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Simple Summary: Sepsis is a widespread concern in human and veterinary medicine. Over the past several years, numerous strategies have been implemented to try to combat it; however, mortality remains high in all species. The use of dexmedetomidine, an alpha-two agonist drug with sedative and analgesic properties, is gaining popularity as a synergistic treatment strategy in the management of sepsis, thanks to its anti-apoptotic and neuroprotective properties and its ability to preserve hemodynamic function. We therefore hypothesized that a continuous rate infusion of dexmedetomidine in septic patients, undergoing emergency surgery, could decrease the requirement for vasopressors. The results of this study show that an infusion of 1 mcg/kg/h of dexmedetomidine decreases intraoperative vasopressor use and improves 28-day mortality. However, given the small sample size, a larger prospective study should be undertaken to confirm these findings. The purpose of this study was to determine if a continuous rate infusion (CRI) of dexmedetomidine decreases vasopressor requirements in septic dogs undergoing surgery. Vital parameters, sequential organ failure assessment (SOFA) score, vasopressor requirement, and 28-day mortality were recorded. Dogs were randomly divided into two groups: a dexmedetomidine (DEX) (1 mcg/kg/h) group and a control group (NaCl), which received an equivalent CRI of NaCl. Dogs were premedicated with fentanyl 5 mcg/kg IV, induced with propofol, and maintained with sevoflurane and a variable rate fentanyl infusion. DEX or NaCl infusions were started 10 min prior to induction. Fluid-responsive hypotensive patients received repeated Ringer's lactate boluses (2 mL/kg) until stable or they were no longer fluid-responsive. Patients that remained hypotensive following fluid boluses received norepinephrine at a starting dose of 0.05 mcg/kg/min, with increases of 0.05 mcg/kg/min. Rescue adrenaline boluses were administered (0.001 mg/kg) if normotension was not achieved within 30 min of starting norepinephrine. The NaCl group received a significantly higher dose of norepinephrine (0.8, 0.4–2 mcg/kg/min) than the DEX group (0.12, 0–0.86 mcg/kg/min). Mortality was statistically lower in the DEX group (1/10) vs. the NaCl group (5/6). Results of this study suggest that a 1 mcg/kg/h CRI of dexmedetomidine decreases the demand for intraoperative vasopressors and may improve survival in septic dogs. [ABSTRACT FROM AUTHOR]

We compared Systemic Inflammatory Response Syndrome (SIRS), Sequential Organ Failure Assessment (SOFA), Quick Sepsis-related Organ Failure Assessment (qSOFA), and National Early Warning Score (NEWS) for sepsis diagnosis and adverse outcomes prediction. Clinical studies that used SIRS, SOFA, qSOFA, and NEWS for sepsis diagnosis and prognosis assessment were included. Data were extracted, and meta-analysis was performed for outcome measures, including sepsis diagnosis, in-hospital mortality, 7/10/14-day mortality, 28/30-day mortality, and ICU admission. Fifty-seven included studies showed good overall quality. Regarding sepsis prediction, SIRS demonstrated high sensitivity (0.85) but low specificity (0.41), qSOFA showed low sensitivity (0.42) but high specificity (0.98), and NEWS exhibited high sensitivity (0.71) and specificity (0.85). For predicting in-hospital mortality, SOFA demonstrated the highest sensitivity (0.89) and specificity (0.69). In terms of predicting 7/10/14-day mortality, SIRS exhibited high sensitivity (0.87), while qSOFA had high specificity (0.75). For predicting 28/30-day mortality, SOFA showed high sensitivity (0.97) but low specificity (0.14), whereas qSOFA displayed low sensitivity (0.41) but high specificity (0.88). NEWS independently demonstrates good diagnostic capability for sepsis, especially in high-income countries. SOFA emerges as the optimal choice for predicting in-hospital mortality and can be employed as a screening tool for 28/30-day mortality in low-income countries. [ABSTRACT FROM AUTHOR]

Introduction: Sepsis is a clinical condition that seriously threatens the body’s balance and is still a significant cause of death. Therefore, clinical management is aimed at a timely classification and implementation of emergency measures based on systems of scales for detection that helps reduce complications in patients. That is the importance of using SOFA (Sequential Organ Failure Assessment) and qSOFA (quick SOFA) in the different services for hospitalized patients. Objective: To evaluate the usefulness of SOFA and qSOFA scale as a predictor of mortality in patients with sepsis hospitalized in the intensive care unit (ICU) of the Good Hope Clinic from January to December 2015. Materials and methods: Retrospective study of adult patients hospitalized in ICU/NICU with sepsis diagnoses. Epidemiological, clinical, and laboratory data were collected to apply the SOFA and qSOFA scales. We performed a description of the variables studied, an analysis of the variables, and the scoring systems compared in the ROC curve. Results: The main infectious focus was respiratory (41.5%). The patients died was 28.3%. The variables serum creatinine and lactate were statistically significant with OR = 11.67 (95% CI 2.58-52.85, p

The purpose of this study was to determine if a continuous rate infusion (CRI) of dexmedetomidine decreases vasopressor requirements in septic dogs undergoing surgery. Vital parameters, sequential organ failure assessment (SOFA) score, vasopressor requirement, and 28-day mortality were recorded. Dogs were randomly divided into two groups: a dexmedetomidine (DEX) (1 mcg/kg/h) group and a control group (NaCl), which received an equivalent CRI of NaCl. Dogs were premedicated with fentanyl 5 mcg/kg IV, induced with propofol, and maintained with sevoflurane and a variable rate fentanyl infusion. DEX or NaCl infusions were started 10 min prior to induction. Fluid-responsive hypotensive patients received repeated Ringer’s lactate boluses (2 mL/kg) until stable or they were no longer fluid-responsive. Patients that remained hypotensive following fluid boluses received norepinephrine at a starting dose of 0.05 mcg/kg/min, with increases of 0.05 mcg/kg/min. Rescue adrenaline boluses were administered (0.001 mg/kg) if normotension was not achieved within 30 min of starting norepinephrine. The NaCl group received a significantly higher dose of norepinephrine (0.8, 0.4–2 mcg/kg/min) than the DEX group (0.12, 0–0.86 mcg/kg/min). Mortality was statistically lower in the DEX group (1/10) vs. the NaCl group (5/6). Results of this study suggest that a 1 mcg/kg/h CRI of dexmedetomidine decreases the demand for intraoperative vasopressors and may improve survival in septic dogs.

Objective: Sepsis is a syndrome of physiologic, pathologic, and biochemical abnormalities that is induced by infection. Sepsis constitutes 5,2% of total hospital and 0,4% of emergency department admissions, and has high mortality rates (as high as 28%). Materials and Methods: In the application to the emergency department, patients' comorbid disorders and demographic information indicated by patients and their relatives; blood pressure, pulsation, body temperature, respiratory rate, white blood cell count, platelet count, bilirubin level, creatinine level, urine output; and GCS score, SIRS criteria, SOFA and qSOFA scores and culture results were saved to the form prepared for the study. Results: 59% of the patients were male and 41% of them were female. Mean age of the patients was 62,25±16,48 years. According to diagnosis, SIRS criteria and SOFA scores had higher sensitivity rate than qSOFA scores. According to the mortality, SOFA score had highest sensitivity and NPV, qSOFA had highest specificity and PPV. SIRS criteria, SOFA and qSOFA scores and mortality rate were examined, there was a moderate positive relationship (r=0.44) only between SOFA scores and mortality rate. Conclusion: As a result it was concluded that usage of qSOFA scores is more optimal in emergency department for giving fast decision. However it was found that the qSOFA scores have low sensitivity for diagnosis and prediction of the mortality. [ABSTRACT FROM AUTHOR]

