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Febrile neutropenia (FN) is a common consequence of intensive chemotherapy in hematological patients. More than 90% of the patients with acute myeloid leukemia (AML) develop FN, and 5%–10% of them die from subsequent sepsis. FN is very common also in autologous stem cell transplant recipients, but the risk of death is lower than in AML patients. In this review, we discuss biomarkers that have been evaluated for diagnostic and prognostic purposes in hematological patients with FN. In general, novel biomarkers have provided little benefit over traditional inflammatory biomarkers, such as C‐reactive protein and procalcitonin. The utility of most biomarkers in hematological patients with FN has been evaluated in only a few small studies. Although some of them appear promising, much more data is needed before they can be implemented in the clinical evaluation of FN patients. Currently, close patient follow‐up is key to detect complicated course of FN and the need for further interventions such as intensive care unit admission. Scoring systems such as q‐SOFA (Quick Sequential Organ Failure Assessment) or NEWS (National Early Warning Sign) combined with traditional and/or novel biomarkers may provide added value in the clinical evaluation of FN patients. [ABSTRACT FROM AUTHOR]

The article discusses the challenges in diagnosing sepsis and the need for biomarkers that can be used in the emergency department (ED) to rapidly identify high-risk patients. A study conducted in German tertiary hospitals tested the performance of various biomarkers, with procalcitonin performing the best in identifying patients with sepsis. However, the accuracy of procalcitonin was still moderate, and other promising biomarkers were not tested in this study. The study suggests that while procalcitonin testing can be used in selected patients with suspected sepsis, it should not override clinical judgment. The study provides preliminary data for future trials examining the impact of biomarkers on clinical management and patient outcomes. [Extracted from the article]

Background: A new strain of coronavirus responsible for pneumonia of unknown origin was detected in early January 2020, named as 2019-novel coronavirus. Even though COVID-19 has affected all regions of the world, there are great variations in the prevalence of the disease and mortality rates in different countries, the reasons for which are poorly understood. In this study, we analysed the clinical manifestation, laboratory profile and final outcome in COVID-19 patients in our Medical College & Hospital providing tertiary care with the purpose of adding information to the already existing data. Material and Methods: Inclusion Criteria: All positive and confirmed cases of COVID-19 disease, admitted in COVID wards, HDU, ICU of our Medical College & Hospital, irrespective of age & gender. Results: Majority of study subjects (61%) were above 40 years of age. The commonest presenting complaint was cough with less than one-fifth having fever. Sputum was present in 27% of cases and more common in live subjects. Breathlessness was present in 56% of cases and more common in expired subjects. Oxygen support was required in 59% of cases. Treatment with Remdesivir was needed in more than 80% of non-survivors of Covid-19 disease while less than 30% survivors needed Remdesivir therapy. Plasma treatment therapy was given in 6% and Mechanical ventilation in 34% of cases. Conclusion: Majority of the patients were asymptomatic but potential spreaders of the disease. Fever, cough, and breathlessness were the major presenting symptoms. Advanced age, high TLC with high N/L ratio, high CRP level, high serum ferritin level, high D-dimer value and low vitamin D levels correlated positively with severity of disease responsible for high mortality rate. [ABSTRACT FROM AUTHOR]

Introduction: Sepsis is a life-threatening condition with a very narrow golden period in which confirmatory diagnosis may change the outcome dramatically. No confirmatory biomarker is available till date for early diagnosis of sepsis. This study aimed to evaluate the combined and independent role of quick sequential organ failure assessment (qSOFA) score, lactate, and neutrophil–lymphocyte ratio (NLR) in diagnosis and mortality prediction in early sepsis. Methods: This was a hospital-based, single-center, prospective cohort study conducted in a tertiary care institute, Karnataka, India. Three hundred adult sepsis patients were recruited during 10-month period, and demographic data, qSOFA score, lactate, NLR, and culture samples were collected in ED within 1 h of admission. Outcome groups (survivor and nonsurvivor) were statistically analyzed with relative frequencies (%), median, mean ± standard deviation with 95% confidence interval (CI), univariate, bivariate, and multivariate logistic regression analysis, and Receiver -operating characteristic curve (ROC) curve to test the predictive ability of initial levels of three biomarkers. Results: Sepsis was more prevalent among middle-aged male patients. Male gender (odds ratio [OR], 6.9; 95% CI: 1.61–30.1), qSOFA (OR, 154; 95% CI: 15–1565), and lactate (OR, 1.36; 95% CI: 22–833) show 97% (area under the curve) predictive accuracy of the model for sepsis on bivariate and multivariate logistic regression analysis. A significant rise in NLR was a poor outcome indicator on univariate analysis (P = 0.773). Conclusion: All three biomarkers are good outcome predictors whereas qSOFA and lactate have diagnostic significance in early sepsis. These markers can be used for patient triaging, minimizing culture report dependence for treatment and ultimately the outcome. [ABSTRACT FROM AUTHOR]

The concept of the quick sequential organ failure assessment (qSOFA) simplifies sepsis detection, and the next SOFA should be analyzed subsequently to diagnose sepsis. However, it does not include the concept of suspected infection. Thus, we simply developed a biomarker-based assessment model for detecting sepsis (BADS). We retrospectively reviewed the electronic health records of patients admitted to the intensive care unit (ICU) of a 2000-bed university tertiary referral hospital in South Korea. A total of 989 patients were enrolled, with 77.4% (n = 765) of them having sepsis. The patients were divided into a ratio of 8:2 and assigned to a training and a validation set. We used logistic regression analysis and the Hosmer–Lemeshow test to derive the BADS and assess the model. BADS was developed by analyzing the variables and then assigning weights to the selected variables: mean arterial pressure, shock index, lactate, and procalcitonin. The area under the curve was 0.754, 0.615, 0.763, and 0.668 for BADS, qSOFA, SOFA, and acute physiology and chronic health evaluation (APACHE) II, respectively, showing that BADS is not inferior in sepsis prediction compared with SOFA. BADS could be a simple scoring method to detect sepsis in critically ill patients quickly at the bedside. [ABSTRACT FROM AUTHOR]

