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The Integration of qSOFA with Clinical Variables and Serum Biomarkers Improves the Prognostic Value of qSOFA Alone in Patients with Suspected or Confirmed Sepsis at ED Admission
Background: The prognostic value of quick sepsis-related organ failure assessment (qSOFA) outside intensive care units has been criticized. Therefore, we aimed to improve its ability in predicting 30-day all-cause mortality, and in ruling out the cases at high risk of death among patients with suspe...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7230329/ https://www.ncbi.nlm.nih.gov/pubmed/32331426 http://dx.doi.org/10.3390/jcm9041205 |
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author | Mearelli, Filippo Barbati, Giulia Casarsa, Chiara Giansante, Carlo Breglia, Andrea Spica, Andrea Moras, Cristina Olivieri, Gaia Occhipinti, Alessandro Agostino De Nardo, Margherita Spagnol, Francesca Fiotti, Nicola Di Girolamo, Filippo Giorgio Ruscio, Maurizio Castello, Luigi Mario Colonetti, Efrem Marino, Rossella Ronco, Claudio Zanetti, Michela Lupia, Enrico Muiesan, Maria Lorenza Di Somma, Salvatore Avanzi, Gian Carlo Biolo, Gianni |
author_facet | Mearelli, Filippo Barbati, Giulia Casarsa, Chiara Giansante, Carlo Breglia, Andrea Spica, Andrea Moras, Cristina Olivieri, Gaia Occhipinti, Alessandro Agostino De Nardo, Margherita Spagnol, Francesca Fiotti, Nicola Di Girolamo, Filippo Giorgio Ruscio, Maurizio Castello, Luigi Mario Colonetti, Efrem Marino, Rossella Ronco, Claudio Zanetti, Michela Lupia, Enrico Muiesan, Maria Lorenza Di Somma, Salvatore Avanzi, Gian Carlo Biolo, Gianni |
author_sort | Mearelli, Filippo |
collection | PubMed |
description | Background: The prognostic value of quick sepsis-related organ failure assessment (qSOFA) outside intensive care units has been criticized. Therefore, we aimed to improve its ability in predicting 30-day all-cause mortality, and in ruling out the cases at high risk of death among patients with suspected or confirmed sepsis at emergency department (ED) admission. Methods: This study is a secondary analysis of a prospective multicenter study. We built three predictive models combining qSOFA with the clinical variables and serum biomarkers that resulted in an independent association with 30-day mortality, in both 848 undifferentiated patients (Group 1) and in 545 patients definitively diagnosed with sepsis (Group 2). The models reaching the highest negative predictive value (NPV) with the minimum expenditure of biomarkers in Group 1 and in Group 2 were validated in two cohorts of patients initially held out due to missing data. Results: In terms of the area under the receiver-operating characteristic curve, all six models significantly exceeded qSOFA in predicting prognosis. An “extended” qSOFA (eqSOFA1) in Group 1 and an eqSOFA2 integrated with C-reactive protein and mid-regional proadrenomedullin (eqSOFA2+CRP+MR-proADM) in Group 2 reached the best NPV (0.94 and 0.93, respectively) and ease of use. eqSOFA1 and eqSOFA2+CRP+MR-proADM performed equally well in both the inception and validation cohorts. Conclusions: We have derived and validated two prognostic models that outweigh qSOFA in predicting mortality and in identifying the low risk of death among patients with suspected or confirmed sepsis at ED admission. |
format | Online Article Text |
