Amith Shetty1,2, Stephen Pj MacDonald3,4,5, Julian M Williams6, John van Bockxmeer7, Bas de Groot8, Laura M Esteve Cuevas9, Annemieke Ansems9, Malcolm Green10, Kelly Thompson11, Harvey Lander10, Jaimi Greenslade6,12, Simon Finfer11, Jonathan Iredell1. 1. Westmead Institute for Medical Research, NHMRC Centre for Research Excellence in Critical Infection, Sydney, New South Wales, Australia. 2. Westmead Emergency Medical Research Unit, Westmead Hospital, Sydney, New South Wales, Australia. 3. Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia. 4. Department of Emergency Medicine, Royal Perth Hospital, Perth, Western Australia, Australia. 5. Division of Emergency Medicine, The University of Western Australia, Perth, Western Australia, Australia. 6. Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia. 7. Western Australia Country Health Service, South Hedland, Western Australia, Australia. 8. Department of Emergency Medicine, Leiden University Medical Centre, Leiden, The Netherlands. 9. Emergency Department, Albert Schweitzer Ziekenhuis, Dordrecht, The Netherlands. 10. Clinical Excellence Commission, Sydney, New South Wales, Australia. 11. Critical Care and Trauma Division, The George Institute for Global Health, Sydney, New South Wales, Australia. 12. Department of Biostatistics, Queensland University of Technology, Brisbane, Queensland, Australia.
Abstract
OBJECTIVE: The Sepsis-3 task force recommends the use of the quick Sequential Organ Failure Assessment (qSOFA) score to identify risk for adverse outcomes in patients presenting with suspected infection. Lactate has been shown to predict adverse outcomes in patients with suspected infection. The aim of the study is to investigate the utility of a post hoc lactate threshold (≥2 mmol/L) added qSOFA score (LqSOFA(2) score) to predict primary composite adverse outcomes (mortality and/or ICU stay ≥72 h) in patients presenting to ED with suspected sepsis. METHODS: Retrospective cohort study was conducted on a merged dataset of suspected or proven sepsis patients presenting to ED across multiple sites in Australia and The Netherlands. Patients are identified as candidates for quality improvement initiatives or research studies at respective sites based on local screening procedures. Data-sharing was performed across sites of demographics, qSOFA, SOFA, lactate thresholds and outcome data for included patients. LqSOFA(2) scores were calculated by adding an extra point to qSOFA score in patients who met lactate thresholds of ≥2 mmol/L. RESULTS: In a merged dataset of 12 555 patients where a full qSOFA score and outcome data were available, LqSOFA(2) ≥2 identified more patients with an adverse outcome (sensitivity 65.5%, 95% confidence interval 62.6-68.4) than qSOFA ≥2 (sensitivity 47.6%, 95% confidence interval 44.6- 50.6). The post hoc addition of lactate threshold identified higher proportion of patients at risk of adverse outcomes. CONCLUSIONS: The lactate ≥2 mmol/L threshold-based LqSOFA(2) score performs better than qSOFA alone in identifying risk of adverse outcomes in ED patients with suspected sepsis.
OBJECTIVE: The Sepsis-3 task force recommends the use of the quick Sequential Organ Failure Assessment (qSOFA) score to identify risk for adverse outcomes in patients presenting with suspected infection. Lactate has been shown to predict adverse outcomes in patients with suspected infection. The aim of the study is to investigate the utility of a post hoc lactate threshold (≥2 mmol/L) added qSOFA score (LqSOFA(2) score) to predict primary composite adverse outcomes (mortality and/or ICU stay ≥72 h) in patients presenting to ED with suspected sepsis. METHODS: Retrospective cohort study was conducted on a merged dataset of suspected or proven sepsispatients presenting to ED across multiple sites in Australia and The Netherlands. Patients are identified as candidates for quality improvement initiatives or research studies at respective sites based on local screening procedures. Data-sharing was performed across sites of demographics, qSOFA, SOFA, lactate thresholds and outcome data for included patients. LqSOFA(2) scores were calculated by adding an extra point to qSOFA score in patients who met lactate thresholds of ≥2 mmol/L. RESULTS: In a merged dataset of 12 555 patients where a full qSOFA score and outcome data were available, LqSOFA(2) ≥2 identified more patients with an adverse outcome (sensitivity 65.5%, 95% confidence interval 62.6-68.4) than qSOFA ≥2 (sensitivity 47.6%, 95% confidence interval 44.6- 50.6). The post hoc addition of lactate threshold identified higher proportion of patients at risk of adverse outcomes. CONCLUSIONS: The lactate ≥2 mmol/L threshold-based LqSOFA(2) score performs better than qSOFA alone in identifying risk of adverse outcomes in ED patients with suspected sepsis.
Authors: Colin A Graham; Ling Yan Leung; Ronson Sze Long Lo; Chun Yu Yeung; Suet Yi Chan; Kevin Kei Ching Hung Journal: Ann Med Date: 2020-06-25 Impact factor: 4.709
Authors: Sietske C van Nassau; Ron H van Beek; Gertjan J Driessen; Jan A Hazelzet; Herbert M van Wering; Navin P Boeddha Journal: Front Pediatr Date: 2018-10-01 Impact factor: 3.418
Authors: Flavia R Machado; Alexandre B Cavalcanti; Mariana B Monteiro; Juliana L Sousa; Aline Bossa; Antonio T Bafi; Felipe Dal-Pizzol; Flavio G R Freitas; Thiago Lisboa; Glauco A Westphal; Andre M Japiassu; Luciano C P Azevedo Journal: Am J Respir Crit Care Med Date: 2020-04-01 Impact factor: 21.405