Najla Lemachatti1,2, Mar Ortega3, Andrea Penaloza4, Pierrick Le Borgne5, Pierre-Géraud Claret6, Céline Occelli7, Jennifer Truchot8, Florence Dumas9, Anne-Laure Feral-Pierssens10, Héry Andrianjafy11, Sebastien Beaune12, Youri Yordanov1,13, Pierre Hausfater1,2, Bruno Riou1,2, Ben Bloom14, Evguenia Krastinova15, Yonathan Freund1,2. 1. Sorbonne Université, GRC 14 BIOSFAST and UMR INSERM 1166, IHU ICAN. 2. Emergency Department, Hôpital Pitie-Salpêtrière. 3. Emergency Department, Hospital Clinic, Universidad de Barcelona, Barcelona, Spain. 4. Emergency Department, Cliniques Universitaires St Luc, Bruxelles, Belgium. 5. Emergency Department, Hôpitaux universitaires de Strasbourg, Strasbourg. 6. Emergency Department, Centre Hospitalo-universitaire, Nîmes. 7. Emergency Department, Hôpital Pasteur, Nice. 8. Emergency Department, Hôpital Lariboisière. 9. Emergency Department, Hôpital Cochin. 10. Emergency Department, Hôpital Européen Georges Pompidou. 11. Emergency Department, Centre hospitalier des deux vallées, Longjumeau. 12. Emergency Department, Hôpital Ambroise Paré, Paris Diderot University. 13. Emergency Department, Hôpital Saint-Antoine, Assistance Publique - Hôpitaux de Paris (APHP), Paris. 14. Emergency Department, Barts Health NHS Trust, Queen Mary University, London, UK. 15. Department of Public Health, Centre Hospitalier Intercommunal, Créteil.
Abstract
BACKGROUND: The quick sequential organ failure assessment (qSOFA) score showed good prognostic performance in patients with suspicion of infection in the emergency department (ED). However, previous studies only assessed the performance of individual values of qSOFA during the ED stay. As this score may vary over short timeframes, the optimal time of measurement, and the prognostic value of its variation are unclear. The objective of the present study was to prospectively assess the prognostic value of the change in qSOFA over the first 3 h (ΔqSOFA = qSOFA at 3 h-qSOFA at inclusion). PATIENTS AND METHODS: This is an international prospective cohort study conducted in 17 EDs in France, Belgium, and Spain. From November 2016 to March 2017, patients with a suspected infection and a qSOFA score of 2 or higher were included and followed up until death or hospital discharge. qSOFA was measured at inclusion, 1 h and 3 h. Primary end point was in-hospital mortality, truncated at 28 days. RESULTS: Of 534 recruited patients, 512 were included in the analysis. The qSOFA was improved at 3 h (ΔqSOFA < 0) in 287 (55%) patients. Overall in-hospital mortality was 27%: 44% when ΔqSOFA greater than 0, 36% when ΔqSOFA = 0, and 18% when ΔqSOFA less than 0. A positive ΔqSOFA was independently associated with reduced in-hospital mortality (adjusted hazard ratio of 0.48, 95% confidence interval: 0.34-0.68). After modeling qSOFA kinetics in the first 3 h, there was a significant difference in adjusted slopes between patients who died and those who survived (0.15, 95% confidence interval: 0.09-0.22, P < 0.001). CONCLUSION: In patients with suspected infection presenting to the ED with a qSOFA of 2 or higher, the early change in qSOFA is a strong independent predictor of mortality.
BACKGROUND: The quick sequential organ failure assessment (qSOFA) score showed good prognostic performance in patients with suspicion of infection in the emergency department (ED). However, previous studies only assessed the performance of individual values of qSOFA during the ED stay. As this score may vary over short timeframes, the optimal time of measurement, and the prognostic value of its variation are unclear. The objective of the present study was to prospectively assess the prognostic value of the change in qSOFA over the first 3 h (ΔqSOFA = qSOFA at 3 h-qSOFA at inclusion). PATIENTS AND METHODS: This is an international prospective cohort study conducted in 17 EDs in France, Belgium, and Spain. From November 2016 to March 2017, patients with a suspected infection and a qSOFA score of 2 or higher were included and followed up until death or hospital discharge. qSOFA was measured at inclusion, 1 h and 3 h. Primary end point was in-hospital mortality, truncated at 28 days. RESULTS: Of 534 recruited patients, 512 were included in the analysis. The qSOFA was improved at 3 h (ΔqSOFA < 0) in 287 (55%) patients. Overall in-hospital mortality was 27%: 44% when ΔqSOFA greater than 0, 36% when ΔqSOFA = 0, and 18% when ΔqSOFA less than 0. A positive ΔqSOFA was independently associated with reduced in-hospital mortality (adjusted hazard ratio of 0.48, 95% confidence interval: 0.34-0.68). After modeling qSOFA kinetics in the first 3 h, there was a significant difference in adjusted slopes between patients who died and those who survived (0.15, 95% confidence interval: 0.09-0.22, P < 0.001). CONCLUSION: In patients with suspected infection presenting to the ED with a qSOFA of 2 or higher, the early change in qSOFA is a strong independent predictor of mortality.
Authors: Sarah M Perman; Mark E Mikkelsen; Munish Goyal; Adit Ginde; Abhishek Bhardwaj; Byron Drumheller; S Cham Sante; Anish K Agarwal; David F Gaieski Journal: Sci Rep Date: 2020-11-23 Impact factor: 4.379
Authors: Lara E E C Zonneveld; Raymond J van Wijk; Tycho J Olgers; Hjalmar R Bouma; Jan C Ter Maaten Journal: Eur J Emerg Med Date: 2022-06-23 Impact factor: 4.106