Background: Sepsis is often accompanied with acute kidney injury (AKI). The incidence of AKI in patients visiting the emergency department (ED) with sepsis according to the new SOFA criteria is not exactly known, because the definition of sepsis has changed and many definitions of AKI exist. Given the important consequences of early recognition of AKI in sepsis, our aim was to assess the epidemiology of sepsis-associated AKI using different AKI definitions (RIFLE, AKIN, AKIB, delta check, and KDIGO) for the different sepsis classifications (SIRS, qSOFA, and SOFA). Methods: We retrospectively enrolled patients with sepsis in the ED in three hospitals and applied different AKI definitions to determine the incidence of sepsis-associated AKI. In addition, the association between the different AKI definitions and persistent kidney injury, hospital length of stay, and 30-day mortality were evaluated. Results: In total, 2065 patients were included. The incidence of AKI was 17.7–51.1%, depending on sepsis and AKI definition. The highest incidence of AKI was found in qSOFA patients when the AKIN and KDIGO definitions were applied (51.1%). Applying the AKIN and KDIGO definitions in patients with sepsis according to the SOFA criteria, AKI was present in 37.3% of patients, and using the SIRS criteria, AKI was present in 25.4% of patients. Crude 30-day mortality, prolonged length of stay, and persistent kidney injury were comparable for patients diagnosed with AKI, regardless of the definition used. Conclusion: The incidence of AKI in patients with sepsis is highly dependent on how patients with sepsis are categorised and how AKI is defined. When AKI (any definition) was already present at the ED, 30-day mortality was high (22.2%). The diagnosis of AKI in sepsis can be considered as a sign of severe disease and helps to identify patients at high risk of adverse outcome at an early stage. [ABSTRACT FROM AUTHOR]

Pungkava Sricharoen, Chaithawat Chueluecha, Chaiyaporn Yuksen, Chetsadakon Jenpanitpong Department of Emergency Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, ThailandCorrespondence: Chaiyaporn YuksenDepartment of Emergency Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand, Email Chaipool0634@hotmail.comBackground: Sepsis causes high mortality in vulnerable groups such as hematologic malignancy (HM) patients. There are various early warning scores of sepsis, eg, qSOFA, SOFA, and Ramathibodi Early Warning Score (REWS). This study aimed to compare REWS, qSOFA, and SOFA in predicting severe complications in hematologic malignancy patients visiting ED.Methods: The study was conducted as a retrospective cohort study at the ED of Ramathibodi Hospital, Bangkok, Thailand. Adult HM patients suspected of sepsis and have visited ED between March 2016 and December 2019.Results: Among 124 patients in our cohort, 51 (41%) had serious complication in ED and 20 (16%) died within 28 days after admission. The AUROCs of SOFA and qSOFA indicate significantly higher predicting in serious complication in ED than REWS (SOFA, 0.81 [95% CI, 0.73– 0.89], qSOFA, 0.73 [95% CI, 0.65– 0.81], REWS, 0.62 [95% CI, 0.52– 0.72] p=0.004) while the predicting in 28-day mortality is not statistically significantly different (SOFA, 0.73 [95% CI, 0.60– 0.85], qSOFA, 0.69 [95% CI, 0.58– 0.80], REWS, 0.60 [95% CI, 0.44– 0.75] p=0.25).Conclusion: The SOFA score is highest in predicting severe complications among hematologic malignancy patients.Keywords: sepsis, qSOFA, SOFA, early warning score, hematologic malignancy

Introduction: Prediction of 28 days mortality in ICU patients with sepsis enables physicians to pay special attention to concerned patients and may affect their management. Scoring systems are widely used in clinical practice as mortality predictors. But all have their limitation. Different biomarkers also lack enough sensitivity and specificity. We studied the concentrations of suPAR, measured in serum on the first day of suspected sepsis, comparing combined suPAR and qSOFA with suPAR, qSOFA and SOFA (alone) as a predictor of 28 days mortality in ICU patients. Method: This study was conducted in ICU at Zagazig University Hospitals. 131 sepsis patients were included and classified according to 28 days mortality into: survivors (113/86.3%) and non-survivors (18/13.7%). Serum sample for suPAR measurement, and parameters of SOFA were collected upon suspicion of sepsis. Then, SOFA and qSOFA were calculated. Results: The best predictor of 28 days mortality was SOFA at cutoff 9 (AUC) followed by suPAR at cutoff 12.32 ng/ml (AUC 0.918 and 0.770) and (95% CI 0.849-0.988 and 0.634-0.906) respectively with no statistical difference between them. Combining suPAR and SOFA and combining suPAR and qSOFA increased AUC to 0.941 and 0.827 (95% CI 0.892-0.990 and 0.729-0.926) respectively. There was no statistical difference between AUC of combined suPAR and qSOFA and AUC of standard SOFA score. Conclusion: In our model, suPAR had 28 days mortality prognostic ability comparable to SOFA and better than qSOFA. Combining suPAR and qSOFA increased the prognostic ability of qSOFA to be not inferior to that of SOFA. [ABSTRACT FROM AUTHOR]

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SM Osama Bin Abdullah,1 Rune Husås Sørensen,1 Finn Erland Nielsen2,3 1Department of Emergency Medicine, Slagelse Hospital, Slagelse, Denmark; 2Department of Emergency Medicine, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Slagelse, Denmark; 3Copenhagen Center for Translational Research, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Slagelse, DenmarkCorrespondence: SM Osama Bin AbdullahDepartment of Emergency Medicine, Slagelse Hospital, Ingemannsvej 50, Slagelse, DK-4200, DenmarkTel +45 31 61 81 84Email sabdu@regionsjaelland.dkObjective: This study aimed to determine the prognostic accuracy of SOFA in comparison to quick-SOFA (qSOFA) and systemic inflammatory response syndrome (SIRS) in predicting 28-day mortality in the emergency department (ED) patients with infections.Methods: A secondary analysis of data from a prospective study of adult patients with documented or suspected infections admitted to an ED in Denmark from Oct-2017 to Mar-2018. The SOFA scores were calculated after adjustment for chronic diseases. The prognostic accuracy was assessed by analysis of sensitivity, specificity, predictive values, likelihood ratios, and area under the receiver operating characteristic curve (AUROC) with 95% confidence intervals (CI).Results: A total of 2045 patients with a median age of 73.2 (IQR: 60.9– 82.1) years were included. The overall 28-day mortality was 7.7%. In patients meeting a SOFA score ≥ 2, qSOFA score ≥ 2, and SIRS criteria ≥ 2 the 28-day mortality was 13.6% (11.2– 16.3), 17.8% (12.4– 24.3) and 8.3% (6.7– 10.2), respectively. SOFA ≥ 2 had a sensitivity of 61.4% (53.3– 69.0) and specificity of 67.3% (65.1– 69.4), qSOFA ≥ 2 had a sensitivity of 19.6% (13.7– 26.7) and specificity of 92.4% (91.1– 93.6), and SIRS ≥ 2 had a sensitivity of 52.5% (44.4– 60.5) and specificity of 51.5% (49.2– 53.7). The AUROC for SOFA compared to SIRS was: 0.68 vs 0.52; p< 0.001 and compared to qSOFA: 0.68 vs 0.63; p=0.018.Conclusion: A SOFA score of at least two had better prognostic accuracy for 28-day mortality than SIRS and qSOFA. However, the overall accuracy of SOFA was poor for the prediction of 28-day mortality.Keywords: emergency department, infectious disease, SOFA, SIRS, qSOFA, sepsis, mortality, prognostic accuracy

Two years after the outbreak of the COVID-19 pandemic, the disease continues to claim victims worldwide. Assessing the disease's severity on admission may be useful in reducing mortality among patients with COVID-19. The present study was designed to assess the prognostic value of SOFA and qSOFA scoring systems for in-hospital mortality among patients with COVID-19. The study included 133 patients with COVID-19 proven by reverse transcriptase polymerase chain reaction (RT-PCR) admitted to the Municipal Emergency Clinical Hospital of Timisoara, Romania between 1 October 2020 and 15 March 2021. Data on clinical features and laboratory findings on admission were collected from electronic medical records and used to compute SOFA and qSOFA. Mean SOFA and qSOFA values were higher in the non-survivor group compared to survivors (3.5 vs. 1 for SOFA and 2 vs. 1 for qSOFA, respectively). Receiver operating characteristic (ROC) and area under the curve (AUC) analyses were performed to determine the discrimination accuracy, both risk scores being excellent predictors of in-hospital mortality, with ROC–AUC values of 0.800 for SOFA and 0.794 for qSOFA. The regression analysis showed that for every one-point increase in SOFA score, mortality risk increased by 1.82 and for every one-point increase in qSOFA score, mortality risk increased by 5.23. In addition, patients with SOFA and qSOFA above the cut-off values have an increased risk of mortality with ORs of 7.46 and 11.3, respectively. In conclusion, SOFA and qSOFA are excellent predictors of in-hospital mortality among COVID-19 patients. These scores determined at admission could help physicians identify those patients at high risk of severe COVID-19. [ABSTRACT FROM AUTHOR]