Purpose: Myriad operative factors and characteristics of patients may influence the risk of infection in a patient undergoing stone surgery. We prospectively determined the risk factors for systemic inflammatory response syndrome (SIRS) and quick sequential organ failure assessment (qSOFA) in patients undergoing percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS). Materials and Methods: Patients who underwent PCNL and RIRS from March 2018 to January 2020 satisfying our selection criteria were enrolled. Samples of urine from the renal pelvis, bladder, and retrieved stones were sent for culture testing. Postoperatively patients were keenly supervised for any indications of SIRS and qSOFA. The association between stone and urine cultures across various sites was examined. Regression analysis was performed to ascertain clinical variables affiliated with SIRS and qSOFA. Results: The study included a total of 150 patients including both PCNL and RIRS, of which 23% post-PCNL and 20% post-RIRS met the criteria of SIRS and qSOFA. On univariate analysis in PCNL-Dilated pelvicalyceal system (PCS), renal pelvic urine culture (RPUC), stone culture (SC), and operative time >124 min among others were identified as risk factors whereas, in RIRS-residual calculus, RPUC, SC and operative time >62 min were risk factors. Multivariate analysis identified dilated PCS and SC for PCNL and only intraoperative RPUC for RIRS as independent risk factors. Only a significantly strong correlation among culture analysis was found between RPUC and SC in both the procedures. Conclusion: Intraoperative RPUC and SCs are better predictors of post-PCNL SIRS while Intraoperative RPUC and duration of surgery are better predictors of post-RIRS sepsis. We, therefore, recommend that both these cultures must routinely be obtained in the above procedures to identify the offending organisms and amend antibiotic therapy during treatment and surgical duration should be kept <62 min in RIRS. SIRS serves as a sensitive review tool which is specifically useful for initial care and on the contrary qSOFA is well suited for patients at greater risk of demise, thereby guiding clinicians to decide future care and course of treatment of patients. [ABSTRACT FROM AUTHOR]

Objective: Several scoring systems have been proposed for EDs to identify patients at increased risk of mortality from sepsis. The modified Sequential Organ Failure Assessment (mSOFA) score, proposed in 2019, demonstrated a high negative predictive value. We aimed to validate mSOFA and compare its accuracy for predicting 30‐day mortality to the simple bedside score, quick SOFA (qSOFA). Methods: Over 1 month in 2018, consecutive patients with suspected sepsis were prospectively identified. A retrospective chart review was conducted to calculate both the mSOFA and qSOFA scores for these patients. The primary outcome was 30‐day mortality. Results: There were 252 patients with suspected sepsis identified over the study period. Thirty‐day mortality was 13/39 (33.3%) for those with a positive mSOFA and 15/211 (7.1%) for those with a negative mSOFA score. Sensitivity was 46.4% (95% confidence interval [CI] 27.5–66.1%), specificity 88.3% (95% CI 83.3–92.2%), positive likelihood ratio 3.96 (95% CI 2.32–6.78), negative likelihood ratio 0.61 (95% CI 0.43–0.86). The area under the curve (AUC) was 0.74 (95% CI 0.64–0.85). qSOFA sensitivity was 39.3% (95% CI 21.5–59.4%), specificity 91.9% (95% CI 87.5–95.1%), positive likelihood ratio 4.85 (95% CI 2.56–9.18) and negative likelihood ratio 0.66 (95% CI 0.49–0.89). The AUC for qSOFA was 0.81 (95% CI 0.73–0.88). The difference in the AUC was −0.07 (95% CI −0.18 to 0.05), P = 0.25. Conclusions: In the present study, neither mSOFA nor qSOFA was adequately sensitive for predicting 30‐day mortality, although both scores were highly specific and their overall accuracy was similar. The added complexity of the mSOFA without a significant increase in discriminative ability makes it unlikely to replace qSOFA in the ED setting. [ABSTRACT FROM AUTHOR]

Objective: To investigate the relationship between the quick Sequential Organ Failure Assessment (qSOFA) score, blood lactate (Lac) and red blood cell distribution width (RDW) and the severity of illness of acute upper gastrointestinal bleeding (AUGIB) and their efficacy in predicting patient prognosis. Methods: 230 patients with AUGIB who were admitted to our hospital from June 2017 to June 2022 were selected as the research objects. They were divided into low risk group with 44 cases, medium risk group with 140 cases, high risk group with 36 cases, and extremely high risk group with 10 cases according to the severity of the disease. They were also divided into death group (n=31) and survival group (n=199) according to their survival within 28 days after admission. The clinical data of patients with AUGIB were collected, the blood Lac and RDW levels were detected, and the qSOFA score was calculated. Multivariate Logistic regression was used to analyze the influencing factors of poor prognosis of patients with AUGIB, and the predictive value of qSOFA score and blood Lac, RDW on poor prognosis of patients with AUGIB was analyzed by receiver operating characteristic (ROC) curve. Resultds: The qSOFA score, blood Lac and RDW levels in the low risk group, medium risk group, high risk group and extremely high risk group increased in turn (P<0.05). The mortality of 230 patients with AUGIB within 28 days after admission was 13.48%(31/230). Multivariate Logistic regression analysis showed that increased of age, GBS score greater than or equal to 6 scores, shock index, qSOFA score, blood urea nitrogen, blood Lac and RDW levels were independent risk factors for poor prognosis of patients with AUGIB (P<0.05). ROC curve analysis showed that the area under curve of qSOFA score, blood Lac and RDW combined to predict poor prognosis of patients with AUGIB was larger than that of qSOFA score, blood Lac and RDW alone. The increased of qSOFA score, blood Lac and RDW levels in patients with AUGIB is closely related to the aggravation of the disease and poor prognosis. Conclusion: The combination of qSOFA score, blood Lac and RDW has a higher efficacy in predicting the poor prognosis of patients with AUGIB. [ABSTRACT FROM AUTHOR]

Background: Sepsis is a major cause of death in hospitalised patients worldwide. Most studies for assessing outcomes in sepsis are from the western literature. Sparse data from Indian settings are available comparing the systemic inflammatory response syndrome (SIRS), Sequential Organ Failure Assessment (SOFA) and quick SOFA (qSOFA) (sepsis 3 criteria) for assessing outcomes in sepsis. In this study, we aimed to compare the SIRS criteria and sepsis 3 criteria to assess disease outcome at day 28 (recovery/mortality) in a North Indian tertiary care teaching hospital. Methods: A prospective observational study was performed in the Department of Medicine from 2019 to early 2020. Patients admitted to the medical emergency with clinical suspicion of sepsis were included. Systemic inflammatory response syndrome, qSOFA and SOFA scores were calculated at the time of presentation to the hospital. Patients were followed through the course of their hospital stay. Results: Out of 149 patients, 139 were included in the analysis. Patients who died had significantly higher mean SOFA, qSOFA scores and mean change in SOFA score than patients who survived (P value <0.01). There was no statistical difference between recovery and deaths at similar SIRS scores. A 40.30% fatality rate was recorded. Systemic inflammatory response syndrome had low Area Under Curve (AUC) (0.47) with low sensitivity (76.8) and specificity (21.7). SOFA had the maximum AUC (0.68) compared to qSOFA (0.63) and SIRS (0.47). SOFA also had the maximum sensitivity (98.1) while the qSOFA score had the maximum specificity (84.3). Conclusion: SOFA and qSOFA scores had superior predictive ability as compared to the SIRS score in assessing mortality in sepsis patients [ABSTRACT FROM AUTHOR]

