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Am J Emerg Med. 2019 Jun;37(6):1054-1059. doi: 10.1016/j.ajem.2018.08.046. Epub 2018 Aug 21.

Prognostic performance of disease severity scores in patients with septic shock presenting to the emergency department.

Author information

1
Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea.
2
Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Republic of Korea. Electronic address: pys0905@yuhs.ac.
3
Department of Emergency Medicine, Sungkyunkwan University School of Medicine, Samsung Medical Center, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Republic of Korea.
4
Department of Emergency Medicine, Korea University College of Medicine, Anam Hospital, 73 Inchon-ro, Seongbuk-gu, Seoul 02841, Republic of Korea.
5
Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea.
6
Department of Emergency Medicine, Hallym University College of Medicine, Gangnam Medical Center, 1 Singil-ro, Yeongdeungpo-gu, Seoul 07741, Republic of Korea.
7
Department of Emergency Medicine, Seoul National University College of Medicine, Bundang Hospital, 82 Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam, Gyeonggi-do 13620, Republic of Korea.
8
Department of Emergency Medicine, Korea University College of Medicine, Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul 08308, Republic of Korea.
9
Department of Emergency Medicine, Hanyang University College of Medicine, 222-1 Wangsimni-ro, Seongdong-gu, Seoul 04763, Republic of Korea.
10
Department of Emergency Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea.

Abstract

BACKGROUND:

An accurate disease severity score that can quickly predict the prognosis of patients with sepsis in the emergency department (ED) can aid clinicians in distributing resources appropriately or making decisions for active resuscitation measures. This study aimed to compare the prognostic performance of quick sequential organ failure assessment (qSOFA) with that of other disease severity scores in patients with septic shock presenting to an ED.

METHODS:

We performed a prospective, observational, registry-based study. The discriminative ability of each disease severity score to predict 28-day mortality was evaluated in the overall cohort (which included patients who fulfilled previously defined criteria for septic shock), the newly defined sepsis subgroup, and the newly defined septic shock subgroup.

RESULTS:

A total of 991 patients were included. All disease severity scores had poor discriminative ability for 28-day mortality. The sequential organ failure assessment and acute physiology and chronic health evaluation II scores had the highest area under the receiver-operating characteristic curve (AUC) values, which were significantly higher than the AUC values of other disease severity scores in the overall cohort and the sepsis and septic shock subgroups. The discriminative ability of each disease severity score decreased as the mortality rate of each subgroup increased.

CONCLUSIONS:

All disease severity scores, including qSOFA, did not display good discrimination for 28-day mortality in patients with serious infection and refractory hypotension or hypoperfusion; additionally, none of the included scoring tools in this study could consistently predict 28-day mortality in the newly defined sepsis and septic shock subgroups.

KEYWORDS:

Mortality; Prognosis; Sepsis; Shock

PMID:
30220642
DOI:
10.1016/j.ajem.2018.08.046

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