Otavio T Ranzani1,2, Elena Prina1, Rosario Menéndez3, Adrian Ceccato1,4, Catia Cilloniz1, Raul Méndez3, Albert Gabarrus1, Enric Barbeta1, Gianluigi Li Bassi1, Miquel Ferrer1, Antoni Torres1. 1. 1 Department of Pulmonology, Hospital Clinic of Barcelona, University of Barcelona, Institut D'investigacions August Pi i Sunyer, Centro de Investigación Biomedica En Red-Enfermedades Respiratorias, Barcelona, Spain. 2. 2 Respiratory Intensive Care Unit, Pulmonary Division, Heart Institute, Hospital das Clínicas, University of Sao Paulo, Sao Paulo, Brazil. 3. 3 Pneumology Department, Instituto de Investigación Sanitaria/Hospital Universitario y Politecnico La Fe, Centro de Investigación Biomedica En Red-Enfermedades Respiratorias, Valencia, Spain; and. 4. 4 Seccion Neumologia, Hospital Nacional Prof. Alejandro Posadas, Palomar, Argentina.
Abstract
RATIONALE: The Sepsis-3 Task Force updated the clinical criteria for sepsis, excluding the need for systemic inflammatory response syndrome (SIRS) criteria. The clinical implications of the proposed flowchart including the quick Sequential (Sepsis-related) Organ Failure Assessment (qSOFA) and SOFA scores are unknown. OBJECTIVES: To perform a clinical decision-making analysis of Sepsis-3 in patients with community-acquired pneumonia. METHODS: This was a cohort study including adult patients with community-acquired pneumonia from two Spanish university hospitals. SIRS, qSOFA, the Confusion, Respiratory Rate and Blood Pressure (CRB) score, modified SOFA (mSOFA), the Confusion, Urea, Respiratory Rate, Blood Pressure and Age (CURB-65) score, and Pneumonia Severity Index (PSI) were calculated with data from the emergency department. We used decision-curve analysis to evaluate the clinical usefulness of each score and the primary outcome was in-hospital mortality. MEASUREMENTS AND MAIN RESULTS: Of 6,874 patients, 442 (6.4%) died in-hospital. SIRS presented the worst discrimination, followed by qSOFA, CRB, mSOFA, CURB-65, and PSI. Overall, overestimation of in-hospital mortality and miscalibration was more evident for qSOFA and mSOFA. SIRS had lower net benefit than qSOFA and CRB, significantly increasing the risk of over-treatment and being comparable with the "treat-all" strategy. PSI had higher net benefit than mSOFA and CURB-65 for mortality, whereas mSOFA seemed more applicable when considering mortality/intensive care unit admission. Sepsis-3 flowchart resulted in better identification of patients at high risk of mortality. CONCLUSIONS: qSOFA and CRB outperformed SIRS and presented better clinical usefulness as prompt tools for patients with community-acquired pneumonia in the emergency department. Among the tools for a comprehensive patient assessment, PSI had the best decision-aid tool profile.
RATIONALE: The Sepsis-3 Task Force updated the clinical criteria for sepsis, excluding the need for systemic inflammatory response syndrome (SIRS) criteria. The clinical implications of the proposed flowchart including the quick Sequential (Sepsis-related) Organ Failure Assessment (qSOFA) and SOFA scores are unknown. OBJECTIVES: To perform a clinical decision-making analysis of Sepsis-3 in patients with community-acquired pneumonia. METHODS: This was a cohort study including adult patients with community-acquired pneumonia from two Spanish university hospitals. SIRS, qSOFA, the Confusion, Respiratory Rate and Blood Pressure (CRB) score, modified SOFA (mSOFA), the Confusion, Urea, Respiratory Rate, Blood Pressure and Age (CURB-65) score, and Pneumonia Severity Index (PSI) were calculated with data from the emergency department. We used decision-curve analysis to evaluate the clinical usefulness of each score and the primary outcome was in-hospital mortality. MEASUREMENTS AND MAIN RESULTS: Of 6,874 patients, 442 (6.4%) died in-hospital. SIRS presented the worst discrimination, followed by qSOFA, CRB, mSOFA, CURB-65, and PSI. Overall, overestimation of in-hospital mortality and miscalibration was more evident for qSOFA and mSOFA. SIRS had lower net benefit than qSOFA and CRB, significantly increasing the risk of over-treatment and being comparable with the "treat-all" strategy. PSI had higher net benefit than mSOFA and CURB-65 for mortality, whereas mSOFA seemed more applicable when considering mortality/intensive care unit admission. Sepsis-3 flowchart resulted in better identification of patients at high risk of mortality. CONCLUSIONS: qSOFA and CRB outperformed SIRS and presented better clinical usefulness as prompt tools for patients with community-acquired pneumonia in the emergency department. Among the tools for a comprehensive patient assessment, PSI had the best decision-aid tool profile.
Authors: C J Reuß; M Bernhard; C Beynon; A Hecker; C Jungk; C Nusshag; M A Weigand; D Michalski; T Brenner Journal: Anaesthesist Date: 2018-09 Impact factor: 1.041
Authors: Ana Motos; Gianluigi Li Bassi; Francesco Pagliara; Laia Fernandez-Barat; Hua Yang; Eli Aguilera Xiol; Tarek Senussi; Francesco A Idone; Chiara Travierso; Chiara Chiurazzi; Rosanel Amaro; Minlan Yang; Joaquim Bobi; Montserrat Rigol; David P Nicolau; Gerard Frigola; Roberto Cabrera; Jose Ramirez; Paolo Pelosi; Francesco Blasi; Massimo Antonelli; Antonio Artigas; Jordi Vila; Marin Kollef; Antoni Torres Journal: Antimicrob Agents Chemother Date: 2021-01-20 Impact factor: 5.191
Authors: Mark E Nunnally; Ricard Ferrer; Greg S Martin; Ignacio Martin-Loeches; Flavia R Machado; Daniel De Backer; Craig M Coopersmith; Clifford S Deutschman Journal: Intensive Care Med Exp Date: 2021-07-02