Background: Bacterial sepsis is associated with significant morbidity and mortality. However, to date, there is no single test that predicts sepsis with reproducible results. We proposed that using a combination of clinical and laboratory parameters and a novel biomarker, plasma neutrophil gelatinase-associated lipocalin (NGAL) may aid in early diagnosis. Method: A prospective cohort study was conducted at a tertiary care center in South India (June 2017 to April 2018) on patients with acute febrile episodes fulfilling the Systemic Inflammatory Response Syndrome (SIRS) criteria. Plasma NGAL and standard clinical and laboratory parameters were collected at the admission. Bacterial sepsis was diagnosed based on blood culture positivity or clinical diagnosis. Clinically relevant plasma NGAL cut-off values were identified using the receive operating characteristic (ROC) curve. Clinically relevant clinical parameters along with plasma NGAL's risk ratios estimated from the multivariable Poisson regression model were rounded and used as weights to create a new scoring tool. Results: Of 100 patients enrolled, 37 had bacterial sepsis. The optimal plasma NGAL cut-off value to predict sepsis was 570 ng/mL [area under the curve (AUC): 0.69]. The NGAL sepsis screening tool consists of the following clinical parameter: diabetes mellitus, the presence of rigors, quick sequential organ failure assessment (qSOFA) >2, a clear focus of infection, and the plasma NGAL >570 ng/mL. A score of <3 ruled out bacterial sepsis and a score >7 were highly suggestive of bacterial sepsis with an interval likelihood ratio (LR) of 7.77. Conclusion: The NGAL sepsis screening tool with a score >7 can be used in the emergency department (ED) to identify bacterial sepsis. [ABSTRACT FROM AUTHOR]

Introduction: Sepsis is the leading cause of mortality, and various scoring systems have been developed for its early identification and treatment. The objective was to test the ability of quick sequential organ failure assessment (qSOFA) score to identify sepsis and predict sepsis-related mortality in the emergency department (ED). Methods: We conducted a prospective study from July 2018 to April 2020. Consecutive patients with age ≥18 years who presented to the ED with a clinical suspicion of infection were included. Sensitivity, specificity, positive predictive value (PPV), negative predictive values (NPV), and odds ratio (OR) for sepsis related mortality on day 7 and 28 were measured. Results: A total of 1200 patients were recruited; of which 48 patients were excluded and 17 patients were lost to follow-up. 54 (45.4%) of 119 patients with positive qSOFA (qSOFA >2) died at 7 days and 76 (63.9%) died at 28 days. A total of 103 (10.1%) of 1016 patients with negative qSOFA (qSOFA score <2) died at 7 days and 207 (20.4%) died at 28 days. Patients with positive qSOFA score were at higher odds of dying at 7 days (OR: 3.9, 95% confidence interval [CI]: 3.1–5.2, P < 0.001) and 28 days (OR: 6.9, 95% CI: 4.6–10.3, P < 0.001). The PPV and NPV with positive qSOFA score to predict 7- and 28-day mortality were 45.4%, 89.9% and 63.9%, 79.6%, respectively. Conclusion: The qSOFA score can be used as a risk stratification tool in a resource-limited setting to identify infected patients at an increased risk of death. [ABSTRACT FROM AUTHOR]

Background: High in-hospital mortality in sepsis patients remains challenging for clinicians worldwide. Early recognition, prognostication, and aggressive management are essential for treating septic patients. Many scores have been formulated to guide clinicians to predict the early deterioration of such patients. Our objective was to compare predictive values of quick Sequential Organ Failure Assessment (qSOFA) and National Early Warning Score 2 (NEWS2) with respect to in-hospital mortality. Methods: This prospective observational study was conducted in a tertiary care center in India. Adults with suspected infection with at least two Systemic Inflammatory Response Syndrome criteria presenting to the emergency department (ED) were enrolled. NEWS2 and qSOFA scores were calculated, and patients were followed until their primary outcome of mortality or hospital discharge. The diagnostic accuracy of qSOFA and NEWS2 for predicting mortality was analyzed. Results: Three hundred and seventy-three patients were enrolled. Overall mortality was 35.12%. A majority of patients had LOS between 2 and 6 days (43.70%). NEWS2 had higher area under curve at 0.781 (95% confidence interval [CI] (0.59, 0.97)) than qSOFA at 0.729 (95% CI [0.51, 0.94]), with P < 0.001. Sensitivity, specificity, and diagnostic efficiency to predict mortality by NEWS2 were 83.21% (95% CI [83.17%, 83.24%]); 57.44% (95% CI [57.39%, 57.49%]); and 66.48% (95% CI [66.43%, 66.53%]), respectively. qSOFA score had sensitivity, specificity, and diagnostic efficiency to predict mortality of 77.10% (95% CI [77.06%, 77.14%]); 42.98% (95% CI [42.92%, 43.03%]); and 54.95% (95% CI [54.90%, 55.00%]), respectively. Conclusion: NEWS2 is superior to qSOFA in predicting in-hospital mortality for sepsis patients presenting to the ED in India. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study is to determine whether the addition of decade and gender to quick Sequential Organ Failure Assessment (qSOFA) is superior to qSOFA alone in predicting the mortality of sepsis patients presented to our emergency department. Methods: We included 300 sepsis patients in our study. The gender with higher mortality received 1 more point. We added the qSOFA score and decade to this value and compared qSOFA and the new scoring system to predict mortality. Furthermore, we determined a cutoff value for age to systolic blood pressure to predict mortality. Results: Forty-six percentages of our patients were female, and 54% were male. Patients in their 80s (34%) and 90s (26%) comprised the majority of the study group. Mortality rates were higher in males when compared with females. Mortality rate was positively related with age and systolic blood pressure. The cutoff value for age and systolic blood pressure was 0.71 (AUC: 0.799, CI: 0.750-0.848, p=0.00). Patients were at higher risk for mortality if their ratio of age to systolic blood pressure was higher than 0.71 (OR: 2.58). We added a decade and one more point to the qSOFA for the male gender and compared this value with the qSOFA score. The new scoring system (qSOFA+decade+male gender +>0.71) (CI: -2.49--1.67) was superior to qSOFA alone to predict (CI: -1.20--0.80) mortality. Conclusion: Age to systolic blood pressure ratio alone can also predict mortality better than qSOFA. The qSOFAm scoring system may be useful in determining the mortality of sepsis patients. [ABSTRACT FROM AUTHOR]