Background: Sepsis is defined as a life-threatening organ dysfunction due to an inflammatory immune response triggered by an infection. In 2016, a shortened sequential organ failure assessment score (SOFA score), known as the quick SOFA (qSOFA) score, replaced the systemic inflammatory response syndrome (SIRS) system of diagnosis. Objective: The aim of our work was to investigate the validity of qSOFA in predicting the outcome of patients with sepsis in the emergency department (ED). Methods: This prospective comparative study was conducted on 100 patients from August 2017 to August 2018, with sepsis and evidence of multi-organ failure (MOF) at the time of emergency department presentation, who was admitted to the critical care department, Cairo University, Egypt, to evaluate the qSOFA score for predicting outcome in septic patients. Results: The mean age of all patients was 67.55±13.3 years and the majority (74%) of patients were males. The predominant cause of sepsis was pneumonia (87%). Multiple regression analysis showed that qSOFA at day-0 had an independent effect on increasing organ dysfunction (p<0.05). The overall mortality was 32%. By using receiver operating characteristic (ROC) curve analysis, qSOFA score at day-0 predicted patients' mortality with poor accuracy (sensitivity= 43% and specificity=70%) (p=0.042). SOFA score at day-1 predicted patients' mortality with good accuracy (sensitivity=84% and specificity= 76%) (p<0.01). The Acute Physiology and Chronic Health Evaluation II (APACHE II) score predicted patients' mortality with good accuracy (sensitivity=87% and specificity=72%) (p<0.01). Conclusion: qSOFA at admission is a useful predictor of sepsis and evidence of multi-organ failure in critically ill patients in ED. qSOFA had poor sensitivity and moderate specificity for short-term mortality. [ABSTRACT FROM AUTHOR]

We aimed to decide which scoring system is the best for the evaluation of the course of Crimean-Congo Hemorrhagic Fever (CCHF) by comparing scoring systems such as qSOFA (quick Sequential Organ Failure Assessment), SOFA (Sequential Organ Failure Assessment), APACHE II (Acute Physiology and Chronic Health Evaluation II) and SGS (Severity Grading System) in centers where patients with CCHF were monitored. The study was conducted with patients diagnosed with CCHF in five different centers where the disease was encountered most commonly. Patients having proven PCR and/or IgM positivity for CCHF were included in the study. The scores of the scoring systems on admission, at the 72nd hour and at the 120th hour were calculated and evaluated. The data of 388 patients were obtained from five centers and evaluated. SGS, SOFA and APACHE II were the best scoring systems in predicting mortality on admission. All scoring systems were significant in predicting mortality at the 72nd and 120th hours. On admission, there was a correlation between the qSOFA, SOFA and APACHE II scores and the SGS scores in the group of survivors. All scoring systems had a positive correlation in the same direction. The correlation coefficients were strong for qSOFA and SOFA, but poor for APACHE II. A one-unit rise in SGS increased the probability of death by 12.818 times. qSOFA did not provide significant results in predicting mortality on admission. SGS, SOFA and APACHE II performed best at admission and at the 72nd and 120th hours. [ABSTRACT FROM AUTHOR]

Introduction: Various mortality predictive score models for coronavirus disease-2019 (COVID-19) have been deliberated. We studied how sequential organ failure assessment (SOFA), quick sequential organ failure assessment (qSOFA), acute physiology and chronic health evaluation II (APACHE II), and new early warning signs (NEWS-2) scores estimate mortality in COVID-19 patients. Materials and methods: We conducted a prospective cohort study of 53 patients with moderate-to-severe COVID-19. We calculated qSOFA, SOFA, APACHE II, and NEWS-2 on initial admission and re-evaluated on day 5. We performed logistic regression analysis to differentiate the predictors of qSOFA, SOFA, APACHE II, and NEWS-2 scores on mortality. Result: qSOFA, SOFA, APACHE II, and NEWS-2 scores on day 5 exhibited a difference between survivors and nonsurvivors (p <0.05), also between ICU and non-ICU admission (p <0.05). The initial NEWS-2 revealed a higher AUC value than the qSOFA, APACHE II, and SOFA score in estimating mortality (0.867; 0.83; 0.822; 0.794). In ICU, APACHE II score revealed a higher AUC value than the SOFA, NEWS-2, and qSOFA score (0.853; 0.832; 0.813; 0.809). Concurrently, evaluation on day 5 showed that qSOFA AUC had higher scores than the NEWS-2, APACHE II, and SOFA (0.979; 0.965; 0.939; 0.933) in predicting mortality, while SOFA and APACHE II AUC were higher in ICU admission than NEWS-2 and qSOFA (0.968; 0.964; 0.939; 0.934). According to the cutoff score, APACHE II on day 5 revealed the highest sensitivity and specificity in predicting the mortality (sensitivity 95.7%, specificity 86.7%). Conclusion: All scores signify good predictive values on COVID-19 patients mortality following the evaluation on the day 5. Nonetheless, APACHE-II appears to be the best at predicting mortality and ICU admission rate. [ABSTRACT FROM AUTHOR]

Key summary points: Aim: To study delirium screening upon Emergency Department admission among patients admitted with suspected sepsis. Findings: Delirium screening upon Emergency Department admission, using 4AT, was useful among patients aged ≥65 years admitted with suspected sepsis. Two out of three patients had at least one feature of delirium upon admission. Message: This study suggest increased awareness of delirium among older patients with suspected sepsis. Purpose: We aimed to study the use of The 4 'A's test (4AT), a rapid delirium screening tool, performed upon Emergency Department (ED) admission, and to characterize older patients admitted to the ED with and without sepsis in terms of delirium features. Methods: In this prospective cohort study, we included patients aged ≥ 65 years, admitted to the ED with suspected sepsis. ED nurses and doctors performed delirium screening with 4AT within two hours after ED admission, and registered the time spent on the screening in each case. Sepsis and delirium during the hospital stay were diagnosed retrospectively, according to recommended diagnosis criteria. Results: Out of the 196 patients included (mean age 81 years, 60% men), 100 patients fulfilled the sepsis diagnosis criteria. The mean 4AT screening time was 2.5 Minutes. In total, 114 patients (58%) had a 4AT score ≥ 1, indicating cognitive impairment, upon ED admission. Sepsis patients more often had a 4AT score ≥ 4, indicating delirium, than patients without sepsis (40% vs. 26%, p < 0.05). Out of the 100 patients with sepsis, 68 (68%) had delirium during the hospital stay, as compared to 34 out of 96 patients (35%) without sepsis (p < 0.05). Conclusion: Delirium screening upon ED admission, using 4AT, was feasible among patients aged ≥ 65 years admitted with suspected sepsis. Two out of three patients had at least one feature of delirium upon admission. The prevalence of delirium during the hospital stay was high, particularly in patients with sepsis. [ABSTRACT FROM AUTHOR]

Abstract Background Sepsis is a common critical condition caused by the body’s overwhelming response to certain infective agents. Many biomarkers, including the serum lactate level, have been used for sepsis diagnosis and guiding treatment. Recently, the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) recommended the Sequential Organ Failure Assessment (SOFA) and the quick SOFA (qSOFA) rather than lactate for screening sepsis and assess prognosis. Here, we aim to explore and compare the prognostic accuracy of the lactate level, the SOFA score and the qSOFA score for mortality in septic patients using the public Medical Information Mart for Intensive Care III database (MIMIC III). Methods The baseline characteristics, laboratory test results and outcomes for sepsis patients were retrieved from MIMIC III. Survival was analysed by the Kaplan-Meier method. Univariate and multivariate analysis was performed to identify predictors of prognosis. Receiver operating characteristic curve (ROC) analysis was conducted to compare lactate with SOFA and qSOFA scores. Results A total of 3713 cases were initially identified. The analysis cohort included 1865 patients. The 24-h average lactate levels and the worst scores during the first 24 h of ICU admission were collected. Patients in the higher lactate group had higher mortality than those in the lower lactate group. Lactate was an independent predictor of sepsis prognosis. The AUROC of lactate (AUROC, 0.664 [95% CI, 0.639–0.689]) was significantly higher than that of qSOFA (AUROC, 0.547 [95% CI, 0.521–0.574]), and it was similar to the AUROC of SOFA (AUROC, 0.686 [95% CI, 0.661–0.710]). But the timing of lactate relative to SOFA and qSOFA scores was inconsistent. Conclusion Lactate is an independent prognostic predictor of mortality for patients with sepsis. It has superior discriminative power to qSOFA, and shows discriminative ability similar to that of SOFA.

