrospective cohort study among regional referral centers from various regions of the country. Participants recruited data of patients admitted to emergency departments and obtained a diagnosis of sepsis syndrome. Crude in-hospital mortality was the primary endpoint. A generalized mixed-effects model with random intercepts produced estimates for adverse outcomes. Model-based recursive partitioning demonstrated the effects and thresholds of significant covariates. Scores were internally validated. The H measure compared performances of scores. A total of 580 patients from 22 centers were included for further analysis. Stages of sepsis, age, time to antibiotics, and administration of carbapenem for empirical treatment were entered the final model. Among these, severe sepsis (OR, 4.40; CIs, 2.35–8.21), septic shock (OR, 8.78; CIs, 4.37–17.66), age (OR, 1.03; CIs, 1.02–1.05) and time to antibiotics (OR, 1.05; CIs, 1.01–1.10) were significantly associated with fatal outcomes. A decision tree demonstrated the thresholds for age. We modified the quick Sequential Organ Failure Assessment (mod-qSOFA) score by adding age (> 50 years old = one point) and compared this to the conventional score. H-measures for qSOFA and mod-qSOFA were found to be 0.11 and 0.14, respectively, whereas AUCs of both scores were 0.64. We propose the use of the modified qSOFA score for early risk assessment among sepsis patients for improved triage and management of this fatal syndrome. |
format | Online Article Text |
id | pubmed-6157867 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-61578672018-10-19 Development and validation of a modified quick SOFA scale for risk assessment in sepsis syndrome Cag, Yasemin Karabay, Oguz Sipahi, Oguz Resat Aksoy, Firdevs Durmus, Gul Batirel, Ayse Ak, Oznur Kocak-Tufan, Zeliha Atilla, Aynur Piskin, Nihal Akbas, Turkay Erol, Serpil Ozturk-Engin, Derya Caskurlu, Hulya Onal, Ugur Erdogan, Haluk Demirel, Aslıhan Dogru, Arzu Harman, Rezan Hamidi, Aziz Ahmad Karasu, Derya Korkmaz, Fatime Korkmaz, Pınar Civelek Eser, Fatma Onem, Yalcin Cesur, Sinem Salmanoglu, Musa Erdem, İlknur Diktas, Hüsrev Vahaboglu, Haluk PLoS One Research Article Sepsis is a severe clinical syndrome owing to its high mortality. Quick Sequential Organ Failure Assessment (qSOFA) score has been proposed for the prediction of fatal outcomes in sepsis syndrome in emergency departments. Due to the low predictive performance of the qSOFA score, we propose a modification to the score by adding age. We conducted a multicenter, retrospective cohort study among regional referral centers from various regions of the country. Participants recruited data of patients admitted to emergency departments and obtained a diagnosis of sepsis syndrome. Crude in-hospital mortality was the primary endpoint. A generalized mixed-effects model with random intercepts produced estimates for adverse outcomes. Model-based recursive partitioning demonstrated the effects and thresholds of significant covariates. Scores were internally validated. The H measure compared performances of scores. A total of 580 patients from 22 centers were included for further analysis. Stages of sepsis, age, time to antibiotics, and administration of carbapenem for empirical treatment were entered the final model. Among these, severe sepsis (OR, 4.40; CIs, 2.35–8.21), septic shock (OR, 8.78; CIs, 4.37–17.66), age (OR, 1.03; CIs, 1.02–1.05) and time to antibiotics (OR, 1.05; CIs, 1.01–1.10) were significantly associated with fatal outcomes. A decision tree demonstrated the thresholds for age. We modified the quick Sequential Organ Failure Assessment (mod-qSOFA) score by adding age (> 50 years old = one point) and compared this to the conventional score. H-measures for qSOFA and mod-qSOFA were found to be 0.11 and 0.14, respectively, whereas AUCs of both scores were 0.64. We propose the use of the modified qSOFA score for early risk assessment among sepsis patients for improved triage and management of this fatal syndrome. Public Library of Science 2018-09-26 /pmc/articles/PMC6157867/ /pubmed/30256855 http://dx.doi.org/10.1371/journal.pone.0204608 Text en © 2018 Cag et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Cag, Yasemin Karabay, Oguz Sipahi, Oguz Resat Aksoy, Firdevs Durmus, Gul Batirel, Ayse Ak, Oznur Kocak-Tufan, Zeliha Atilla, Aynur Piskin, Nihal Akbas, Turkay Erol, Serpil Ozturk-Engin, Derya Caskurlu, Hulya Onal, Ugur Erdogan, Haluk Demirel, Aslıhan Dogru, Arzu Harman, Rezan Hamidi, Aziz Ahmad Karasu, Derya Korkmaz, Fatime Korkmaz, Pınar Civelek Eser, Fatma Onem, Yalcin Cesur, Sinem Salmanoglu, Musa Erdem, İlknur Diktas, Hüsrev Vahaboglu, Haluk Development and validation of a modified quick SOFA scale for risk assessment in sepsis syndrome |
title | Development and validation of a modified quick SOFA scale for risk assessment in sepsis syndrome |
title_full | Development and validation of a modified quick SOFA scale for risk assessment in sepsis syndrome |
title_fullStr | Development and validation of a modified quick SOFA scale for risk assessment in sepsis syndrome |
title_full_unstemmed | Development and validation of a modified quick SOFA scale for risk assessment in sepsis syndrome |
title_short | Development and validation of a modified quick SOFA scale for risk assessment in sepsis syndrome |
title_sort | development and validation of a modified quick sofa scale for risk assessment in sepsis syndrome |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6157867/ https://www.ncbi.nlm.nih.gov/pubmed/30256855 http://dx.doi.org/10.1371/journal.pone.0204608 |
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