To determine the prognostic performance of soluble urokinase-type plasminogen activator receptor (suPAR) and quick Sequential Organ Failure Assessment (qSOFA) in predicting the 28-day mortality of sepsis patients admitted to the emergency department (ED). A prospective, single-center observational study was conducted between June 2018 and June 2019. In total, 175 patients with sepsis and septic shock admitted to the ED were enrolled based on the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). We assessed the qSOFA score on ED admission and measured serum suPAR levels by quantitative enzyme-linked immunosorbent assay. Univariate and multivariate analysis was performed to identify predictors of prognosis. Kaplan-Meier survival curves and areas under the receiver operating characteristic (ROC) curve for 28-day mortality were calculated. We estimated category-free net reclassification improvement (NRI) when suPAR was added to qSOFA. Increased suPAR levels were significantly associated with 28-day mortality [1.74 (1.24-2.51) ng/mL in survivors vs. 1.34 (0.96-2.00) ng/mL in non-survivors, p = 0.011] and with sepsis severity [1.34 (0.991.98) ng/mL in sepsis vs. 1.74 (1.22-2.65) ng/mL in septic shock, p = 0.039]. The area under the curve (AUC) for the prediction of 28-day mortality was 0.646 (95% confidence interval (CI): 0.553-0.740) for suPAR, 0.832 (95% CI: 0.692-0.923) for qSOFA and 0.864 (95% CI: 0.802-0.928) for combined suPAR and qSOFA. Serum suPAR did not significantly increase the AUC of the basic qSOFA, but a model containing suPAR and qSOFA had a continuous NRI of 11% (95% CI: 3.5-18.5%; p = 0.004). Serum suPAR was associated with sepsis severity and 28-day mortality. Adding suPAR to qSOFA increased the ROC curve area and improved its discrimination, suggesting that this might be a useful tool in sepsis mortality prediction models. [ABSTRACT FROM AUTHOR]

BACKGROUND: The quick sequential organ failure assessment (qSOFA) is recommended to identify sepsis and predict sepsis mortality. However, some studies have recently shown its poor performance in sepsis mortality prediction. To enhance its effectiveness, researchers have developed various revised versions of the qSOFA by adding other parameters, such as the lactate-enhanced qSOFA (LqSOFA), the procalcitonin-enhanced qSOFA (PqSOFA), and the modified qSOFA (MqSOFA). This study aimed to compare the performance of these versions of the qSOFA in predicting sepsis mortality in the emergency department (ED). METHODS: This retrospective study analyzed data obtained from an electronic register system of adult patients with sepsis between January 1 and December 31, 2019. Receiver operating characteristic (ROC) curve analyses were performed to determine the area under the curve (AUC), with sensitivity, specificity, and positive and negative predictive values calculated for the various scores. RESULTS: Among the 936 enrolled cases, there were 835 survivors and 101 deaths. The AUCs of the LqSOFA, MqSOFA, PqSOFA, and qSOFA were 0.740, 0.731, 0.712, and 0.705, respectively. The sensitivity of the LqSOFA, MqSOFA, PqSOFA, and qSOFA were 64.36%, 51.40%, 71.29%, and 39.60%, respectively. The specificity of the four scores were 70.78%, 80.96%, 61.68%, and 91.62%, respectively. The LqSOFA and MqSOFA were superior to the qSOFA in predicting in-hospital mortality. CONCLUSIONS: Among patients with sepsis in the ED, the performance of the PqSOFA was similar to that of the qSOFA and the values of the LqSOFA and MqSOFA in predicting in-hospital mortality were greater compared to qSOFA. As the added parameter of the MqSOFA was more convenient compared to the LqSOFA, the MqSOFA could be used as a candidate for the revised qSOFA to increase the performance of the early prediction of sepsis mortality. [ABSTRACT FROM AUTHOR]

Background: Sepsis is a disease with a high mortality rate without prompt treatment. However, this entity is difficult to diagnose in the elderly population in the emergency room; for this reason, it is necessary to have diagnostic tools for early detection. Objective: The aim of the study was to determine the highest diagnostic yield of procalcitonin (PCT), Quick Sequential Organ Failure Assessment (qSOFA), and Sequential Organ Failure Assessment (SOFA) for sepsis (based on the sepsis-3 consensus), on admission at the emergency department, in those older than 65 years. Methods: This is a diagnostic test study of a historical cohort of 65-year-old patients with suspected sepsis. Results: In the sample of 179 patients, 53.6% had confirmed sepsis. Significant differences were found (p < 0.0001), with a greater diagnostic and predictive capacity of PCT for the diagnosis of sepsis (receiver operating characteristics curve area [area under the curve (AUC) = 0.883, 95% CI: 0.835–0.931] than qSOFA (AUC = 0.559, 95% CI: 0.485–0.663) and SOFA (AUC = 0.662, 95% CI: 0.584–0.739); these results were similar in the cohort of patients ≥75 years. In positive PCT(≥0.5 ng/mL), the sensitivity was 71.8% (95% CI: 62.36–81.39), specificity of 89.1% (95% CI: 81.87–96.45%), V+ 88.4% (95% CI: 80.73–96.19%), V− of 73.2% (95% CI: 64.14–82.39%), positive likelihood ratio of 6.63 (95% CI: 3.53–12.44), and negative likelihood ratio of 0.32 (95% CI: 0.23–0.44); these results were similar in the cohort of patients ≥75 years. Lactate ≥2 mmol/L (RR = 1.659 [95% CI: 1.002–2.747]) and PCT ≥0.5 ng/mL (RR = 1.942 [95% CI: 1.157–3.261]) showed a significant association with in-hospital mortality. Conclusion: In the elderly population with suspicion of infection on admission to the emergency department, qSOFA presents a low diagnostic performance of confirmed sepsis and in-hospital mortality, for which other tools with higher diagnostic and prognostic performance should be added, such as PCT and lactate. [ABSTRACT FROM AUTHOR]

Objective: Researchers have been investigating numerous biomarkers and scoring systems to predict the prognosis of coronavirus disease 2019 (COVID-19). We aimed to determine the effectiveness of the quick sequential organ failure assessment (qSOFA) scoring system in pre-hospital emergency health care for predicting COVID-19 prognosis in terms of the intensive care unit (ICU) admission and mortality. Materials and Methods: We enrolled 9850 patients suspected to have COVID-19 who were transferred by 112 emergency medical services (EMS) between April 1, 2020 and July 1, 2020. Demographic and clinical data of the patients were obtained from the Ankara Emergency Health Services Automation System. The qSOFA score was calculated based on the data obtained from the ambulance medical records. Results: The 28-day mortality rate was 6.2% (n=13) and the cut-off for the qSOFA score was >1 [area under the curve (AUC)=0.955, sensitivity 84.62%, specificity 90.4%, p<0.001, 95% confidence interval (CI): 0.918-0.979)]. The cut-off for ICU admission was a qSOFA score >1 (AUC=0.942; sensitivity 97.37%; specificity 84.97%; p<0.001; 95% CI, 0.901-0.969). The mortality risk was 51.8 times more in patients with a high qSOFA score (p<0.001; 95% CI, 10.682-251.340). Moreover, patients with a high qSOFA score were 47.7 times more likely to require ICU admission (p<0.001; 95% CI, 16.735-136.039). Conclusion: Thus, the pre-hospital qSOFA score that comprises the ambulance vital signs of the patients can be used to predict ICU admissions and mortality in patients with COVID-19. [ABSTRACT FROM AUTHOR]

