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Do SOFA, qSOFA, and SIRS Predict In-Hospital Mortality in Septic Patients Admitted from the Emergency Department to the Intensive Care Unit in an Urban, Safety Net Hospital?
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A3297 - Do SOFA, qSOFA, and SIRS Predict In-Hospital Mortality in Septic Patients Admitted from the Emergency Department to the Intensive Care Unit in an Urban, Safety Net Hospital?
Author Block: C. Graziani1, A. Mohsin2, H. Wu3, H. Feng3, J. E. Sevransky4, A. M. Esper4, G. S. Martin4, C. C. Polito4; 1Internal Medicine, Emory University School of Medicine, Atlanta, GA, United States, 2Columbus Regional Health, Columbus, GA, United States, 3Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, GA, United States, 4Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, Atlanta, GA, United States.
INTRODUCTION: Per Sepsis-3 guidelines, quick sequential organ failure assessment (qSOFA) screening is recommended for use in patients outside the intensive care unit (ICU) who have suspected infection as a way to identify patients at increased risk of sepsis-related, in-hospital mortality. Sequential organ failure assessment (SOFA) screening is validated for ICU patients with suspected sepsis. The utility of qSOFA and SOFA in predicting sepsis-related mortality has not been investigated in public, safety net hospitals. This study was conducted to investigate the utility of SOFA, qSOFA, and SIRS (systemic inflammatory response syndrome) criteria in predicting in-hospital mortality in septic patients admitted from the emergency department (ED) to the ICU at Grady Memorial Hospital (GMH).
METHODS: We performed a retrospective cohort study of septic patients admitted to GMH from November 1 2010 through March 31 2016. We included in our analysis patients who presented to the ED and were (1) admitted with a diagnosis of severe sepsis or septic shock per Sepsis-1 criteria and (2) admitted or transferred to the GMH ICU within one day of presentation to the ED. Patients who presented following trauma or experienced cardiac arrest prior to sepsis workup were excluded. For each patient, we calculated qSOFA and SIRS scores based on first measurements obtained in the ED, and SOFA scores based upon the first 24 hours following presentation to the ED. The associations between SOFA, qSOFA, and SIRS scores and in-hospital mortality were assessed using multivariable logistic regression and area under the receiver operator characteristic (AUROC) curve analysis.
RESULTS: 237 patients were included in final analysis. Median SOFA, qSOFA, and SIRS scores were 10, 1, and 2, respectively. Seventy one (30.1%) patients died in-hospital. SOFA score was associated with higher mortality (adjusted OR 1.17, 1.08-1.27) as compared to qSOFA (adjusted OR 1.15, 0.85-1.56) and SIRS (adjusted OR 0.96, 0.73-1.27). AUROC curve calculations for SOFA, qSOFA and SIRS were 0.654, 0.535 and 0.520, respectively.
CONCLUSION: In an urban, safety-net population, SOFA predicted in-hospital mortality more accurately than qSOFA and SIRS. Larger prospective studies are needed to further evaluate this association.
Author Block: C. Graziani1, A. Mohsin2, H. Wu3, H. Feng3, J. E. Sevransky4, A. M. Esper4, G. S. Martin4, C. C. Polito4; 1Internal Medicine, Emory University School of Medicine, Atlanta, GA, United States, 2Columbus Regional Health, Columbus, GA, United States, 3Department of Biostatistics and Bioinformatics, Emory University Rollins School of Public Health, Atlanta, GA, United States, 4Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Emory University School of Medicine, Atlanta, GA, United States.
INTRODUCTION: Per Sepsis-3 guidelines, quick sequential organ failure assessment (qSOFA) screening is recommended for use in patients outside the intensive care unit (ICU) who have suspected infection as a way to identify patients at increased risk of sepsis-related, in-hospital mortality. Sequential organ failure assessment (SOFA) screening is validated for ICU patients with suspected sepsis. The utility of qSOFA and SOFA in predicting sepsis-related mortality has not been investigated in public, safety net hospitals. This study was conducted to investigate the utility of SOFA, qSOFA, and SIRS (systemic inflammatory response syndrome) criteria in predicting in-hospital mortality in septic patients admitted from the emergency department (ED) to the ICU at Grady Memorial Hospital (GMH).
METHODS: We performed a retrospective cohort study of septic patients admitted to GMH from November 1 2010 through March 31 2016. We included in our analysis patients who presented to the ED and were (1) admitted with a diagnosis of severe sepsis or septic shock per Sepsis-1 criteria and (2) admitted or transferred to the GMH ICU within one day of presentation to the ED. Patients who presented following trauma or experienced cardiac arrest prior to sepsis workup were excluded. For each patient, we calculated qSOFA and SIRS scores based on first measurements obtained in the ED, and SOFA scores based upon the first 24 hours following presentation to the ED. The associations between SOFA, qSOFA, and SIRS scores and in-hospital mortality were assessed using multivariable logistic regression and area under the receiver operator characteristic (AUROC) curve analysis.
RESULTS: 237 patients were included in final analysis. Median SOFA, qSOFA, and SIRS scores were 10, 1, and 2, respectively. Seventy one (30.1%) patients died in-hospital. SOFA score was associated with higher mortality (adjusted OR 1.17, 1.08-1.27) as compared to qSOFA (adjusted OR 1.15, 0.85-1.56) and SIRS (adjusted OR 0.96, 0.73-1.27). AUROC curve calculations for SOFA, qSOFA and SIRS were 0.654, 0.535 and 0.520, respectively.
CONCLUSION: In an urban, safety-net population, SOFA predicted in-hospital mortality more accurately than qSOFA and SIRS. Larger prospective studies are needed to further evaluate this association.
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