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Quick sequential organ failure assessment score combined with other sepsis-related risk factors to predict in-hospital mortality: Post-hoc analysis of prospective multicenter study data
This study aimed to assess the value of quick sequential organ failure assessment (qSOFA) combined with other risk factors in predicting in-hospital mortality in patients presenting to the emergency department with suspected infection. This post-hoc analysis of a prospective multicenter study datase...
Autores principales: | , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8282038/ https://www.ncbi.nlm.nih.gov/pubmed/34264977 http://dx.doi.org/10.1371/journal.pone.0254343 |
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author | Ueno, Ryo Masubuchi, Takateru Shiraishi, Atsushi Gando, Satoshi Abe, Toshikazu Kushimoto, Shigeki Mayumi, Toshihiko Fujishima, Seitaro Hagiwara, Akiyoshi Hifumi, Toru Endo, Akira Komatsu, Takayuki Kotani, Joji Okamoto, Kohji Sasaki, Junichi Shiino, Yasukazu Umemura, Yutaka |
author_facet | Ueno, Ryo Masubuchi, Takateru Shiraishi, Atsushi Gando, Satoshi Abe, Toshikazu Kushimoto, Shigeki Mayumi, Toshihiko Fujishima, Seitaro Hagiwara, Akiyoshi Hifumi, Toru Endo, Akira Komatsu, Takayuki Kotani, Joji Okamoto, Kohji Sasaki, Junichi Shiino, Yasukazu Umemura, Yutaka |
author_sort | Ueno, Ryo |
collection | PubMed |
description | This study aimed to assess the value of quick sequential organ failure assessment (qSOFA) combined with other risk factors in predicting in-hospital mortality in patients presenting to the emergency department with suspected infection. This post-hoc analysis of a prospective multicenter study dataset included 34 emergency departments across Japan (December 2017 to February 2018). We included adult patients (age ≥16 years) who presented to the emergency department with suspected infection. qSOFA was calculated and recorded by senior emergency physicians when they suspected an infection. Different types of sepsis-related risk factors (demographic, functional, and laboratory values) were chosen from prior studies. A logistic regression model was used to assess the predictive value of qSOFA for in-hospital mortality in models based on the following combination of predictors: 1) qSOFA-Only; 2) qSOFA+Age; 3) qSOFA+Clinical Frailty Scale (CFS); 4) qSOFA+Charlson Comorbidity Index (CCI); 5) qSOFA+lactate levels; 6) qSOFA+Age+CCI+CFS+lactate levels. We calculated the area under the receiver operating characteristic curve (AUC) and other key clinical statistics at Youden’s index, where the sum of sensitivity and specificity is maximized. Following prior literature, an AUC >0.9 was deemed to indicate high accuracy; 0.7–0.9, moderate accuracy; 0.5–0.7, low accuracy; and 0.5, a chance result. Of the 951 patients included in the analysis, 151 (15.9%) died during hospitalization. The AUC for predicting in-hospital mortality was 0.627 (95% confidence interval [CI]: 0.580−0.673) for the qSOFA-Only model. Addition of other variables only marginally improved the model’s AUC; the model that included all potentially relevant variables yielded an AUC of only 0.730 (95% CI: 0.687–0.774). Other key statistic values were similar among all models, with sensitivity and specificity of 0.55−0.65 and 0.60−0.75, respectively. In this post-hoc data analysis from a prospective multicenter study based in Japan, combining qSOFA with other sepsis-related risk factors only marginally improved the model’s predictive value. |
format | Online Article Text |
id | pubmed-8282038 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-82820382021-07-28 Quick sequential organ failure assessment score combined with other sepsis-related risk factors to predict in-hospital mortality: Post-hoc analysis of prospective multicenter study data Ueno, Ryo Masubuchi, Takateru Shiraishi, Atsushi Gando, Satoshi Abe, Toshikazu Kushimoto, Shigeki Mayumi, Toshihiko Fujishima, Seitaro Hagiwara, Akiyoshi Hifumi, Toru Endo, Akira Komatsu, Takayuki Kotani, Joji Okamoto, Kohji Sasaki, Junichi Shiino, Yasukazu Umemura, Yutaka PLoS One Research Article This study aimed to assess the value of quick sequential