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Red-flag sepsis and SOFA identifies different patient population at risk of sepsis-related deaths on the general ward
Controversy exists regarding the best diagnostic and screening tool for sepsis outside the intensive care unit (ICU). Sequential organ failure assessment (SOFA) score has been shown to be superior to systemic inflammatory response syndrome (SIRS) criteria, however, the performance of “Red Flag sepsi...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Wolters Kluwer Health
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6310498/ https://www.ncbi.nlm.nih.gov/pubmed/30544383 http://dx.doi.org/10.1097/MD.0000000000013238 |
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author | Kopczynska, Maja Sharif, Ben Cleaver, Sian Spencer, Naomi Kurani, Amit Lee, Camilla Davis, Jessica Durie, Carys Joseph-Gubral, Jude Sharma, Angelica Allen, Lucy Atkins, Billie Gordon, Alex Jones, Llewelyn Noble, Amy Bradley, Matthew Atkinson, Henry Inns, Joy Penney, Harriet Gilbert, Carys Walford, Rebecca Pike, Louise Edwards, Ross Howcroft, Robyn Preston, Hazel Gee, Jennifer Doyle, Nicholas Maden, Charlotte Smith, Claire Azis, Nik Syakirah Nik Vadivale, Navrhinaa Battle, Ceri Lyons, Ronan Morgan, Paul Pugh, Richard Szakmany, Tamas |
author_facet | Kopczynska, Maja Sharif, Ben Cleaver, Sian Spencer, Naomi Kurani, Amit Lee, Camilla Davis, Jessica Durie, Carys Joseph-Gubral, Jude Sharma, Angelica Allen, Lucy Atkins, Billie Gordon, Alex Jones, Llewelyn Noble, Amy Bradley, Matthew Atkinson, Henry Inns, Joy Penney, Harriet Gilbert, Carys Walford, Rebecca Pike, Louise Edwards, Ross Howcroft, Robyn Preston, Hazel Gee, Jennifer Doyle, Nicholas Maden, Charlotte Smith, Claire Azis, Nik Syakirah Nik Vadivale, Navrhinaa Battle, Ceri Lyons, Ronan Morgan, Paul Pugh, Richard Szakmany, Tamas |
author_sort | Kopczynska, Maja |
collection | PubMed |
description | Controversy exists regarding the best diagnostic and screening tool for sepsis outside the intensive care unit (ICU). Sequential organ failure assessment (SOFA) score has been shown to be superior to systemic inflammatory response syndrome (SIRS) criteria, however, the performance of “Red Flag sepsis criteria” has not been tested formally. The aim of the study was to investigate the ability of Red Flag sepsis criteria to identify the patients at high risk of sepsis-related death in comparison to SOFA based sepsis criteria. We also investigated the comparison of Red Flag sepsis to quick SOFA (qSOFA), SIRS, and national early warning score (NEWS) scores and factors influencing patient mortality. Patients were recruited into a 24-hour point-prevalence study on the general wards and emergency departments across all Welsh acute hospitals. Inclusion criteria were: clinical suspicion of infection and NEWS 3 or above in-line with established escalation criteria in Wales. Data on Red Flag sepsis and SOFA criteria was collected together with qSOFA and SIRS scores and 90-day mortality. 459 patients were recruited over a 24-hour period. 246 were positive for Red Flag sepsis, mortality 33.7% (83/246); 241 for SOFA based sepsis criteria, mortality 39.4% (95/241); 54 for qSOFA, mortality 57.4% (31/54), and 268 for SIRS, mortality 33.6% (90/268). 55 patients were not picked up by any criteria. We found that older age was associated with death with OR (95% CI) of 1.03 (1.02–1.04); higher frailty score 1.24 (1.11–1.40); DNA-CPR order 1.74 (1.14–2.65); ceiling of care 1.55 (1.02–2.33); and SOFA score of 2 and above 1.69 (1.16–2.47). The different clinical tools captured different subsets of the at-risk population, with similar sensitivity. SOFA score 2 or above was independently associated with increased risk of death at 90 days. The sequalae of infection-related organ dysfunction cannot be reliably captured based on routine clinical and physiological parameters alone. |
format | Online Article Text |
id | pubmed-6310498 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Wolters Kluwer Health |
record_format | MEDLINE/PubMed |
