Shigeki Kushimoto1, Satoshi Gando2, Hiroshi Ogura3, Yutaka Umemura3, Daizoh Saitoh4, Toshihiko Mayumi5, Seitaro Fujishima6, Toshikazu Abe7, Atsushi Shiraishi8, Hiroto Ikeda9, Joji Kotani10, Yasuo Miki11, Shin-Ichiro Shiraishi12, Koichiro Suzuki13, Yasushi Suzuki14, Naoshi Takeyama15, Kiyotsugu Takuma16, Ryosuke Tsuruta17, Yoshihiro Yamaguchi18, Norio Yamashita19, Naoki Aikawa20. 1. Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Aoba-ku, Miyagi, Japan. 2. Division of Acute and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan. 3. Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita-shi, Osaka, Japan. 4. Division of Traumatology, Research Institute, National Defense Medical College, Tokorozawa-shi, Saitama, Japan. 5. Department of Emergency Medicine, School of Medicine, University of Occupational and Environmental Health, Iseigaoka, Kitakyushu, Fukuoka, Japan. 6. Center for General Medicine Education, School of Medicine, Keio University, Shinjukuku, Tokyo, Japan. 7. Department of Emergency and Disaster Medicine, Juntendo University, Urayasu Hospital, Tomioka, Chiba, Japan. 8. Emergency Department, Kameda Medical Center, Higashimachi, Kamogawa, Japan. 9. Trauma and Resuscitation Center, Department of Emergency Medicine, Teikyo University School of Medicine, Itabashiku, Tokyo, Japan. 10. Department of Emergency, Disaster and Critical Care Medicine, Hyogo College of Medicine, Nishinomiya-shi, Japan. 11. Advanced Critical Care Center, Aichi Medical University Hospital, Nagakute-shi, Aichi, Japan. 12. Department of Emergency and Critical Care Medicine, Nippon Medical School, Bunkyouku, Tokyo, Japan. 13. Department of Acute Medicine, Kawasaki Medical School, Kurashiki-shi, Okayama, Japan. 14. Department of Critical Care Medicine, Iwate Medical University, Morioka-shi, Iwate, Japan. 15. Department of Emergency and Critical Care Medicine, Aichi Medical University, Nagakute, Aichi, Japan. 16. Emergency and Critical Care Center, Kawasaki Municipal Hospital, Kawasakiku, Kawasaki-shi, Kanagawa, Japan. 17. Advanced Medical Emergency and Critical Care Center, Yamaguchi University Hospital, Ube-shi, Yamaguchi, Japan. 18. Department of Trauma and Critical Care Medicine, School of Medicine, Kyorin University, Mitaka-shi, Tokyo, Japan. 19. Department of Emergency and Critical Care Medicine, School of Medicine, Kurume University, Kurume-shi, Fukuoka, Japan. 20. Emergency and Critical Care Medicine, School of Medicine, Keio University, Shinjukuku, Tokyo, Japan.
Abstract
BACKGROUND: Although the quick Sequential Organ Failure Assessment (qSOFA) has been recommended for identifying patients at higher risk of hospital death, it has only a 60% sensitivity for in-hospital mortality. On the other hand, hypothermia associates with increased mortality and organ failure in patients with sepsis. This study aimed to assess the predictive validity of qSOFA for identifying patients with sepsis at higher risk of multiple organ dysfunction or death and the complementary effect of hypothermia. METHODS: Patients with severe sepsis admitted to intensive care units (ICUs) were retrospectively analyzed. The predictive validities of qSOFA (≥2, positive) and the complementary effect of hypothermia (body temperature ≤36.5°C) for the identification of death or multiorgan dysfunction were evaluated. RESULTS: Of the 624 patients, 230 (36.9%) developed multiorgan dysfunction and 144 (23.1%) died within 28 days; 527 (84.5%) had a positive qSOFA. The 28-day mortality rates of patients with positive and negative qSOFA were 25.4% and 10.3%, respectively (P = .001). The rate of positive qSOFA was higher in patients with multiorgan dysfunction (sensitivity, 0.896; specificity, 0.185) and among patients who died within 28 days (sensitivity, 0.931; specificity, 0.181); 10 (6.9%) of 144 deaths were not identified. In cases of positive qSOFA without hypothermia, positive qSOFA + hypothermia, or negative qSOFA with hypothermia, the predictive value for 28-day mortality improved (sensitivity, 0.979). Among the 144 patients who died, only 3 were not identified. CONCLUSION: A qSOFA score ≥2 may identify >90% of 28-day deaths among patients with severe sepsis; hypothermia may complement the predictive ability of qSOFA.
BACKGROUND: Although the quick Sequential Organ Failure Assessment (qSOFA) has been recommended for identifying patients at higher risk of hospital death, it has only a 60% sensitivity for in-hospital mortality. On the other hand, hypothermia associates with increased mortality and organ failure in patients with sepsis. This study aimed to assess the predictive validity of qSOFA for identifying patients with sepsis at higher risk of multiple organ dysfunction or death and the complementary effect of hypothermia. METHODS: Patients with severe sepsis admitted to intensive care units (ICUs) were retrospectively analyzed. The predictive validities of qSOFA (≥2, positive) and the complementary effect of hypothermia (body temperature ≤36.5°C) for the identification of death or multiorgan dysfunction were evaluated. RESULTS: Of the 624 patients, 230 (36.9%) developed multiorgan dysfunction and 144 (23.1%) died within 28 days; 527 (84.5%) had a positive qSOFA. The 28-day mortality rates of patients with positive and negative qSOFA were 25.4% and 10.3%, respectively (P = .001). The rate of positive qSOFA was higher in patients with multiorgan dysfunction (sensitivity, 0.896; specificity, 0.185) and among patients who died within 28 days (sensitivity, 0.931; specificity, 0.181); 10 (6.9%) of 144 deaths were not identified. In cases of positive qSOFA without hypothermia, positive qSOFA + hypothermia, or negative qSOFA with hypothermia, the predictive value for 28-day mortality improved (sensitivity, 0.979). Among the 144 patients who died, only 3 were not identified. CONCLUSION: A qSOFA score ≥2 may identify >90% of 28-day deaths among patients with severe sepsis; hypothermia may complement the predictive ability of qSOFA.
Entities:
Keywords:
body temperature; critical care; mortality; quick SOFA; sepsis
Authors: Cássia Maria Frediani Morsch; Jaqueline Sangiogo Haas; Rose Plotnick; Taciana de Castilhos Cavalcanti; Patrícia Cristina Cardoso; Tatiana Pilger; Juliana Teixeira da Silveira; Fernando Saldanha Thomé Journal: Rev Bras Ter Intensiva Date: 2021 Jan-Mar