id | pubmed-7230329 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-72303292020-05-22 The Integration of qSOFA with Clinical Variables and Serum Biomarkers Improves the Prognostic Value of qSOFA Alone in Patients with Suspected or Confirmed Sepsis at ED Admission Mearelli, Filippo Barbati, Giulia Casarsa, Chiara Giansante, Carlo Breglia, Andrea Spica, Andrea Moras, Cristina Olivieri, Gaia Occhipinti, Alessandro Agostino De Nardo, Margherita Spagnol, Francesca Fiotti, Nicola Di Girolamo, Filippo Giorgio Ruscio, Maurizio Castello, Luigi Mario Colonetti, Efrem Marino, Rossella Ronco, Claudio Zanetti, Michela Lupia, Enrico Muiesan, Maria Lorenza Di Somma, Salvatore Avanzi, Gian Carlo Biolo, Gianni J Clin Med Article Background: The prognostic value of quick sepsis-related organ failure assessment (qSOFA) outside intensive care units has been criticized. Therefore, we aimed to improve its ability in predicting 30-day all-cause mortality, and in ruling out the cases at high risk of death among patients with suspected or confirmed sepsis at emergency department (ED) admission. Methods: This study is a secondary analysis of a prospective multicenter study. We built three predictive models combining qSOFA with the clinical variables and serum biomarkers that resulted in an independent association with 30-day mortality, in both 848 undifferentiated patients (Group 1) and in 545 patients definitively diagnosed with sepsis (Group 2). The models reaching the highest negative predictive value (NPV) with the minimum expenditure of biomarkers in Group 1 and in Group 2 were validated in two cohorts of patients initially held out due to missing data. Results: In terms of the area under the receiver-operating characteristic curve, all six models significantly exceeded qSOFA in predicting prognosis. An “extended” qSOFA (eqSOFA1) in Group 1 and an eqSOFA2 integrated with C-reactive protein and mid-regional proadrenomedullin (eqSOFA2+CRP+MR-proADM) in Group 2 reached the best NPV (0.94 and 0.93, respectively) and ease of use. eqSOFA1 and eqSOFA2+CRP+MR-proADM performed equally well in both the inception and validation cohorts. Conclusions: We have derived and validated two prognostic models that outweigh qSOFA in predicting mortality and in identifying the low risk of death among patients with suspected or confirmed sepsis at ED admission. MDPI 2020-04-22 /pmc/articles/PMC7230329/ /pubmed/32331426 http://dx.doi.org/10.3390/jcm9041205 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Mearelli, Filippo Barbati, Giulia Casarsa, Chiara Giansante, Carlo Breglia, Andrea Spica, Andrea Moras, Cristina Olivieri, Gaia Occhipinti, Alessandro Agostino De Nardo, Margherita Spagnol, Francesca Fiotti, Nicola Di Girolamo, Filippo Giorgio Ruscio, Maurizio Castello, Luigi Mario Colonetti, Efrem Marino, Rossella Ronco, Claudio Zanetti, Michela Lupia, Enrico Muiesan, Maria Lorenza Di Somma, Salvatore Avanzi, Gian Carlo Biolo, Gianni The Integration of qSOFA with Clinical Variables and Serum Biomarkers Improves the Prognostic Value of qSOFA Alone in Patients with Suspected or Confirmed Sepsis at ED Admission |
title | The Integration of qSOFA with Clinical Variables and Serum Biomarkers Improves the Prognostic Value of qSOFA Alone in Patients with Suspected or Confirmed Sepsis at ED Admission |
title_full | The Integration of qSOFA with Clinical Variables and Serum Biomarkers Improves the Prognostic Value of qSOFA Alone in Patients with Suspected or Confirmed Sepsis at ED Admission |
title_fullStr | The Integration of qSOFA with Clinical Variables and Serum Biomarkers Improves the Prognostic Value of qSOFA Alone in Patients with Suspected or Confirmed Sepsis at ED Admission |
title_full_unstemmed | The Integration of qSOFA with Clinical Variables and Serum Biomarkers Improves the Prognostic Value of qSOFA Alone in Patients with Suspected or Confirmed Sepsis at ED Admission |
title_short | The Integration of qSOFA with Clinical Variables and Serum Biomarkers Improves the Prognostic Value of qSOFA Alone in Patients with Suspected or Confirmed Sepsis at ED Admission |
title_sort | integration of qsofa with clinical variables and serum biomarkers improves the prognostic value of qsofa alone in patients with suspected or confirmed sepsis at ed admission |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7230329/ https://www.ncbi.nlm.nih.gov/pubmed/32331426 http://dx.doi.org/10.3390/jcm9041205 |
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