Abstract Background There is a lack of validated tools to assess potential disease progression and hospitalisation decisions in patients presenting to the emergency department (ED) with a suspected infection. This study aimed to identify suitable blood biomarkers (MR-proADM, PCT, lactate and CRP) or clinical scores (SIRS, SOFA, qSOFA, NEWS and CRB-65) to fulfil this unmet clinical need. Methods An observational derivation patient cohort validated by an independent secondary analysis across nine EDs. Logistic and Cox regression, area under the receiver operating characteristic (AUROC) and Kaplan-Meier curves were used to assess performance. Disease progression was identified using a composite endpoint of 28-day mortality, ICU admission and hospitalisation > 10 days. Results One thousand one hundred seventy-five derivation and 896 validation patients were analysed with respective 28-day mortality rates of 7.1% and 5.0%, and hospitalisation rates of 77.9% and 76.2%. MR-proADM showed greatest accuracy in predicting 28-day mortality and hospitalisation requirement across both cohorts. Patient subgroups with high MR-proADM concentrations (≥ 1.54 nmol/L) and low biomarker (PCT

The alarmingly aggravating incidents of sepsis and septic shock, and associated mortality, morbidity, and annual treatment costs among ICU admissions are an increasing concern. SepINav is a medical informatics endeavor that helps ICU practitioners and researchers to monitor and intervene on the existing sepsis patients more efficiently and interactively and conduct retrospective studies to seek rationales to different sepsis scenarios in the ICU. Moreover, Bayesian Online Changepoint Detection will help the practitioners understand the structural changes in patients’ vital sign regimes that may harbinger prior to septic shock. Besides, several additional features are added to this data-driven software tool to promise efficient monitoring and intervention and address confounding medical interventions in the ICU.

Background: The new definition of Sepsis-3 defines sepsis as life-threatening organ dysfunction, demonstrated by an increase in the Sequential Organ Failure Assessment (SOFA) of 2 or more points, caused by a dysregulated host response to infection. The performance of SOFA score data in a setting of a tertiary public hospital in a middle-income country remains limited. Objective: To determine the accuracy of the SOFA score to predict the 28-day mortality in community-acquired sepsis patients. Materials and Methods: A retrospective study enrolled community-acquired sepsis and septic shock patients admitted between January and December 2015 in Hatyai Hospital, a tertiary public Hospital in Southern Thailand. All variables for calculating the SOFA and qSOFA scores were collected. The primary outcome was the 28-day mortality. Results: Three hundred seventy-nine patients were enrolled. Eighty-seven patients (23%) died. The median (IQR) SOFA score was 6 (3, 9) points. The SOFA score had a fair predictive performance (AUROC 0.71, 95% CI 0.65 to 0.77), which was higher than qSOFA score (AUROC 0.67, 95% CI 0.62 to 0.73). The SOFA score of 2 points associated with mortality (13%) and higher score patients had an incremental increase mortality rate. The hazard ratio (HR) was 4.59 (95% Cl 1.3 to 15.78, p=0.02) for SOFA Score 6 to 7 points. Conclusion: Among patients presenting with community-acquired infection, the SOFA score indicated the fair predicting ability for the 28-day mortality and performed better than qSOFA score. [ABSTRACT FROM AUTHOR]

Background The diagnostic and prognostic utility of various sepsis scores varied among different cohorts and settings. Methods A prospective cohort study in adult patients with sepsis at Siriraj Hospital (Bangkok, Thailand) was conducted during January to July 2019. The performance of sepsis assessments, including systemic inflammatory response syndrome (SIRS) score, sequential organ failure assessment (SOFA) score, quick sepsis-related organ failure assessment (qSOFA) score, modified early warning score (MEWS), and national early warning score (NEWS), for sepsis detection and mortality prediction were compared with agreement between 2 infectious disease (ID) specialists to determine their sepsis and septic shock status as the reference standard. Results Among the 470 subjects included in this study, 206 patients (43.8%) were determined by 2 ID specialists to have sepsis. Systemic inflammatory response syndrome ≥2, qSOFA ≥2, and NEWS ≥5 yielded the highest sensitivity (93.2%), specificity (81.3%), and accuracy (72.6%), respectively, for detecting sepsis. The SIRS ≥2 had the highest sensitivity (97.8%), whereas qSOFA ≥2 had the highest specificity (61%) and accuracy (69.7%) for predicting mortality among sepsis patients. Receiver operating characteristic (ROC) curve showed MEWS to have the highest discriminatory power for sepsis detection (area under the ROC curve [AUROC], 0.79; 95% confidence interval [CI], 0.74–0.83), whereas SOFA had the highest discriminatory power for predicting hospital mortality (AUROC, 0.76; 95% CI, 0.69–0.79). Conclusions The NEWS ≥5 and qSOFA ≥2 were the most accurate scoring systems for sepsis detection and mortality prediction, respectively. Each scoring system is useful for different specific purposes relative to early detection and mortality prediction in sepsis patients. [ABSTRACT FROM AUTHOR]

Aims: There is no gold standard to predict outcome in acute decompensated heart failure (ADHF). Several scores for mortality prediction of patients with ADHF have been developed and mostly consist of complex regression models. None of these models has been widely adopted by clinicians. The quick SOFA score (qSOFA) is a simple score including three parameters (systolic blood pressure ≤ 100 mmHg, respiratory rate ≥22 breathes/min, and GCS

The objective of the study: to define the informative value of qSOFA score in the prediction of sepsis outcomes in the patients admitted to the intensive care wards of medical units in the Russian Federation.Subjects and methods. The multi-center, prospective, and observational trial was conducted. The following data were analyzed in the patients admitted to intensive care wards: number of qSOFA and SOFA scores, the presence of SIRS criteria, levels of lactate, and the outcome of the admission to the intensive care wards. The informative value of different scores and lactate level was analyzed using ROC-analysis.Results. The following areas under ROC-curves were defined for prediction of a lethal outcome in the patients with sepsis: qSOFA – 0.644 (95% CI 0.593–0.693); SOFA – 0.731 (95% CI 0.683–0.776); SIRS – 0.508 (95% CI 0.456–0.560); [qSOFA + lactate ≥ 4 mmol/L] – 0.713 (95% CI 0.646–0.774).Conclusion. To predict a lethal outcome in the patients with sepsis admitted to intensive care wards, qSOFA surpasses SIRS criteria, but it is not as good as SOFA score. The informative value of the prediction model [qSOFA+lactate ≥ 4 mmol/L] surpasses qSOFA score in the prediction of the outcome in sepsis patients, and it is as good as SOFA score.

