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qSOFA score: Predictive validity in Enterobacteriaceae bloodstream infections.
J Crit Care. 2018 Feb; 43:143-147.JC

Abstract

PURPOSE

To determine whether the quick Sequential Organ Failure Assessment (qSOFA) retains predictive validity in patients with Enterobacteriaceae sepsis that all received appropriate initial antimicrobial therapy.

MATERIALS AND METHODS

Retrospective cohort at Barnes-Jewish Hospital including individuals with Enterobacteriaceae sepsis receiving appropriate initial antimicrobial therapy between 6/2009-12/2013. Outcomes were compared according to qSOFA score and sepsis classification.

RESULTS

We identified 510 patients with Enterobacteriaceae sepsis; 67 (13.1%) died. Mortality was higher in patients with qSOFA scores of 2 or 3 than those with scores of 0 or 1 (13.3% and 42.4% versus 5.1% and 1.8%). In multivariate logistic regression analysis, altered mental status (AMS) alone or qSOFA score≥2 were both predictors of mortality with odds ratios of 8.01 and 5.39, respectively. Regardless of sepsis severity, non-survivors were significantly more likely to have AMS than survivors. Sepsis severity, qSOFA, and AMS had comparable predictive validity for mortality.

CONCLUSIONS

Our results support qSOFA score, AMS, and sepsis severity as acceptable bedside tools for prognostication during initial clinical assessment in patients with sepsis. qSOFA retained its predictive validity in this cohort, suggesting that appropriate initial antimicrobial therapy is not an effect modifier for mortality when using qSOFA for prognostication.

Authors+Show Affiliations

Division of Infectious Diseases, Washington University School of Medicine, 4523 Clayton Avenue, Campus Box 8051, St. Louis, MO 63110, United States. Electronic address: burnham@wustl.edu.Division of Pulmonary and Critical Care Medicine, Washington University School of Medicine, 4523 Clayton Avenue, Campus Box 8052, St. Louis, MO 63110, United States. Electronic address: kollefm@wustl.edu.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28898743

Citation

Burnham, Jason P., and Marin H. Kollef. "QSOFA Score: Predictive Validity in Enterobacteriaceae Bloodstream Infections." Journal of Critical Care, vol. 43, 2018, pp. 143-147.
Burnham JP, Kollef MH. QSOFA score: Predictive validity in Enterobacteriaceae bloodstream infections. J Crit Care. 2018;43:143-147.
Burnham, J. P., & Kollef, M. H. (2018). QSOFA score: Predictive validity in Enterobacteriaceae bloodstream infections. Journal of Critical Care, 43, 143-147. https://doi.org/10.1016/j.jcrc.2017.09.011
Burnham JP, Kollef MH. QSOFA Score: Predictive Validity in Enterobacteriaceae Bloodstream Infections. J Crit Care. 2018;43:143-147. PubMed PMID: 28898743.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - qSOFA score: Predictive validity in Enterobacteriaceae bloodstream infections. AU - Burnham,Jason P, AU - Kollef,Marin H, Y1 - 2017/09/06/ PY - 2017/02/24/received PY - 2017/07/27/revised PY - 2017/09/06/accepted PY - 2017/9/13/pubmed PY - 2018/6/28/medline PY - 2017/9/13/entrez KW - Enterobacteriaceae sepsis KW - Quick SOFA KW - qSOFA SP - 143 EP - 147 JF - Journal of critical care JO - J Crit Care VL - 43 N2 - PURPOSE: To determine whether the quick Sequential Organ Failure Assessment (qSOFA) retains predictive validity in patients with Enterobacteriaceae sepsis that all received appropriate initial antimicrobial therapy. MATERIALS AND METHODS: Retrospective cohort at Barnes-Jewish Hospital including individuals with Enterobacteriaceae sepsis receiving appropriate initial antimicrobial therapy between 6/2009-12/2013. Outcomes were compared according to qSOFA score and sepsis classification. RESULTS: We identified 510 patients with Enterobacteriaceae sepsis; 67 (13.1%) died. Mortality was higher in patients with qSOFA scores of 2 or 3 than those with scores of 0 or 1 (13.3% and 42.4% versus 5.1% and 1.8%). In multivariate logistic regression analysis, altered mental status (AMS) alone or qSOFA score≥2 were both predictors of mortality with odds ratios of 8.01 and 5.39, respectively. Regardless of sepsis severity, non-survivors were significantly more likely to have AMS than survivors. Sepsis severity, qSOFA, and AMS had comparable predictive validity for mortality. CONCLUSIONS: Our results support qSOFA score, AMS, and sepsis severity as acceptable bedside tools for prognostication during initial clinical assessment in patients with sepsis. qSOFA retained its predictive validity in this cohort, suggesting that appropriate initial antimicrobial therapy is not an effect modifier for mortality when using qSOFA for prognostication. SN - 1557-8615 UR - https://www.unboundmedicine.com/medline/citation/28898743/qSOFA_score:_Predictive_validity_in_Enterobacteriaceae_bloodstream_infections_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0883-9441(17)30295-2 DB - PRIME DP - Unbound Medicine ER -