Background & objectives: Early diagnosis and prompt treatment remain a challenge in sepsis. To study the role of quick Sequential Organ Failure Assessment (qSOFA), blood lactate levels and a new score Lactate - Enhanced-qSOFA 2 (LqSOFA2) in predicting outcome in patients with sepsis and their association with established severity scores. Methods: This was a prospective, observational study in patients admitted to ICU of a tertiary care hospital in north India. qSOFA, Acute Physiology and Chronic Health Evaluation II (APACHE II), SOFA score and LqSOFA2 were calculated in 150 patients with sepsis. Measurements of lactate and SOFA score was done on days one, three and seven. Results: The mean arterial pressure (MAP) was significantly higher in survivors (70.14±19.54 vs. 48.53±26.86). The mean qSOFA significantly predicted mortality (1.81 vs. 2.63; P<0.0001). The mean lactate on days one, three and seven in survivors were 2.27±0.91, 1.72±0.77 and 1.14±0.48, respectively, while it was 4.32±2.35, 3.57±2.28 and 2.13±1.22, respectively, in the non-survivor group (P<0.001). The new score LqSOFA2 also significantly predicted mortality between non survivors and survivors (3.52±0.71 vs. 2.37±0.91). There was a significant correlation of qSOFA with SOFA and APACHE II on day one. Lactate levels and SOFA correlated on all three days. Interpretation & conclusions: qSOFA, a novel score and lactate can independently predict mortality in patients with sepsis. They correlate with APACHE II and SOFA but fail to equilibrate with either. The combination score LqSOFA2 showed marginal (statistically insignificant) increase in predictive accuracy and specificity when compared to lactate or qSOFA alone. Early diagnosis by LqSOFA2 makes it a good standalone bedside prognostic marker. [ABSTRACT FROM AUTHOR]

Background: In March 2020, Saudi Arabia (KSA) experienced a Coronavirus disease 2019 (COVID-19) outbreak. The mitigation strategy aimed to reduce both the impact on vulnerable groups and the risk of admission to the intensive care unit (ICU). Risk factors, such as sequential organ failure, comorbidities, ventilation, and mortality, have not been described in different settings of care. Materials and Methods: A multicenter, retrospective chart review of 220 adults with COVID-19 admitted to the ICU included demographics and ICU admission factors (e.g., quick sequential organ failure assessment (qSOFA) score, ventilator status, comorbidities, days from laboratory confirmation to ICU admission, and days from hospitalization to ICU admission). Regression was utilized to identify predictors of need for mechanical ventilation (MV) and mortality in ICU patients. Results: ICU admission, COVID-19 hospital mortality, and ventilator-associated mortality rates were 26.5%, 44%, and 30.5%, respectively. The mean patients' age was 30 years. Across four cities, Jeddah patients were at the highest risk of MV (<0.001). Within the 1st day of hospitalization, without lymphocytopenia, non-Saudi patients with a qSOFA score of 2 and 3 were at the highest risk of ventilation (odds ratio [OR], 3.9; 95% confidence interval [CI], 1.72-8.66; OR, 11.4; 95% CI, 2.35-55.47; and OR, 6.1; 95% CI, 1.0-37.33, respectively). Moreover, within the same period of hospital stay, mechanically-ventilated patients with a qSOFA score of 3 who received antiviral medications were significantly at the higher risk of death (OR, 2.8.4; 95% CI, 1.44-5.64; OR, 13.1; 95% CI, 1.23-39.68; and OR, 2.2; 95% CI, 1.14-4.14, respectively). Conclusions: The 1st day of hospitalization, along with an assessment of the dyspnea status using the qSOFA score, is the window of opportunity for minimizing ICU admission risk. Neither lymphocytopenia nor comorbidities are associated with the risk of mechanical ventilation. Factors were also discussed. Reviews are needed on the indications for the use of antiviral agents, intubation, and ventilation in hospitalized patients. [ABSTRACT FROM AUTHOR]

Background: In March 2020, Saudi Arabia (KSA) experienced a coronavirus disease 2019 (COVID-19) outbreak. The mitigation strategy aimed to reduce both the impact on vulnerable groups and the risk of admission to the intensive care unit (ICU). Risk factors, such as sequential organ failure, comorbidities, ventilation, and mortality, have not been described in different settings of care. Materials and Methods: A multicenter, retrospective chart review of 220 adults with COVID-19 admitted to the ICU included demographics and ICU admission factors (e.g., quick sequential organ failure assessment (qSOFA) score, ventilator status, comorbidities, days from laboratory confirmation to ICU admission, and days from hospitalization to ICU admission). Regression was utilized to identify predictors of need for mechanical ventilation (MV) and mortality in ICU patients. Results: ICU admission, COVID-19 hospital mortality, and ventilator-associated mortality rates were 26.5%, 44%, and 30.5%, respectively. The mean patients' age was 30 years. Across four cities, Jeddah patients were at the highest risk of MV (<0.001). Within the 1st day of hospitalization, without lymphocytopenia, non-Saudi patients with a qSOFA score of 2 and 3 were at the highest risk of ventilation (odds ratio [OR], 3.9; 95% confidence interval [CI], 1.72-8.66; OR, 11.4; 95% CI, 2.35-55.47; and OR, 6.1; 95% CI, 1.0-37.33, respectively). Moreover, within the same period of hospital stay, mechanically-ventilated patients with a qSOFA score of 3 who received antiviral medications were significantly at the higher risk of death (OR, 2.8.4; 95% CI, 1.44-5.64; OR, 13.1; 95% CI, 1.23-39.68; and OR, 2.2; 95% CI, 1.14-4.14, respectively). Conclusions: The 1st day of hospitalization, along with an assessment of the dyspnea status using the qSOFA score, is the window of opportunity for minimizing ICU admission risk. Neither lymphocytopenia nor comorbidities are associated with the risk of mechanical ventilation. Factors were also discussed. Reviews are needed on the indications for the use of antiviral agents, intubation, and ventilation in hospitalized patients. [ABSTRACT FROM AUTHOR]