Abstract Background Community acquired bloodstream infection (CABSI) in low- and middle income countries is associated with a high mortality. This study describes the clinical manifestations, laboratory findings and correlation of SOFA and qSOFA with mortality in patients with CABSI in northern Vietnam. Methods This was a retrospective study of 393 patients with at least one positive blood culture with not more than one bacterium taken within 48 h of hospitalisation. Clinical characteristic and laboratory results from the first 24 h in hospital were collected. SOFA and qSOFA scores were calculated and their validity in this setting was evaluated. Results Among 393 patients with bacterial CABSI, approximately 80% (307/393) of patients had dysfunction of one or more organ on admission to the study hospital with the most common being that of coagulation (57.1% or 226/393). SOFA performed well in prediction of mortality in those patients initially admitted to the critical care unit (AUC 0.858, 95%CI 0.793–0.922) but poor in those admitted to medical wards (AUC 0.667, 95%CI 0.577–0.758). In contrast qSOFA had poor predictive validity in both settings (AUC 0.692, 95%CI 0.605–0.780 and AUC 0.527, 95%CI 0.424–0.630, respectively). The overall case fatality rate was 28%. HIV infection (HR = 3.145, p = 0.001), neutropenia (HR = 2.442, p = 0.002), SOFA score 1-point increment (HR = 1.19, p

Introduction: This study was proposed to compare the ability and accuracy of modified sequential organ failure assessment (mSOFA), quick SOFA (qSOFA), and qSOFA-65 in predicting the status of nontraumatic patients referred to hospital emergency departments (EDs). Materials and methods: This study was a prospective design that performed on the 746 nontraumatic patients referred to the ED. Each patient data was collected using a demographic questionnaire, mSOFA, qSOFA, and qSOFA-65 scales. Related variables of each scale were recorded based on patients' medical records. Then, the outcome of each patient in the ED was followed up and recorded. The severity and specificity of each scale were estimated by the area under receiver operating characteristic (AUROC) curve at 99% confidence interval (CI). Results: The mean and standard deviation of scores were as follows: mSOFA = 4.40 ± 2.58, qSOFA = 0.50 ± 0.70, and qSOFA-65 = 0.92 ± 0.96. Patients requiring admission to the intensive care unit (ICU) were identified with AUROC curve as follows: mSOFA = 0.882 (99% CI = 0.778--0.865); qSOFA = 0.717 (99% CI = 0.662--0.773); and qSOFA-65 = 0.771 (99% CI = 0.721--0.820), which showed that mSOFA has higher sensitivity and specificity than the other two scales in identifying patients requiring admission to the ICU. Conclusion: All three scales were found to be reliable for identifying nontraumatic patients at risk of death and patients requiring admission to the ICU. However, since the time and data required to complete qSOFA and qSOFA-65 are much less than those of mSOFA, it is recommended that qSOFA and especially qSOFA-65 be used in ED to identify critically ill nontraumatic patients. [ABSTRACT FROM AUTHOR]

Background: Routine use of the Sequential Organ Failure Assessment (SOFA) score to prognosticate patients with sepsis is challenged by the requirement to perform numerous laboratory tests. The prognostic accuracy of the quick SOFA (qSOFA) without or with lactate criteria has not been prospectively investigated in low and middle income countries. We assessed the performance of simplified prognosis criteria using qSOFA-lactate criteria in the emergency department of a hospital with limited resources, in comparison with SOFA prognosis criteria and systemic inflammatory response syndrome (SIRS) screening criteria.Methods: This prospective cohort study was conducted between March and December 2017 in adult patients with suspected bacterial infection visiting the emergency department of the Indonesian National Referral Hospital. Variables from sepsis prognosis and screening criteria and venous lactate concentration at enrolment were recorded. Patients were followed up until hospital discharge or death. Prognostic accuracy was measured using area under the receiver operating characteristic curve (AUROC) of each criterion in the prediction of in-hospital mortality.Results: Of 3026 patients screened, 1213 met the inclusion criteria. The AUROC of qSOFA-lactate criteria was 0.74 (95% CI 0.71 to 0.77). The AUROC of qSOFA-lactate was not statistically significantly different to the SOFA score (AUROC 0.75, 95% CI 0.72 to 0.78; p=0.462). The qSOFA-lactate was significantly higher than qSOFA (AUROC 0.70, 95% CI0.67 to 0.74; p=0.006) and SIRS criteria (0.57, 95% CI0.54 to 0.60; p<0.001).Conclusions: The prognostic accuracy of the qSOFA-lactate criteria is as good as the SOFA score in the emergency department of a hospital with limited resources. The performance of the qSOFA criteria is significantly lower than the qSOFA-lactate criteria and SOFA score.This abstract has been translated and adapted from the original English-language content. Translated content is provided on an "as is" basis. Translation accuracy or reliability is not guaranteed or implied. BMJ is not responsible for any errors and omissions arising from translation to the fullest extent permitted by law, BMJ shall not incur any liability, including without limitation, liability for damages, arising from the translated text. [ABSTRACT FROM AUTHOR]

Introduction: The prognostic performance of scoring systems for illness severity in infectious kidney transplant recipients (KTRs) is rarely reported. We investigated the ability of the scores for the quick Sequential Organ Failure Assessment (qSOFA), Sequential Organ Failure Assessment (SOFA) and Systemic Inflammatory Response Syndrome (SIRS) to predict in-hospital mortality, intensive care unit (ICU) admission and mechanical ventilation (MV) requirement.Methods: This was a second analysis of a retrospective observational study. Scores for SIRS, SOFA and qSOFA were calculated upon hospitalization (infection onset was before hospitalization) or on the day of infection onset (infection episodes were during hospitalization). The primary outcome was in-hospital mortality. The secondary outcomes were ICU admission and MV requirement. Binary logistic regression and area under the receiver operating characteristic curve (AUC) were employed to assess prognostic performance.Results: A total of 161 infectious episodes occurred in 97 KTRs. Forty patients (41%) experienced more than one episode. The SOFA score was available in 161 infections, and scores for qSOFA and SIRS were available in 160 infections. The SIRS score was not different between KTRs with opposite outcomes. The qSOFA score was higher in infections necessitating MV. The SOFA score was significantly higher in the deceased, those needing ICU admission, MV, and for those with positive etiology results. The SOFA score was the only independent predictor of in-hospital mortality, ICU admission, and MV requirement, and the AUCs were 0.879, 0.815, and 0.784, respectively. The optimum cutoff value of predicting the three outcomes was SOFA score ≥ 3.Conclusions: The SOFA score (but not those for SIRS and qSOFA) independently predicted in-hospital mortality, ICU admission, and MV requirement in infectious KTRs. [ABSTRACT FROM AUTHOR]

Sepsis has a new definition, and it is defined as dysregulated host response and organ dysfunction due to infection. To clearly define and screen for organ dysfunction, sequential organ failure assessment (SOFA), and quick SOFA scoring system is recommended. Septic shock is a subset of sepsis in which profound circulatory, cellular and metabolic abnormalities are associated with a higher mortality risk. Sepsis incidence in India is under-reported. Inflammatory process and coagulation are closely linked in sepsis pathogenesis. Lactate measurement and its clearance are used both as a diagnosis and management tool for resuscitation in sepsis. Major recommendations by surviving sepsis campaign (SSC) for the management of sepsis are grouped in bundles of interventions. Recognition of golden hour in sepsis for early antibiotics and resuscitation is crucial. 30 cc/Kg crystalloid fluid bolus for septic shock should be infused within 3 h of triage or sepsis diagnosis. Fluid resuscitation in septic shock can be described in four stages - the rescue, optimization, stabilization, and evacuation phases. Instead of targeting distinct values of central venous pressure and mixed venous oxygen saturation, the SSC guidelines now recommend to re-assess volume status and tissue perfusion within 6-h by repeated focused exam and lactate clearance. The first line vasopressor recommended in septic shock is norepinephrine. For patients with sepsis-induced adult respiratory distress syndrome, using higher over lower positive end-expiratory pressure, lower over higher tidal volume setting on the mechanical ventilator, and prone positioning is recommended. A protocolized approach should be used for blood glucose management in patients with sepsis, commencing insulin dosing when two consecutive blood glucose levels are >180 mg/dL and maintaining upper blood glucose level ≤180 mg/dL rather than ≤110 mg/dL. Assessment of nutritional status using scoring systems such as NUTRIC score and NRS 2002 should be made, and early enteral trophic feeding should be initiated and advanced within 24–48 h. Any initiative designed to improve adherence to the sepsis guidelines and thus improve performance in sepsis core measures requires an institution-specific, strategic, and planned approach. A trans-disciplinary team charged with the functions of raising sepsis awareness, developing sepsis focused educational programs, establishing a care pathway model and monitoring compliance and adherence to the sepsis bundles can help improve the sepsis outcomes. Future focus in sepsis is on earlier recognition, newer screening tools, education among public and health-care workers and optimizing recovery.

