E J Giamarellos-Bourboulis1, T Tsaganos2, I Tsangaris3, M Lada4, C Routsi5, D Sinapidis6, M Koupetori7, M Bristianou8, G Adamis9, K Mandragos10, G N Dalekos11, I Kritselis12, G Giannikopoulos13, I Koutelidakis14, M Pavlaki15, E Antoniadou16, G Vlachogiannis17, V Koulouras18, A Prekates19, G Dimopoulos3, A Koutsoukou20, I Pnevmatikos21, A Ioakeimidou22, A Kotanidou5, S E Orfanos3, A Armaganidis3, C Gogos23. 1. 4(th) Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece. Electronic address: egiamarel@med.uoa.gr. 2. 4(th) Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece. 3. 2(nd) Department of Critical Care Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece. 4. 2(nd) Department of Internal Medicine, Sismanogleion General Hospital, Athens, Greece. 5. 1(st) Department of Critical Care Medicine, National and Kapodistrian University of Athens, Medical School, Athens, Greece. 6. Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Medical School, Athens, Greece. 7. 1(st) Department of Internal Medicine, Thriasion Elefsis General Hospital, Elefsina, Greece. 8. Department of Urology, Lamia General Hospital, Lamia, Greece. 9. 1(st) Department of Internal Medicine, "G.Gennimatas" Athens General Hospital, Athens, Greece. 10. Intensive Care Unit, Korgialeneion-Benakeion General Hospital, Athens, Greece. 11. Department of Medicine and Research Laboratory of Internal Medicine, Larissa University Hospital, University of Thessaly, Medical School, Larissa, Greece. 12. Department of Surgery, Nafplion General Hospital, Nafplion, Greece. 13. Department of Internal Medicine, Chios General Hospital, Chios, Greece. 14. 2(nd) Department of Surgery, Aristotle University of Thessaloniki, Thessaloniki, Greece. 15. Department of Internal Medicine, Argos General Hospital, Argos, Greece. 16. Intensive Care Unit, "G.Gennimatas" General Hospital, Thessaloniki, Greece. 17. Intensive Care Unit, "Aghios Dimitrios" General Hospital, Thessaloniki, Greece. 18. Department of Critical Care Medicine, University of Ioannina, Medical School, Ioannina, Greece. 19. Intensive Care Unit, Tzaneion General Hospital, Piraeus, Greece. 20. 1(st) Department of Pulmonary Medicine, National and Kapodistrian University of Athens, Athens, Greece. 21. Department of Critical Care Medicine, Alexandroupolis University Hospital, Alexandroupolis, Greece. 22. Intensive Care Unit, Korinthos General Hospital, Korinthos, Greece. 23. Department of Internal Medicine, University of Patras, Medical School, Patras, Greece.
Abstract
OBJECTIVES: Sepsis-3 definitions generated controversies regarding their general applicability. The Sepsis-3 Task Force outlined the need for validation with emphasis on the quick Sequential Organ Failure Assessment (qSOFA) score. This was done in a prospective cohort from a different healthcare setting. METHODS: Patients with infections and at least two signs of systemic inflammatory response syndrome (SIRS) were analysed. Sepsis was defined as total SOFA ≥2 outside the intensive care unit (ICU) or as an increase of ICU admission SOFA ≥2. The primary endpoints were the sensitivity of qSOFA outside the ICU and sepsis definition both outside and within the ICU to predict mortality. RESULTS: In all, 3346 infections outside the ICU and 1058 infections in the ICU were analysed. Outside the ICU, respective mortality with ≥2 SIRS and qSOFA ≥2 was 25.3% and 41.2% (p <0.0001); the sensitivities of qSOFA and of sepsis definition to predict death were 60.8% and 87.2%, respectively. This was 95.9% for sepsis definition in the ICU. The sensitivity of qSOFA and of ≥3 SIRS criteria for organ dysfunction outside the ICU was 48.7% and 72.5%, respectively (p <0.0001). Misclassification outside the ICU with the 1991 and Sepsis-3 definitions into stages of lower severity was 21.4% and 3.7%, respectively (p <0.0001) and 14.9% and 3.7%, respectively, in the ICU (p <0.0001). Adding arterial pH ≤7.30 to qSOFA increased sensitivity for prediction of death to 67.5% (p 0.004). CONCLUSIONS: Our analysis positively validated the use of SOFA score to predict unfavourable outcome and to limit misclassification into lower severity. However, qSOFA score had inadequate sensitivity for early risk assessment.