Objectives: Biliary tract infection (BTI) is a common cause of bacteremia and is associated with high morbidity and mortality. However, studies on screening tools to predict disease severity in BTI patients are lacking. This study aimed to comparatively validate CRB, CRB-65, quick Sequential Organ Failure Assessment (qSOFA), and Systemic Inflammatory Response Syndrome (SIRS) in predicting the clinical outcomes of BTI patients. Methods: This retrospective cohort study included patients with BTI who visited the emergency department of a medical center between February 2018 and March 2020. Baseline patient data were compared to assess the prevalence of intensive care unit (ICU) admission and in-hospital mortality. The effectiveness of CRB, CRB-65, qSOFA, and SIRS scores as indicators of ICU admission and in-hospital mortality was evaluated using the area under the receiver operating characteristic (AUROC) curve. Results: This study included 745 patients, of whom 111 (14.8%) were admitted to the ICU and 20 (2.7%) died in-hospital. AUROC values (95% CI) for predicting ICU admission and in-hospital mortality were as follows: CRB, 0.774 and 0.707 (0.742 - 0.803 and 0.673 - 0.739); CRB - 65, 0.816 and 0.735 (0.786 - 0.843 and 0.0.702 - 0.766); qSOFA, 0.779 and 0.724 (03747 - 0.808 and 0.690 - 0.755); and SIRS, 0.686 and 0.659 (0.651 - 0.719 and 0.623 - 0.693), respectively. Conclusions: CRB-65 can be used as useful screening tools to predict ICU admission in patients with BTI on presentation to the emergency department. [ABSTRACT FROM AUTHOR]

To explore the predictive value of high risk of sepsis score (HRSS) for the mortality risks of septic patients, and compare the difference of the sequential organ failure assessment (SOFA) and quick sequential organ failure assessment（qSOFA). Methods A total of 125 patients with sepsis admitted to our hospital from February 2016 to June 2018 were retrospectively analyzed. Patients were divided into the survival group (86 cases) and death group (39 cases). The HRSS, SOFA and qSOFA scores were recorded in patients. HRSS score includes patient age, respiratory rate, blood oxygen saturation, pulse, systolic pressure, Glasgow Coma Score (GCS), body temperature and skin abnormalities. SOFA score includes oxygenation index, platelet, bilirubin, creatinine, cardiovascular score and GCS score. qSOFA score includes consciousness, respiratory rate and systolic pressure. HRSS, SOFA and qSOFA scores were calculated. Results The systolic blood pressure and oxygenation index were lower in the dead group than those of the living group. Data of patient age, skin abnormalities, bilirubin, creatinine, cardiovascular score and proportion of consciousness disorders were significantly higher in the dead group than those of the living group (P＜0.05). The scores of HRSS, SOFA and qSOFA were significantly higher in the dead group than those of the living group (P＜0.05). The areas under the ROC of HRSS, SOFA and qSOFA were 0.795 (95%CI: 0.714-0.876，P＜0.01)，0.828 (95%CI: 0.756-0.900，P＜0.01) and 0.624 (95%CI: 0.511- 0.736, P＜0.05). When the critical values were 4.5, 9.5 and 2.5, respectively, the Youden index was the largest, which were 0.455, 0.588 and 0.224, respectively. Conclusion The predicting value of HRSS in the risk of death in sepsis patients is similar to that of SOFA, which is better than that of qSOFA. [ABSTRACT FROM AUTHOR]

SEPSIS-3 DEFINITION: Sepsis is defined as life-threatening organ dysfunction due to a dysregulated host response to infection. The clinical criteria of sepsis include organ dysfunction, which is defined as an increase of two points or more on the sequential organ failure assessment (SOFA). For patients with infection, an increase of 2 SOFA points yields an overall mortality rate of 10%. Patients with suspected infection who are likely to have a prolonged intensive care unit (ICU) stay or to have in-hospital mortality can be promptly identified at the bedside with a quick SOFA (qSOFA) score of 2 or higher.Importance: The sepsis-3 criteria have emphasized the value of a change of two or more points on the SOFA, introduced the qSOFA, and removed the systemic inflammatory response syndrome (SIRS) criteria from the sepsis definition.Objective: To externally validate and assess the discriminatory capacities of an increase in the SOFA score by two or more points, the presence of two or more SIRS criteria, or a qSOFA score of 2 or more points for outcomes in 5109 patients, the vast majority of whom were postcardiac surgery patients who were admitted to a Cardiothoracic Surgical ICU in Singapore.Design, Setting, and Participants: A retrospective cohort analysis of 5109 patients with an infection-related primary admission diagnosis in the cardiothoracic intensive care unit (CTICU) at the National University Hospital (NUH) in Singapore from 2010 to 2016.Exposures: The SOFA, qSOFA, and SIRS criteria were applied to the data representing the worst condition within 24 hours of ICU admission.Main Outcomes and Measures: The primary outcome was in-hospital mortality. Discrimination was assessed using the area under the receiver operating characteristic curve (AUROC).Results: In 5109 patients, the average mortality of patients with an increase in the SOFA scores of less than 2 points was 3.5% (n = 64), and it was 6% (n = 199) for those with an increase in the SOFA scores of 2 or more points. The mortality of patients with an increase in the qSOFA scores of less than 2 points was 2.6% (n = 7), and it was 5.3% (n = 256) for those with an increase in the qSOFA scores of 2 or more points. The mortality of patients with an increase in the SIRS criteria of less than 2 points was 3.6% (n = 30), and it was 5.4% (n = 233) for those with an increase in the SIRS criteria of 2 or more points. The AUROC of in-hospital mortality of patients with an increase in the SOFA, qSOFA, and SIRS criteria of 2 or more points was 0.96, 0.95, and 0.95, respectively.Conclusions and Relevance: In adults with suspected infection admitted to the CTICU in NUH, the change in in-hospital mortality between patients with an increase in SOFA scores of less than 2 and those with an increase of 2 or more was 2.5 percentage points. In contrast to other studies, the absolute change in mortality was nearly the same compared to the qSOFA and SIRS criteria, and the qSOFA score had the greatest percentage increase of 104%, compared to 71% for the SOFA score and 50% for the SIRS criteria. Besides, from the perspective of discriminatory capacities, an increase in SOFA scores of 2 or more did not demonstrate significantly greater prognostic accuracy for in-hospital mortality than equivalent increases in qSOFA scores or SIRS criteria. These findings suggest distinctive characteristics of the study population in the CTICU that are different from the general population. [ABSTRACT FROM AUTHOR]

The aim of the present study was to validate the prognostic effectiveness of Sepsis-3 criteria, including sequential organ failure assessment (SOFA) and quick SOFA (qSOFA), with systemic inflammatory response syndrome (SIRS) criteria among patients with urolithiasis associated sepsis that were transferred to intensive care unit (ICU) facilities following surgical interventions. To achieve this, the records of all patients transferred to ICU following surgical interventions with urolithiasis-associated sepsis between January 2010 to July 2017 at Xin Hua Hospital Affiliated to Shanghai Jiao Tong University were retrospectively reviewed. A total of 107 patients were enrolled. The prognostic performances of SOFA, qSOFA and SIRS for predicting in-hospital mortality (sepsis-related mortality during patients' hospitalizations) or prolonged length of ICU stay (>3 days) were compared using the area under the receiver operating characteristic curve (AUROC) and Z statistic values. The results revealed that the overall in-hospital mortality rate was 8.4% and the percentage of in-hospital mortality or prolonged length of ICU stay (>3 days) was 72.0% among the 107 patients. The favorable outcome group exhibited significantly decreased white blood cell counts, and levels of C-reactive protein and procalcitonin and increased systolic blood pressure and mean arterial pressure. The AUROC of qSOFA, SIRS and SOFA were 0.615, 0.625 and 0.860, respectively. SOFA was significantly more effective at predicting adverse outcomes when compared with SIRS and qSOFA criteria. Following adjustments for patient age and comorbidities, the AUROC values of qSOFA, SIRS and SOFA were 0.713, 0.722 and 0.940. In conclusion, the results of the present study indicate that the prognostic performance of SOFA for predicting in-hospital mortality or prolonged ICU stay among patients with urolithiasis-associated sepsis following surgical interventions was significantly improved when compared with qSOFA or SIRS criteria. Based on these results it is recommended that urologists use the SOFA score for patients with urolithiasis-associated sepsis. [ABSTRACT FROM AUTHOR]