Sepsis remains a major cause of morbidity and mortality worldwide, with increased burden in low- and middle-resource settings. The role of the inflammatory response in the pathogenesis of the syndrome has supported the modern concept of sepsis. Nevertheless, a definition of sepsis and the criteria for its recognition is a continuous process, which reflects the growing knowledge of its mechanisms and the success and failure of diagnostic and therapeutic interventions. Here we review the evolving concepts of sepsis, from the “systemic inflammatory response syndrome triggered by infection” (Sepsis-1) to “a severe, potentially fatal, organic dysfunction caused by an inadequate or dysregulated host response to infection” (Sepsis-3). We focused in the pathophysiology behind the concept and the criteria for recognition and diagnosis of sepsis. A major challenge in evaluating the host response in sepsis is to characterize what is protective and what is harmful, and we discuss that, at least in part, the apparent dysregulated host response may be an effort to adapt to a hostile environment. The new criteria for recognition and diagnosis of sepsis were derived from robust databases, restricted, however, to developed countries. Since then, the criteria have been supported in different clinical settings and in different economic and epidemiological contexts, but still raise discussion regarding their use for the identification versus the prognostication of the septic patient. Clinicians should not be restricted to definition criteria when evaluating patients with infection and should wisely use the broad array of information obtained by rigorous clinical observation.

Key Summary Points: Aim: To determine adding lactate to SOFA and qSOFA score improves the performance of the predicting mortailty of older patients. Findings: Cut-off value for lactate was 2.3 mmol/L in our ROC analyses. The lactate 2.3 mmol/L threshold-based SOFA-Lactate2.3 and qSOFA-Lactate2.3 scores performs better than standard SOFA and qSOFA identifying hospital mortality risks of patients over 65 who are admitted to the ICU. Message: Lactate value in olders critically ill patients may predict mortality alone and with other scores. Aim: The aim of this study was to determine whether the addition of the lactate level to the SOFA score (SOFA-Laktat) and qSOFA Score (qSOFA-Laktat) improves the performance of the SOFA score and qSOFA score alone in predicting the hospital mortality of critically ill older patients. Material and method: A total of 799 patients over 65 years of age admitted to Emergency Department and hospitalized to intensive care unit (ICU) of our hospital between May 1, 2016, and April 30, 2017, were included in this study. The parameters gender, age, initial complaint, duration of time between the start of their complaint and emergency admission, comorbidities, SOFA scores, qSOFA scores, arterial lactate (AL) values and reason for acute admission, which intensive care unit admitted to, length of stay and patients outcomes (discharge, exitus) were recorded. The primary outcome was to evaluate whether the addition of the evaluation of AL value increased the performance of the SOFA score and qSOFA score in predicting hospital mortality. Results: Data of 799 patients were analyzed, in which 52.8% (n = 422) were male and 47.3% (n = 377) were female. Most frequently hospitalized clinic was coronary ICU (34.7%, n = 277). Mean duration of hospitalization was 5.2 ± 8.7 days. Hospitalization was prolonged with increased lactate, SOFA and qSOFA levels. Cutoff value for lactate was 2.3 mmol/L in our ROC analyses. Predictive value of SOFA-Lactate2.3 for mortality was significantly higher than SOFA score (p < 0.001). Also, predictive value of qSOFA-Lactate2.3 for mortality was significantly higher than qSOFA score (p < 0.001). Conclusion: The lactate 2.3 mmol/L threshold-based SOFA-Lactate2.3 and qSOFA-Lactate2.3 scores perform better than SOFA and qSOFA alone in identifying hospital mortality risks of patients over 65 who are admitted to the ICU. [ABSTRACT FROM AUTHOR]

Purpose: The abdomen is the second most common source of sepsis and is associated with unacceptably high morbidity and mortality. Recently, the essential definitions of sepsis and septic shock were updated (Third International Consensus Definitions for Sepsis and Septic Shock, Sepsis-3) and modified. The purpose of this review is to provide an overview of the changes introduced by Sepsis-3 and the current state of the art regarding the treatment of abdominal sepsis. Results: While Sepsis-1/2 focused on detecting systemic inflammation as a response to infection, Sepsis-3 defines sepsis as a life-threatening organ dysfunction caused by a dysregulated host response to infection. The Surviving Sepsis Campaign (SSC) guideline, which was updated in 2016, recommends rapid diagnosis and initiating standardized therapy. New diagnostic tools, the establishment of antibiotic stewardship programs, and a host of new-generation antibiotics are new landmark changes in the sepsis literature of the last few years. Although the "old" surgical source control consisting of debridement, removal of infected devices, drainage of purulent cavities, and decompression of the abdominal cavity is the gold standard of surgical care, the timing of gastrointestinal reconstruction and closure of the abdominal cavity ("damage control surgery") are discussed intensively in the literature. The SSC guidelines provide evidence-based sepsis therapy. Nevertheless, treating critically ill intensive care patients requires individualized, continuous daily re-evaluation and flexible therapeutic strategies, which can be best discussed in the interdisciplinary rounds of experienced surgeons and intensive care medicals. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Sepsis is a life-threatening disease resulting from the interaction between pathogen and host response; its dysregulation causes organ dysfunction, high morbidity, and mortality. Despite the increase of septic patients admitted to Internal Medicine wards, data about clinical predictors of mortality in this setting are still lacking. The aim of this study was to evaluate the role of MEDS score and vitamin D as predictors of mortality (28-day and 90-day) in septic patients admitted to the Internal Medicine department. PATIENTS AND METHODS: Prospectively collected clinical data, lab tests including vitamin D, and clinical scores (SIRS, MEDS, SCS, REMS, SOFA, qSOFA) were retrospectively analyzed. Eightyeight microbiologically identified septic patients (median age 75 years old, IQR 65-82 years old; range 37-94 years old) were evaluated. RESULTS: Twenty-three patients (26.1%) died at 28 days, 33 (37.5%) died at 90 days. The logistic regression showed a positive effect of MEDS score (p=0.006; OR 1.24, 95% CI 1.08-1.49), and a negative effect of low vitamin D levels (p=0.008, OR 0.83, 95% CI 0.72-0.94) on mortality. Moreover, the cut-off of 7 points for MEDS score and of 7 ng/ml for vitamin D levels significantly predicted poor prognosis at 28 and 90 days. CONCLUSIONS: MEDS score and vitamin D levels represent independent predictors of mortality in a cohort of Internal Medicine septic patients. Further studies on larger samples are needed to confirm our results and to clarify the pathophysiological mechanisms at the basis of vitamin D deficiency as a predictor of mortality in septic patients. [ABSTRACT FROM AUTHOR]

Background: There is a lack of validated tools to assess potential disease progression and hospitalisation decisions in patients presenting to the emergency department (ED) with a suspected infection. This study aimed to identify suitable blood biomarkers (MR-proADM, PCT, lactate and CRP) or clinical scores (SIRS, SOFA, qSOFA, NEWS and CRB-65) to fulfil this unmet clinical need.Methods: An observational derivation patient cohort validated by an independent secondary analysis across nine EDs. Logistic and Cox regression, area under the receiver operating characteristic (AUROC) and Kaplan-Meier curves were used to assess performance. Disease progression was identified using a composite endpoint of 28-day mortality, ICU admission and hospitalisation > 10 days.Results: One thousand one hundred seventy-five derivation and 896 validation patients were analysed with respective 28-day mortality rates of 7.1% and 5.0%, and hospitalisation rates of 77.9% and 76.2%. MR-proADM showed greatest accuracy in predicting 28-day mortality and hospitalisation requirement across both cohorts. Patient subgroups with high MR-proADM concentrations (≥ 1.54 nmol/L) and low biomarker (PCT < 0.25 ng/mL, lactate < 2.0 mmol/L or CRP < 67 mg/L) or clinical score (SOFA < 2 points, qSOFA < 2 points, NEWS < 4 points or CRB-65 < 2 points) values were characterised by a significantly longer length of hospitalisation (p < 0.001), rate of ICU admission (p < 0.001), elevated mortality risk (e.g. SOFA, qSOFA and NEWS HR [95%CI], 45.5 [10.0-207.6], 23.4 [11.1-49.3] and 32.6 [9.4-113.6], respectively) and a greater number of disease progression events (p < 0.001), compared to similar subgroups with low MR-proADM concentrations (< 1.54 nmol/L). Increased out-patient treatment across both cohorts could be facilitated using a derivation-derived MR-proADM cut-off of < 0.87 nmol/L (15.0% and 16.6%), with decreased readmission rates and no mortalities.Conclusions: In patients presenting to the ED with a suspected infection, the blood biomarker MR-proADM could most accurately identify the likelihood of further disease progression. Incorporation into an early sepsis management protocol may therefore aid rapid decision-making in order to either initiate, escalate or intensify early treatment strategies, or identify patients suitable for safe out-patient treatment. [ABSTRACT FROM AUTHOR]