organ failure assessment (qSOFA) combined with other risk factors in predicting in-hospital mortality in patients presenting to the emergency department with suspected infection. This post-hoc analysis of a prospective multicenter study dataset included 34 emergency departments across Japan (December 2017 to February 2018). We included adult patients (age ≥16 years) who presented to the emergency department with suspected infection. qSOFA was calculated and recorded by senior emergency physicians when they suspected an infection. Different types of sepsis-related risk factors (demographic, functional, and laboratory values) were chosen from prior studies. A logistic regression model was used to assess the predictive value of qSOFA for in-hospital mortality in models based on the following combination of predictors: 1) qSOFA-Only; 2) qSOFA+Age; 3) qSOFA+Clinical Frailty Scale (CFS); 4) qSOFA+Charlson Comorbidity Index (CCI); 5) qSOFA+lactate levels; 6) qSOFA+Age+CCI+CFS+lactate levels. We calculated the area under the receiver operating characteristic curve (AUC) and other key clinical statistics at Youden’s index, where the sum of sensitivity and specificity is maximized. Following prior literature, an AUC >0.9 was deemed to indicate high accuracy; 0.7–0.9, moderate accuracy; 0.5–0.7, low accuracy; and 0.5, a chance result. Of the 951 patients included in the analysis, 151 (15.9%) died during hospitalization. The AUC for predicting in-hospital mortality was 0.627 (95% confidence interval [CI]: 0.580−0.673) for the qSOFA-Only model. Addition of other variables only marginally improved the model’s AUC; the model that included all potentially relevant variables yielded an AUC of only 0.730 (95% CI: 0.687–0.774). Other key statistic values were similar among all models, with sensitivity and specificity of 0.55−0.65 and 0.60−0.75, respectively. In this post-hoc data analysis from a prospective multicenter study based in Japan, combining qSOFA with other sepsis-related risk factors only marginally improved the model’s predictive value. Public Library of Science 2021-07-15 /pmc/articles/PMC8282038/ /pubmed/34264977 http://dx.doi.org/10.1371/journal.pone.0254343 Text en © 2021 Ueno et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://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 Ueno, Ryo Masubuchi, Takateru Shiraishi, Atsushi Gando, Satoshi Abe, Toshikazu Kushimoto, Shigeki Mayumi, Toshihiko Fujishima, Seitaro Hagiwara, Akiyoshi Hifumi, Toru Endo, Akira Komatsu, Takayuki Kotani, Joji Okamoto, Kohji Sasaki, Junichi Shiino, Yasukazu Umemura, Yutaka Quick sequential organ failure assessment score combined with other sepsis-related risk factors to predict in-hospital mortality: Post-hoc analysis of prospective multicenter study data |
title | Quick sequential organ failure assessment score combined with other sepsis-related risk factors to predict in-hospital mortality: Post-hoc analysis of prospective multicenter study data |
title_full | Quick sequential organ failure assessment score combined with other sepsis-related risk factors to predict in-hospital mortality: Post-hoc analysis of prospective multicenter study data |
title_fullStr | Quick sequential organ failure assessment score combined with other sepsis-related risk factors to predict in-hospital mortality: Post-hoc analysis of prospective multicenter study data |
title_full_unstemmed | Quick sequential organ failure assessment score combined with other sepsis-related risk factors to predict in-hospital mortality: Post-hoc analysis of prospective multicenter study data |
title_short | Quick sequential organ failure assessment score combined with other sepsis-related risk factors to predict in-hospital mortality: Post-hoc analysis of prospective multicenter study data |
title_sort | quick sequential organ failure assessment score combined with other sepsis-related risk factors to predict in-hospital mortality: post-hoc analysis of prospective multicenter study data |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8282038/ https://www.ncbi.nlm.nih.gov/pubmed/34264977 http://dx.doi.org/10.1371/journal.pone.0254343 |
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