spelling | pubmed-63104982019-01-14 Red-flag sepsis and SOFA identifies different patient population at risk of sepsis-related deaths on the general ward Kopczynska, Maja Sharif, Ben Cleaver, Sian Spencer, Naomi Kurani, Amit Lee, Camilla Davis, Jessica Durie, Carys Joseph-Gubral, Jude Sharma, Angelica Allen, Lucy Atkins, Billie Gordon, Alex Jones, Llewelyn Noble, Amy Bradley, Matthew Atkinson, Henry Inns, Joy Penney, Harriet Gilbert, Carys Walford, Rebecca Pike, Louise Edwards, Ross Howcroft, Robyn Preston, Hazel Gee, Jennifer Doyle, Nicholas Maden, Charlotte Smith, Claire Azis, Nik Syakirah Nik Vadivale, Navrhinaa Battle, Ceri Lyons, Ronan Morgan, Paul Pugh, Richard Szakmany, Tamas Medicine (Baltimore) Research Article Controversy exists regarding the best diagnostic and screening tool for sepsis outside the intensive care unit (ICU). Sequential organ failure assessment (SOFA) score has been shown to be superior to systemic inflammatory response syndrome (SIRS) criteria, however, the performance of “Red Flag sepsis criteria” has not been tested formally. The aim of the study was to investigate the ability of Red Flag sepsis criteria to identify the patients at high risk of sepsis-related death in comparison to SOFA based sepsis criteria. We also investigated the comparison of Red Flag sepsis to quick SOFA (qSOFA), SIRS, and national early warning score (NEWS) scores and factors influencing patient mortality. Patients were recruited into a 24-hour point-prevalence study on the general wards and emergency departments across all Welsh acute hospitals. Inclusion criteria were: clinical suspicion of infection and NEWS 3 or above in-line with established escalation criteria in Wales. Data on Red Flag sepsis and SOFA criteria was collected together with qSOFA and SIRS scores and 90-day mortality. 459 patients were recruited over a 24-hour period. 246 were positive for Red Flag sepsis, mortality 33.7% (83/246); 241 for SOFA based sepsis criteria, mortality 39.4% (95/241); 54 for qSOFA, mortality 57.4% (31/54), and 268 for SIRS, mortality 33.6% (90/268). 55 patients were not picked up by any criteria. We found that older age was associated with death with OR (95% CI) of 1.03 (1.02–1.04); higher frailty score 1.24 (1.11–1.40); DNA-CPR order 1.74 (1.14–2.65); ceiling of care 1.55 (1.02–2.33); and SOFA score of 2 and above 1.69 (1.16–2.47). The different clinical tools captured different subsets of the at-risk population, with similar sensitivity. SOFA score 2 or above was independently associated with increased risk of death at 90 days. The sequalae of infection-related organ dysfunction cannot be reliably captured based on routine clinical and physiological parameters alone. Wolters Kluwer Health 2018-12-10 /pmc/articles/PMC6310498/ /pubmed/30544383 http://dx.doi.org/10.1097/MD.0000000000013238 Text en Copyright © 2018 the Author(s). Published by Wolters Kluwer Health, Inc. http://creativecommons.org/licenses/by-nc/4.0 This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc/4.0 |
spellingShingle | Research Article Kopczynska, Maja Sharif, Ben Cleaver, Sian Spencer, Naomi Kurani, Amit Lee, Camilla Davis, Jessica Durie, Carys Joseph-Gubral, Jude Sharma, Angelica Allen, Lucy Atkins, Billie Gordon, Alex Jones, Llewelyn Noble, Amy Bradley, Matthew Atkinson, Henry Inns, Joy Penney, Harriet Gilbert, Carys Walford, Rebecca Pike, Louise Edwards, Ross Howcroft, Robyn Preston, Hazel Gee, Jennifer Doyle, Nicholas Maden, Charlotte Smith, Claire Azis, Nik Syakirah Nik Vadivale, Navrhinaa Battle, Ceri Lyons, Ronan Morgan, Paul Pugh, Richard Szakmany, Tamas Red-flag sepsis and SOFA identifies different patient population at risk of sepsis-related deaths on the general ward |
title | Red-flag sepsis and SOFA identifies different patient population at risk of sepsis-related deaths on the general ward |
title_full | Red-flag sepsis and SOFA identifies different patient population at risk of sepsis-related deaths on the general ward |
title_fullStr | Red-flag sepsis and SOFA identifies different patient population at risk of sepsis-related deaths on the general ward |
title_full_unstemmed | Red-flag sepsis and SOFA identifies different patient population at risk of sepsis-related deaths on the general ward |
title_short | Red-flag sepsis and SOFA identifies different patient population at risk of sepsis-related deaths on the general ward |
title_sort | red-flag sepsis and sofa identifies different patient population at risk of sepsis-related deaths on the general ward |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6310498/ https://www.ncbi.nlm.nih.gov/pubmed/30544383 http://dx.doi.org/10.1097/MD.0000000000013238 |
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