Objective: The high mortality rate found on infectious patients in the intensive care unit (ICU) calls for sepsis identification tools. Sepsis consensus introduced Systemic Inflammatory Response Syndrome (SIRS) criteria, quick Sequential Organ Failure Assessment (qSOFA) score, and Sequential Organ Failure Assessment (SOFA) score. This study aimed at comparing the accuracy and quality to discriminate among the SIRS, qSOFA score, and SOFA score for predicting mortality among patients at risk of sepsis admitted to the ICU. Design: This study used the analytic observational method with retrospective cohort approach to a sample of 73 qualified medical record data. The data regarding the SIRS, qSOFA, and SOFA criteria were applied after 24 hours of ICU admission. Setting: ICU of Dr. Hasan Sadikin General Hospital, Bandung from January to December 2017. Measurements and results: The results of this study showed the SOFA score as being the most accurate and having a good quality to discriminate, with the value of area under the receiver operating characteristic (AUROC) 0.866 (95% CI 0.782-0.95; p=0.00); the qSOFA score had AUROC of 0.707 (95% CI 0.588-0.826; p=0.002) while SIRS criteria were not significant. Conclusions: The conclusion of this study is that in patients with suspected sepsis admitted to an ICU, the SOFA score is the most accurate to predict mortality, whereas qSOFA could be considered and the SIRS criteria is not recommended. [ABSTRACT FROM AUTHOR]

Highlights • SIRS versus Sepsis-3 regarding mortality in medical patients with acute infectious disease. • SOFA score of at least 2 predicts 28-day mortality in medical patients with acute infectious disease. • SOFA score of at least 2 is a better prognostic marker than qSOFA and SIRS in medical patients with acute infectious disease. Abstract Aims Evaluating the use of sequential organ failure assessment (SOFA) ≥ 2 compared to quick SOFA (qSOFA) and to systemic inflammatory response syndrome (SIRS) in assessing 28-days mortality in medical patients with acute infection. Methods In total, 323 patients with verified infection were stratified in accordance to Sepsis-3. SOFA, qSOFA and SIRS were calculated using registered variables. Adverse outcome was death within 28-days of admission. Results In total, 190 (59%) patients had a SOFA score ≥ 2 and the overall in-hospital mortality was 21 (6%). Scores of SOFA and qSOFA were both significantly elevated in non-survivors. SOFA showed good accuracy (Area under the receiver operating characteristic (AUROC) = 0.83, 95% CI, 0.76 - 0.90) for 28-days mortality compared with qSOFA (AUROC = 0.67, 95% CI, 0.54 - 0.80) and SIRS (AUROC = 0.62, 95% Cl 0.49 - 0.74). SOFA was ≥ 2 in all patients who died, while qSOFA and SIRS was ≥ 2 in 8 (38%) and 17 (81%) of the patients who died, respectively. Conclusion SOFA score ≥ 2 was better than SIRS and qSOFA to predict mortality within 28-days of admission among patients with acute infectious disease. [ABSTRACT FROM AUTHOR]

Objective: We aimed to determine a comparison between the Quick Sequential Organ Failure Assessment (qSOFA) score and existing Sequential Organ Failure Assessment (SOFA) score when applied to severe sepsis & septic shock patients in the Emergency Department (ED) for prediction of in-hospital mortality in the setting of a tertiary care hospital ED in a low-middle income country. Method: We conducted a prospective observational cohort study on 760 subjects. The qSOFA, SOFA score and inhospital mortality were assessed by area under the receiver operating curve (AUROC). We calculated sensitivity and specificity for each score for outcomes at cut-offs of 0.92 and 0.63 for qSOFA and SOFA in Severe Sepsis respectively and 0.89 and 0.63 for qSOFA and SOFA in Septic shock respectively. Results: In patients with severe sepsis, the AUROC of qSOFA for predicting mortality in subjects was 0.92 (95% CI; 0.89-0.94) with 96% sensitivity and 87% specificity in comparison to the AUROC of SOFA score which was 0.63 (95% CI; 0.55-0.70 with 71% sensitivity and 57% specificity. In patients with septic shock, the AUROC of qSOFA for predicting mortality in subjects was 0.89 (95% CI; 0.85-0.92) with 92% sensitivity and 85% specificity in comparison to the AUROC of SOFA score which was 0.63 (95% CI; 0.55-0.70 with 70% sensitivity and 59% specificity. Conclusion: Our study concludes that qSOFA score is an effective tool at predicting in hospital mortality in comparison to SOFA score when applied to severe sepsis and septic shock patients in the setting of a tertiary care hospital ED of a low-middle income country however, further studies are needed before application for this purpose. [ABSTRACT FROM AUTHOR]

Introduction. It is estimated that every year 31 million people suffer from sepsis and even 6 million cases of illness end up in the patient's death. In 2016 the current definition of sepsis was established as a life-threatening multiorgan failure resulting from an abnormal immune response caused by patient infection. The pathobiological approach rejects the current method of diagnosing sepsis based on the occurrence of SIRS, because many other non-infectious diseases may also cause its occurrence. There was proposed a scale of progressive organ failure called SOFA and qSOFA. In May 2017, WHO released a resolution that obliges European Union countries to raise awareness about sepsis prevention, diagnosis, treatment and management. Results. A nurse is the person who spends the most time with a patient, thus becoming the best observer of changes in his/her vital functions and well-being. Nurses working in basic health care, hospital emergency ward and all departments not involved in intensive medical care, have an important role in prevention of infections, as over 70% of sepsis cases begins in a non-hospital environment, and the current level of public knowledge reaches only 14%. [ABSTRACT FROM AUTHOR]

Sepsis is a major global health problem and represents a challenge for physicians all over the world. The knowledge of sepsis and septic shock is a topic of interest among the scientific community and society in general. New guidelines for management of sepsis and septic shock were developed in 2016, providing an update on this area. In Sepsis-3 new definitions for sepsis and septic shock were published. The purpose of this narrative review is to discuss and compare the new criteria of 2016 with the old criteria, purposing at the same time an alternative approach for this topic. SOFA criteria (Sequential Organ Failure Assessment Score) are more complete, but too extensive and usually difficult to apply outside the intensive care units, therefore inducing potentially delay in the proper treatment. We purpose combined criteria for the selection of sepsis patients. Initially, we could apply qSOFA (quick Sepsis Related Organ Failure Assessment) criteria, due to its easy application, associated with the SIRS (systemic inflammatory response syndrome) criteria, allowing to select the patients who are infected and need faster treatment. In that way we would use the best of old and newest criteria, allowing the early selection of patients who are infected and require faster treatment, while the search for a better and faster tool continues. [ABSTRACT FROM AUTHOR]