OBJECTIVES:Sepsis-3 definitions generated controversies regarding their general applicability. The Sepsis-3 Task Force outlined the need for validation with emphasis on the quick Sequential Organ Failure Assessment (qSOFA) score. This was done in a prospective cohort from a different healthcare setting. METHODS:Patients with infections and at least two signs of systemic inflammatory response syndrome (SIRS) were analysed. Sepsis was defined as total SOFA ≥2 outside the intensive care unit (ICU) or as an increase of ICU admission SOFA ≥2. The primary endpoints were the sensitivity of qSOFA outside the ICU and sepsis definition both outside and within the ICU to predict mortality. RESULTS: In all, 3346 infections outside the ICU and 1058 infections in the ICU were analysed. Outside the ICU, respective mortality with ≥2 SIRS and qSOFA ≥2 was 25.3% and 41.2% (p <0.0001); the sensitivities of qSOFA and of sepsis definition to predict death were 60.8% and 87.2%, respectively. This was 95.9% for sepsis definition in the ICU. The sensitivity of qSOFA and of ≥3 SIRS criteria for organ dysfunction outside the ICU was 48.7% and 72.5%, respectively (p <0.0001). Misclassification outside the ICU with the 1991 and Sepsis-3 definitions into stages of lower severity was 21.4% and 3.7%, respectively (p <0.0001) and 14.9% and 3.7%, respectively, in the ICU (p <0.0001). Adding arterial pH ≤7.30 to qSOFA increased sensitivity for prediction of death to 67.5% (p 0.004). CONCLUSIONS: Our analysis positively validated the use of SOFA score to predict unfavourable outcome and to limit misclassification into lower severity. However, qSOFA score had inadequate sensitivity for early risk assessment.
Authors: Flavia Ribeiro Machado; Murillo Santucci Cesar de Assunção; Alexandre Biasi Cavalcanti; André Miguel Japiassú; Luciano Cesar Pontes de Azevedo; Mirella Cristine Oliveira Journal: Rev Bras Ter Intensiva Date: 2016 Oct-Dec
Authors: Massimo Sartelli; Yoram Kluger; Luca Ansaloni; Timothy C Hardcastle; Jordi Rello; Richard R Watkins; Matteo Bassetti; Eleni Giamarellou; Federico Coccolini; Fikri M Abu-Zidan; Abdulrashid K Adesunkanmi; Goran Augustin; Gian L Baiocchi; Miklosh Bala; Oussema Baraket; Marcelo A Beltran; Asri Che Jusoh; Zaza Demetrashvili; Belinda De Simone; Hamilton P de Souza; Yunfeng Cui; R Justin Davies; Sameer Dhingra; Jose J Diaz; Salomone Di Saverio; Agron Dogjani; Mutasim M Elmangory; Mushira A Enani; Paula Ferrada; Gustavo P Fraga; Sabrina Frattima; Wagih Ghnnam; Carlos A Gomes; Souha S Kanj; Aleksandar Karamarkovic; Jakub Kenig; Faryal Khamis; Vladimir Khokha; Kaoru Koike; Kenneth Y Y Kok; Arda Isik; Francesco M Labricciosa; Rifat Latifi; Jae G Lee; Andrey Litvin; Gustavo M Machain; Ramiro Manzano-Nunez; Piotr Major; Sanjay Marwah; Michael McFarlane; Ziad A Memish; Cristian Mesina; Ernest E Moore; Frederick A Moore; Noel Naidoo; Ionut Negoi; Richard Ofori-Asenso; Iyiade Olaoye; Carlos A Ordoñez; Mouaqit Ouadii; Ciro Paolillo; Edoardo Picetti; Tadeja Pintar; Alfredo Ponce-de-Leon; Guntars Pupelis; Tarcisio Reis; Boris Sakakushev; Hossein Samadi Kafil; Norio Sato; Jay N Shah; Boonying Siribumrungwong; Peep Talving; Cristian Tranà; Jan Ulrych; Kuo-Ching Yuan; Fausto Catena Journal: World J Emerg Surg Date: 2018-01-25 Impact factor: 5.469