Prognostic scores and early management of septic patients in the emergency department of a secondary hospital: results of a retrospective study

• Published in: BMC emergency medicine 2021-12, Vol.21 (1), p.152-152, Article 152
• Main Authors: Colussi, GianLuca, Perrotta, Giacomo, Pillinini, Pierpaolo, Dibenedetto, Alessia G, Da Porto, Andrea, Catena, Cristiana, Sechi, Leonardo A
• Format: Article
• Language: English
• Subjects: Age; Aged; Aged, 80 and over; Analysis; APACHE II; Blood pressure; Body temperature; Chronic illnesses; Comorbidity; Confidence intervals; Creatinine; Decision making; Emergency medical care; Emergency medical services; Emergency service; Emergency Service, Hospital; Female; Heart beat; Heart rate; Hematocrit; Hemoglobin; Hospital Mortality; Hospitals; Humans; Infection; Infections; Intensive Care Units; Laboratories; Male; Mechanical ventilation; Medical prognosis; Middle Aged; Mortality; NEWS2; Older people; Oxygen content; Oxygen Saturation; Patients; Potassium; Prognosis; Regression analysis; Retrospective Studies; Risk factors; Risk groups; ROC Curve; SAPS II; Sepsis; Sepsis - diagnosis; Sepsis - therapy; SOFA; Survival; Survival analysis; Urine; Variables; Ventilators
• ISSN: 1471-227X; 1471-227X
• DOI: 10.1186/s12873-021-00547-8

Sequential Organ Failure Assessment (SOFA) and other illness prognostic scores predict adverse outcomes in critical patients. Their validation as a decision-making tool in the emergency department (ED) of secondary hospitals is not well established. The aim of this study was to compare SOFA, NEWS2, APACHE II, and SAPS II scores as predictors of adverse outcomes and decision-making tool in ED. Data of 121 patients (age 73 ± 10 years, 58% males, Charlson Comorbidity Index 5.7 ± 2.1) with a confirmed sepsis were included in a retrospective study between January 2017 and February 2020. Scores were computed within the first 24 h after admission. Primary outcome was the occurrence of either in-hospital death or mechanical ventilation within 7 days. Secondary outcome was 30-day all-cause mortality. Patients older than 64 years (elderly) represent 82% of sample. Primary and secondary outcomes occurred in 40 and 44%, respectively. Median 30-day survival time of dead patients was 4 days (interquartile range 1-11). The best predictive score based on the area under the receiver operating curve (AUROC) was SAPS II (0.823, 95% confidence interval, CI, 0.744-0.902), followed by APACHE II (0.762, 95% CI 0.673-0.850), NEWS2 (0.708, 95% CI 0.616-0.800), and SOFA (0.650, 95% CI 0.548-0.751). SAPS II cut-off of 49 showed the lowest false-positive rate (12, 95% CI 5-20) and the highest positive predictive value (80, 95% CI 68-92), whereas NEWS2 cut-off of 7 showed the lowest false-negative rate (10, 95% CI 2-19) and the highest negative predictive value (86, 95% CI 74-97). By combining NEWS2 and SAPS II cut-offs, we accurately classified 64% of patients. In survival analysis, SAPS II cut-off showed the highest difference in 30-day mortality (Hazards Ratio, HR, 5.24, 95% CI 2.99-9.21, P