Objectives: Suspected infection and sepsis are common conditions seen among older ICU patients. Frailty has prognostic importance among critically ill patients, but its impact on outcomes and resource utilization in older patients with suspected infection is unknown. We sought to evaluate the association between patient frailty (defined as a Clinical Frailty Scale ≥ 5) and outcomes of critically ill patients with suspected infection. We also evaluated the association between frailty and the quick Sequential Organ Failure Assessment score.Design: Analysis of a prospectively collected registry.Setting: Two hospitals within a single tertiary care level hospital system between 2011 and 2016.Patients: We analyzed 1,510 patients 65 years old or older (at the time of ICU admission) and with suspected infection at the time of ICU admission. Of these, 507 (33.6%) were categorized as "frail" (Clinical Frailty Scale ≥ 5).Interventions: None.Measurements and Main Results: The primary outcome was in-hospital mortality. A total of 558 patients (37.0%) died in-hospital. Frailty was associated with increased risk of in-hospital death (adjusted odds ratio, 1.81 [95% CIs, 1.34-2.49]). Frailty was also associated with higher likelihood of discharge to long-term care (adjusted odds ratio, 2.06 [95% CI, 1.50-2.64]) and higher likelihood of readmission within 30 days (adjusted odds ratio, 1.83 [95% CI, 1.38-2.34]). Frail patients had increased ICU resource utilization and total costs. The combination of frailty and quick Sequential Organ Failure Assessment greater than or equal to 2 further increased the risk of death (adjusted odds ratio, 7.54 [95% CI, 5.82-9.90]).Conclusions: The presence of frailty among older ICU patients with suspected infection is associated with increased mortality, discharge to long-term care, hospital readmission, resource utilization, and costs. This work highlights the importance of clinical frailty in risk stratification of older ICU patients with suspected infection. [ABSTRACT FROM AUTHOR]

Objectives: Evaluate the accuracy of the quick Sequential Organ Failure Assessment tool to predict mortality across increasing levels of comorbidity burden.Design: Retrospective observational cohort study.Setting: Twelve acute care hospitals in the Southeastern United States.Patients: A total of 52,187 patients with suspected infection presenting to the Emergency Department between January 2014 and September 2017.Interventions: None.Measurements and Main Results: The primary outcome was hospital mortality. We used electronic health record data to calculate quick Sequential Organ Failure Assessment risk scores from vital signs and laboratory values documented during the first 24 hours. We calculated Charlson Comorbidity Index scores to quantify comorbidity burden. We constructed logistic regression models to evaluate differences in the performance of quick Sequential Organ Failure Assessment greater than or equal to 2 to predict hospital mortality in patients with no documented (Charlson Comorbidity Index = 0), low (Charlson Comorbidity Index = 1-2), moderate (Charlson Comorbidity Index = 3-4), or high (Charlson Comorbidity Index ≥ 5) comorbidity burden. Among the cohort, 2,030 patients died in the hospital (4%). No comorbidities were documented for 5,038 patients (10%), 9,235 patients (18%) had low comorbidity burden, 12,649 patients (24%) had moderate comorbidity burden, and 25,265 patients (48%) had high comorbidity burden. Overall model discrimination for quick Sequential Organ Failure Assessment greater than or equal to 2 was the area under the receiver operating characteristic curve of 0.71 (95% CI, 0.69-0.72). A model including both quick Sequential Organ Failure Assessment and Charlson Comorbidity Index had improved discrimination compared with Charlson Comorbidity Index alone (area under the receiver operating characteristic curve, 0.77; 95% CI, 0.76-0.78 vs area under the curve, 0.61; 95% CI, 0.59-0.62). Discrimination was highest among patients with no documented comorbidities (quick Sequential Organ Failure Assessment area under the receiver operating characteristic curve, 0.84; 95% CI; 0.79-0.89) and lowest among high comorbidity patients (quick Sequential Organ Failure Assessment area under the receiver operating characteristic curve, 0.67; 95% CI, 0.65-0.68). The strength of association between quick Sequential Organ Failure Assessment and mortality ranged from 30.5-fold increased likelihood in patients with no comorbidities to 4.7-fold increased likelihood in patients with high comorbidity.Conclusions: The accuracy of quick Sequential Organ Failure Assessment to predict hospital mortality diminishes with increasing comorbidity burden. Patients with comorbidities may have baseline abnormalities in quick Sequential Organ Failure Assessment variables that reduce predictive accuracy. Additional research is needed to better understand quick Sequential Organ Failure Assessment performance across different comorbid conditions with modification that incorporates the context of changes to baseline variables. [ABSTRACT FROM AUTHOR]

Aim: To clarify the utility of sepsis evaluation using the Quick Sequential Organ Failure Assessment (qSOFA) tool in addition to the Pneumonia Severity Index (PSI); age, dehydration, respiration, orientation and blood pressure (A‐DROP) index; and immunodeficiency, respiration, orientation, age and dehydration (I‐ROAD) scoring systems, and risk factor evaluation of potentially drug‐resistant (PDR) pathogens are suggested in the 2017 guidelines for pneumonia of the Japanese Respiratory Society in nursing‐ and healthcare‐associated pneumonia patients. Methods: We included 289 hospitalized nursing‐ and healthcare‐associated pneumonia patients between April 2016 and March 2017, and investigated the ability of PSI, A‐DROP, I‐ROAD and qSOFA to predict pneumonia‐related mortality. We also evaluated the associations among the risk factors for PDR pathogens, the detection ratio of PDR pathogens and pneumonia‐related mortality. Results: The mortality rate of pneumonia during hospitalization was 6.9% (20/289). The area under the curve for pneumonia‐related mortality predicted using PSI, A‐DROP, I‐ROAD and qSOFA was 0.697 (95% confidence interval [CI] 0.59–0.80), 0.63 (95% CI 0.51–0.76), 0.61 (95% CI 0.52–0.70) and 0.701 (95% CI 0.59–0.81), respectively. In addition, higher areas under the curve were observed for pneumonia‐related mortality predicted according to a combination of PSI and hypoalbuminemia (<2.5 g/dL) (0.75, 95% CI 0.64–0.86), and qSOFA and hypoalbuminemia (0.74, 95% CI 0.62–0.86) than for PSI and qSOFA alone. No significant associations were observed among the risk factors for PDR pathogens, the detection ratios of PDR pathogens and pneumonia‐related mortality. Conclusions: qSOFA and the combination of qSOFA and hypoalbuminemia might be simple and useful evaluation tools for predicting pneumonia‐related mortality in nursing‐ and healthcare‐associated pneumonia patients. Geriatr Gerontol Int 2019; 19: 177–183. [ABSTRACT FROM AUTHOR]

