Francesca Remelli1,2, Federico Castellucci1, Aurora Vitali1,2, Irene Mattioli1,2, Amedeo Zurlo1,2, Savino Spadaro3, Stefano Volpato4,5. 1. Department of Medical Sciences, University of Ferrara, Ferrara, Italy. 2. Geriatrics Unit, Azienda Ospedaliero- universitaria di Ferrara, Ferrara, Italy. 3. Anestesiology and Resuscitation Unit, Department of Morfology, Surgery and Sperimental Medicine, University of Ferrara, Ferrara, Italy. 4. Department of Medical Sciences, University of Ferrara, Ferrara, Italy. vlt@unife.it. 5. Orthogeriatrics Unit, Azienda Ospedaliero-Universitaria di Ferrara, Via Aldo Moro, 8, 44124, Ferrara, Italy. vlt@unife.it.
Abstract
BACKGROUND: QuickSOFA, a prognostic score proposed for patients with infection, has shown a poor predictive value in the geriatric population, probably because of the inappropriateness of the Glasgow Coma Scale (GCS) in assessing acute alteration of mental status in older patients. Indeed, the GCS might result chronically low in older patient with pre-existing cognitive disorders. The aim of this study was to develop an alternative quickSOFA (geriatric-quickSOFA), using the presence of delirium, assessed according to DSM-5 criteria, instead of GCS assessment, to predict mortality in hospitalized older patients with sepsis. METHODS: Retrospective observational study in Acute Geriatrics Unit of St. Anna Hospital of Ferrara (Italy). The study enrolled 165 patients hospitalized between 2017 and 2018 with diagnosis of sepsis or septic shock. Demographic, clinical data and 30-day survival were collected for each patient. Based on arterial blood pressure, respiratory rate, and the presence of delirium, geriatric-quickSOFA was calculated at admission. Primary outcome was 30-day mortality. RESULTS: One hundred sixty-five patients were enrolled with a median age of 88 years; 60.6% were men. High quickSOFA score was not significantly correlated neither with in-hospital nor 30-day mortality. High geriatric-qSOFA score was significantly related to both in-hospital (13.3%vs 51.5%, p = 0.0003) and 30-day mortality (30.0%vs 84.3%, p < 0.00001). CONCLUSION: Geriatric-quickSOFA is significantly associate with short-term mortality risk in older patients with sepsis. Geriatric quickSOFA seems to represent a more suitable and useful predictive tool than the traditional quickSOFA in the geriatric population.
BACKGROUND: QuickSOFA, a prognostic score proposed for patients with infection, has shown a poor predictive value in the geriatric population, probably because of the inappropriateness of the Glasgow Coma Scale (GCS) in assessing acute alteration of mental status in older patients. Indeed, the GCS might result chronically low in older patient with pre-existing cognitive disorders. The aim of this study was to develop an alternative quickSOFA (geriatric-quickSOFA), using the presence of delirium, assessed according to DSM-5 criteria, instead of GCS assessment, to predict mortality in hospitalized older patients with sepsis. METHODS: Retrospective observational study in Acute Geriatrics Unit of St. Anna Hospital of Ferrara (Italy). The study enrolled 165 patients hospitalized between 2017 and 2018 with diagnosis of sepsis or septic shock. Demographic, clinical data and 30-day survival were collected for each patient. Based on arterial blood pressure, respiratory rate, and the presence of delirium, geriatric-quickSOFA was calculated at admission. Primary outcome was 30-day mortality. RESULTS: One hundred sixty-five patients were enrolled with a median age of 88 years; 60.6% were men. High quickSOFA score was not significantly correlated neither with in-hospital nor 30-day mortality. High geriatric-qSOFA score was significantly related to both in-hospital (13.3%vs 51.5%, p = 0.0003) and 30-day mortality (30.0%vs 84.3%, p < 0.00001). CONCLUSION: Geriatric-quickSOFA is significantly associate with short-term mortality risk in older patients with sepsis. Geriatric quickSOFA seems to represent a more suitable and useful predictive tool than the traditional quickSOFA in the geriatric population.
Authors: A Mirijello; A Tosoni; V Zaccone; M Impagnatiello; G Passaro; C V Vallone; A Cossari; G Ventura; G Gambassi; S De Cosmo; A Gasbarrini; G Addolorato; R Landolfi Journal: Eur Rev Med Pharmacol Sci Date: 2019-05 Impact factor: 3.507
Authors: Lenneke E M Haas; Fabian Termorshuizen; Dylan W de Lange; Diederik van Dijk; Nicolette F de Keizer Journal: Acta Anaesthesiol Scand Date: 2020-01-09 Impact factor: 2.105
Authors: Benjamin H Singer; Robert P Dickson; Scott J Denstaedt; Michael W Newstead; Kwi Kim; Nicole R Falkowski; John R Erb-Downward; Thomas M Schmidt; Gary B Huffnagle; Theodore J Standiford Journal: Am J Respir Crit Care Med Date: 2018-03-15 Impact factor: 30.528