Sepsis accounts for an estimated 30 million cases and 6 million deaths globally each year. According to a multidisciplinary task force convened by the Society of Critical Care Medicine and European Society of Intensive Care Medicine, sepsis is defined as life-threatening organ dysfunction due to a dysregulated host response to infection. Sepsis is a medical emergency, so much so that the World Health Organization made it a global health priority. Since patients with cardiovascular diseases have unique risk factors for sepsis, prompt and accurate diagnosis is critical. In this regard, the sepsis- specific Sequential Organ Failure Assessment (SOFA) helps clinicians identify the organ dysfunction and predict outcomes. Sepsis management is grouped into specific interventions called bundles, and completion of each bundle element is time sensitive. The U.S. Centers for Medicaid and Medicare Services and some state-specific regulations have made compliance with these bundles reportable as a quality measure. The updated Surviving Sepsis Campaign Hour-1 bundle recommends that lactate measurement, blood cultures procurement, broad spectrum antibiotics administration, resuscitation with 30 mL/kg crystalloid, and vasopressor initiation for hypotension all be initiated within 1 hour of time zero, which is from the time of triage in the emergency department or from sepsis diagnosis. Septic shock is defined as hypotension with a mean arterial pressure less than 65 mm Hg, requiring vasopressors despite adequate fluid resuscitation and/or lactic acid levels above 2 mmol/L. Both fluid resuscitation and clinical re-evaluation with lactate measurement guide the fluid and vasopressor therapy. Specific guidelines exist for organ support that address mechanical ventilation, blood transfusions, vasopressor choices, and nutrition. [ABSTRACT FROM AUTHOR]

The Japanese Respiratory Society newly updated the prognostic guidelines for pneumonia in 2017. Quick Sequential Organ Failure Assessment (qSOFA) and Sequential Organ Failure Assessment (SOFA) score are used to evaluate the severity of pneumonia and to select the therapy for pneumonia. This is a retrospective study at Aichi Medical University hospital from January to December of 2016 to investigate the accuracy and usefulness of qSOFA and SOFA score in evaluating the severity and prognosis of healthcare-associated pneumonia (HCAP). A total of 81 HCAP patients were enrolled in this study. Both the 30-day and in-hospital mortality were 7.5% (6/81). qSOFA≧2 was in 33/78 patients (42%) and <2 in 45/78 patients (58%), showing a 30-day mortality of 9.1% (3/33) and 6.7% (3/45) ( p = 0.45), respectively. Comparing with qSOFA≧2 and < 2 group, HCAP patients with qSOFA≧2 had much higher A-DROP (31. v.s. 2.2, p < 0.001), CURB-65 (2.7 v.s. 1.9, p < 0.001), PSI (133 v.s. 114, p = 0.014), I-ROAD (2.7 v.s. 1.9, p < 0.001) and SOFA scores (3.8 v.s. 2.8, p < 0.001). With respect to the diagnostic value of predictive values for 30-day mortality among HCAP patients, the area under the receiver-operating characteristic curve for SOFA score was 0.930 with a statistical significance ( p < 0.001). The SOFA score cutoff value was 4 and had a sensitivity of 20%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 68%. In conclusion, SOFA core could be one of the most useful tools in evaluating the severity of HCAP. [ABSTRACT FROM AUTHOR]

Our aim was to prospectively determine the predictive capabilities of SEPSIS-1 and SEPSIS-3 definitions in the emergency departments and general wards. Patients with National Early Warning Score (NEWS) of 3 or above and suspected or proven infection were enrolled over a 24-h period in 13 Welsh hospitals. The primary outcome measure was mortality within 30 days. Out of the 5422 patients screened, 431 fulfilled inclusion criteria and 380 (88%) were recruited. Using the SEPSIS-1 definition, 212 patients had sepsis. When using the SEPSIS-3 definitions with Sequential Organ Failure Assessment (SOFA) score ≥ 2, there were 272 septic patients, whereas with quickSOFA score ≥ 2, 50 patients were identified. For the prediction of primary outcome, SEPSIS-1 criteria had a sensitivity (95%CI) of 65% (54-75%) and specificity of 47% (41-53%); SEPSIS-3 criteria had a sensitivity of 86% (76-92%) and specificity of 32% (27-38%). SEPSIS-3 and SEPSIS-1 definitions were associated with a hazard ratio (95%CI) 2.7 (1.5-5.6) and 1.6 (1.3-2.5), respectively. Scoring system discrimination evaluated by receiver operating characteristic curves was highest for Sequential Organ Failure Assessment score (0.69 (95%CI 0.63-0.76)), followed by NEWS (0.58 (0.51-0.66)) (p < 0.001). Systemic inflammatory response syndrome criteria (0.55 (0.49-0.61)) and quickSOFA score (0.56 (0.49-0.64)) could not predict outcome. The SEPSIS-3 definition identified patients with the highest risk. Sequential Organ Failure Assessment score and NEWS were better predictors of poor outcome. The Sequential Organ Failure Assessment score appeared to be the best tool for identifying patients with high risk of death and sepsis-induced organ dysfunction. [ABSTRACT FROM AUTHOR]

Aim: A new definition of sepsis released by an international task-force has introduced the concept of quick Sequential (Sepsis-Related) Organ Failure Assessment (qSOFA). This study aimed to measure the proportion of patients who fulfilled qSOFA criteria during a Rapid Response Team (RRT) review and to assess their associated outcomes.Methods: We conducted a prospective study of adult RRT reviews over a one month period between 6th June and 10th July 2016 in a large tertiary hospital in Melbourne Australia RESULTS: Over a one-month period, there were 282 RRT reviews, 258 of which were included. One hundred out of 258 (38.8%) RRT review patients fulfilled qSOFA criteria. qSOFA positive patients were more likely to be admitted to the intensive care unit (29% vs 18%, P=0.04), to have repeat RRT reviews (27% vs 13%; p=0.007) and die in hospital (31% vs 10%, P<0.001). qSOFA positive patients with suspected infection were more likely to be admitted to the intensive care unit compared to patients with infection alone (37% vs 15%, P=0.002). Eleven of 42 patients (26%) who had infection and qSOFA died whilst in hospital, compared to 8/55 (15%) of patients with infection alone (P=0.2).Conclusion: Adult patients who are qSOFA positive at the time of their RRT review are at increased risk of in-hospital mortality. The assessment of qSOFA may be a useful triage tool during a RRT review. [ABSTRACT FROM AUTHOR]

Sepsis represents a global health problem in terms of morbidity, mortality, social and economic costs. Although usually managed in Intensive Care Units, sepsis showed an increased prevalence among Internal Medicine wards in the last decade. This is substantially due to the ageing of population and to multi-morbidity. These characteristics represent both a risk factor for sepsis and a relative contra-indication for the admission to Intensive Care Units. Although there is a lack of literature on the management of sepsis in Internal Medicine, the outcome of these patients seems to be gradually improving. This is due to Internists’ increased adherence to guidelines and “bundles”. The routine use of SOFA score helps physicians in the definition of septic patients, even if the optimal score has still to come. Point-of-care ultrasonography, lactates, procalcitonin and beta-d-glucan are of help for treatment optimization. The purpose of this narrative review is to focus on the management of sepsis in Internal Medicine departments, particularly on crucial concepts regarding diagnosis, risk assessment and treatment.Key MessagesSepsis is a life-threatening organ dysfunction caused by a dysregulated host response to infection.The prevalence of sepsis is constantly increasing, affecting more hospital patients than any other disease.At least half of patients affected by sepsis are admitted to Internal Medicine wards.Adherence to guidelines, routine use of clinical and lab scores and point-of-care ultrasonography are of help for early recognition of septic patients and treatment optimization. [ABSTRACT FROM PUBLISHER]

The adoption of the new sepsis definition in early 2016 introduced a new paradigm for the clinical picture of sepsis. Up until now, sepsis was defined as a systemic inflammatory reaction (systemic inflammatory response syndrome, SIRS) to an infection. Based on a better understanding of the molecular mechanisms, the focus of the new definition is no longer the inflammatory response, but rather the tissue damage and impairment of organ function which this induces. The paradigm thus moves away from the infection and the systemic inflammatory response, and toward that which makes sepsis so dangerous in terms of both disease dynamics and outcome: organ failure due to a dysregulated host response to an infection. This change of perspective or paradigm enables patients with an increased risk of developing sepsis to be recognized and treated earlier in clinical routine, even outside of the intensive care unit. The new definition also promotes development of new treatment strategies with improved ability to treat sepsis causally. [ABSTRACT FROM AUTHOR]