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Timing Differences in Diagnosis Between SOFA, qSOFA, and SIRS Criteria in a Large ICU Cohort
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A4280 - Timing Differences in Diagnosis Between SOFA, qSOFA, and SIRS Criteria in a Large ICU Cohort
Author Block: J. Willoughby1, P. G. Belvitch2; 1Depart of Pulmonary, Critical Care, and Sleep Medicine, University of Illinois - Chicago, Chicago, IL, United States, 2Univ of Illinois at Chicago, Chicago, IL, United States.
Rationale: The introduction of the Sepsis-3 Criteria for the diagnosis of sepsis and septic shock in 2016 caused significant changes to the accepted definition of sepsis, severe sepsis, and septic shock. Previous guidelines in 2001 defined sepsis as the presence of the systemic inflammatory response syndrome (SIRS) in addition to the suspected presence of an infection. The 2016 guidelines introduced the Sequential Organ Failure Assessment(SOFA) and quick SOFA (qSOFA) scores as part of the diagnostic criteria of sepsis. Given the complexity of the SOFA score and the lack of specificity of the qSOFA score, there has been concern that adherence to these modalities could result in a delay in recognition of sepsis. Our research compares the use of these three scores with respect to time to sepsis diagnosis in an ICU population.
Methods:We performed a retrospective chart review of 577 patients from 2012-2016 at the University of Illinois at Chicago Hospital with an admitting diagnosis of sepsis, severe sepsis, septicemia, or septic shock. We obtained baseline data, including patient demographics and laboratory values Vital signs and laboratory data over the first twenty-four hours of admission were assessed. The time at which each patient met the definitions of sepsis, severe sepsis or septic shock was recorded based on SIRS criteria, qSOFA score and SOFA score. Additional data points included length of stay, length of ICU stay, and time to first antibiotic.
Results:Our data set included 577 patients with sepsis, severe sepsis, and septic shock. The average age was fifty-five years. Greater than fifty percent of patients were African-American or Hispanic. The most common source of infection was pneumonia. On average, it took 58.3 minutes to meet sepsis by SIRS, 273.7 minutes by qSOFA, and 145.4 minutes by SOFA. The average SOFA score was 7.2. The average length of stay was 12.1 days, with an average of 4.7 days in the ICU.
Conclusion:In this large cohort of septic patients admitted to the ICU, Sepsis-2 criteria for diagnosing sepsis outperformed both the qSOFA and SOFA scores. Given the association between early antibiotic administration and mortality, early recognition of sepsis with Sepsis-2 criteria may still be useful in some settings. This timing difference is an important consideration in future research.
Author Block: J. Willoughby1, P. G. Belvitch2; 1Depart of Pulmonary, Critical Care, and Sleep Medicine, University of Illinois - Chicago, Chicago, IL, United States, 2Univ of Illinois at Chicago, Chicago, IL, United States.
Rationale: The introduction of the Sepsis-3 Criteria for the diagnosis of sepsis and septic shock in 2016 caused significant changes to the accepted definition of sepsis, severe sepsis, and septic shock. Previous guidelines in 2001 defined sepsis as the presence of the systemic inflammatory response syndrome (SIRS) in addition to the suspected presence of an infection. The 2016 guidelines introduced the Sequential Organ Failure Assessment(SOFA) and quick SOFA (qSOFA) scores as part of the diagnostic criteria of sepsis. Given the complexity of the SOFA score and the lack of specificity of the qSOFA score, there has been concern that adherence to these modalities could result in a delay in recognition of sepsis. Our research compares the use of these three scores with respect to time to sepsis diagnosis in an ICU population.
Methods:We performed a retrospective chart review of 577 patients from 2012-2016 at the University of Illinois at Chicago Hospital with an admitting diagnosis of sepsis, severe sepsis, septicemia, or septic shock. We obtained baseline data, including patient demographics and laboratory values Vital signs and laboratory data over the first twenty-four hours of admission were assessed. The time at which each patient met the definitions of sepsis, severe sepsis or septic shock was recorded based on SIRS criteria, qSOFA score and SOFA score. Additional data points included length of stay, length of ICU stay, and time to first antibiotic.
Results:Our data set included 577 patients with sepsis, severe sepsis, and septic shock. The average age was fifty-five years. Greater than fifty percent of patients were African-American or Hispanic. The most common source of infection was pneumonia. On average, it took 58.3 minutes to meet sepsis by SIRS, 273.7 minutes by qSOFA, and 145.4 minutes by SOFA. The average SOFA score was 7.2. The average length of stay was 12.1 days, with an average of 4.7 days in the ICU.
Conclusion:In this large cohort of septic patients admitted to the ICU, Sepsis-2 criteria for diagnosing sepsis outperformed both the qSOFA and SOFA scores. Given the association between early antibiotic administration and mortality, early recognition of sepsis with Sepsis-2 criteria may still be useful in some settings. This timing difference is an important consideration in future research.
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