Background and Aim: Scrub typhus (ST) is an acute infectious disease of variable severity caused by Orientia (formerly Rickettsia) tsutsugamushi. The disease can be complicated by organ dysfunctions and the case fatality rate (CFR) is approximately 15%, which further rises with the development of severe complications. We studied the clinical features of the ST and the performance of critical illness scoring systems (CISSs) – Acute Physiology and Chronic Health Evaluation (APACHE) II, sequential organ failure assessment (SOFA), and quick SOFA (qSOFA) in predicting the clinical outcomes in complicated ST (cST) patients admitted to the emergency department. Study Design and Methods: A prospective observational study was done in 50 patients diagnosed to have cST with one or more organ dysfunctions. Clinical features and laboratory parameters were recorded and the patients were followed up until the end of their stay in the hospital. APACHE II, SOFA, and qSOFA scores at admission were calculated and were analyzed in predicting the clinical outcomes. Results: The median SOFA, APACHE II, and qSOFA scores of the cohort were 7 (interquartile range [IQR] = 13–22), 8 (IQR = 5–11), and 2 (IQR = 1–3), respectively. The median duration of in-hospital stay was 9 (IQR 5–11) days and overall CFR was 8%. On bivariate analysis, both SOFA (P = 0.031) and qSOFA (P = 0.001) predicted mortality. However, only SOFA score correlated with the in-hospital stay duration (Pearson's correlation = 0.311, P = 0.028). Conclusion: Among the three CISSs studied, the SOFA score correlated with in-hospital stay duration and mortality, whereas the qSOFA score formed a simple as well as a convenient tool in predicting the mortality in patients of cST with organ dysfunction. [ABSTRACT FROM AUTHOR]

Objective: The Third International Consensus Definitions Task Force (Sepsis-3) recently recommended changes to the definitions of sepsis. The impact of these changes remains unclear. Our objective was to determine the outcomes of patients meeting Sepsis-3 septic shock criteria versus patients meeting the "old" (1991) criteria of septic shock only.Design: Secondary analysis of two clinical trials of early septic shock resuscitation.Setting: Large academic emergency departments in the United States.Patients: Patients with suspected infection, more than or equal to two systemic inflammatory response syndrome criteria, and systolic blood pressure less than 90 mm Hg after fluid resuscitation.Interventions: Patients were further categorized as Sepsis-3 septic shock if they demonstrated hypotension, received vasopressors, and exhibited a lactate greater than 2 mmol/L. We compared in-hospital mortality in patients who met the old definition only with those who met the Sepsis-3 criteria.Measurements and Main Results: Four hundred seventy patients were included in the present analysis. Two hundred (42.5%) met Sepsis-3 criteria, whereas 270 (57.4%) met only the old definition. Patients meeting Sepsis-3 criteria demonstrated higher severity of illness by Sequential Organ Failure Assessment score (9 vs 5; p < 0.001) and mortality (29% vs 14%; p < 0.001). Subgroup analysis of 127 patients meeting only the old definition demonstrated significant mortality benefit following implementation of a quantitative resuscitation protocol (35% vs 10%; p = 0.006).Conclusion: In this analysis, 57% of patients meeting old definition for septic shock did not meet Sepsis-3 criteria. Although Sepsis-3 criteria identified a group of patients with increased organ failure and higher mortality, those patients who met the old criteria and not Sepsis-3 criteria still demonstrated significant organ failure and 14% mortality rate. [ABSTRACT FROM AUTHOR]

The article discusses the application of quick Sequential Organ Failure Assessment (qSOFA) as illness severity indicator and clinical decision support tool in the diagnosis of sepsis. It mentions that sepsis is a life-threatening acute organ dysfunction due to a dysregulated host response to infection. It notes that the sensitivity of qSOFA for critical care intervention (CCI) and mortality is low.

Background: The study aimed to investigate the predictive value of the quick sequential organ failure assessment (qSOFA) for clinical outcomes in emergency patients with community-acquired pneumonia (CAP).Methods: A total of 742 CAP cases from the emergency department (ED) were enrolled in this study. The scoring systems including the qSOFA, SOFA and CURB-65 (confusion, urea, respiratory rate, blood pressure and age) were used to predict the prognostic outcomes of CAP in ICU-admission, acute respiratory distress syndrome (ARDS) and 28-day mortality. According to the area under the curve (AUC) of the receiver operating characteristic (ROC) curves, the accuracies of prediction of the scoring systems were analyzed among CAP patients.Results: The AUC values of the qSOFA, SOFA and CURB-65 scores for ICU-admission among CAP patients were 0.712 (95%CI: 0.678-0.745, P < 0.001), 0.744 (95%CI: 0.711-0.775, P < 0.001) and 0.705 (95%CI: 0.671-0.738, P < 0.001), respectively. For ARDS, the AUC values of the qSOFA, SOFA and CURB-65 scores were 0.730 (95%CI: 0.697-0.762, P < 0.001), 0.724 (95%CI: 0.690-0.756, P < 0.001) and 0.749 (95%CI: 0.716-0.780, P < 0.001), respectively. After 28 days of follow-up, the AUC values of the qSOFA, SOFA and CURB-65 scores for 28-day mortality were 0.602 (95%CI: 0.566-0.638, P < 0.001), 0.587 (95%CI: 0.551-0.623, P < 0.001) and 0.614 (95%CI: 0.577-0.649, P < 0.001) in turn. There were no statistical differences between qSOFA and SOFA scores for predicting ICU-admission (Z = 1.482, P = 0.138), ARDS (Z = 0.321, P = 0.748) and 28-day mortality (Z = 0.573, P = 0.567). Moreover, we found no differences to predict the ICU-admission (Z = 0.370, P = 0.712), ARDS (Z = 0.900, P = 0.368) and 28-day mortality (Z = 0.768, P = 0.442) using qSOFA or CURB-65 scores.Conclusion: qSOFA was not inferior to SOFA or CURB-65 scores in predicting the ICU-admission, ARDS and 28-day mortality of patients presenting in the ED with CAP. [ABSTRACT FROM AUTHOR]