Journal of Clinical and Diagnostic Research. 2018 Oct, Vol-12(10): OC22-OC26 22 22 DOI: 10.7860/JCDR/2018/37018.12150 Original Article Internal Medicine Section Predictive Performance of Quick Sequential Organ Failure Assessment Scoring in an Argentinian Hospital INTRODUCTION Sepsis is responsible for approximately 30% of in-hospital mortality, with increasing incidence and elevated associated hospitalization costs [1-3]. One third of patients with sepsis are admitted through the Emergency Department (ED) [2-6]. It has been shown that patients admitted to ED and receiving early goal-directed therapy had a 30.5% mortality compared to 46.5% in the group that received standard therapy [7]. However, the window of opportunity to prevent morbidity and mortality occurs during the early phases of sepsis presentation [6]. In 2016, a task force organised by national societies, including the Society of Critical Care Medicine and the European Society of Intensive Care Medicine, sought to update the definition of sepsis and differentiate it from that of uncomplicated infection to be consistent with an improved understanding of the pathobiology [8,9]. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) therefore defined sepsis as a life-threatening organ dysfunction associated to a dysregulated response to infection [8,9]. In this new proposal, both, the use of host inflammatory response syndrome criteria (SIRS) and the term “severe sepsis” have been removed [4,5,8,9]. Moreover, the task force introduced the quick-SOFA (qSOFA) score, a modified and simplified method of the Sequential (Sepsis-related) Organ Failure Assessment score (SOFA), to facilitate the identification of those at risk of dying from sepsis [4,8,10]. Quick-SOFA could be an easy to use and efficient tool for predicting in-hospital mortality and sepsis outside the intensive care unit but its utility disappears in the critical care setting [11]. For patients with infection outside of the Intensive Care Unit (ICU), it is important to recognise sepsis early; however, criteria for organ dysfunction require laboratory data that may prove difficult to obtain [4]. Therefore, the use of a qSOFA score of 2 points or above in encounters with patients with infection in non-ICU settings to consider risk of developing sepsis was recommended [4] Recently, qSOFA showed better discriminative value and hazard ratio than previous criteria for predicting death [12]. To further assess the score, we sought to evaluate mortality rate in ED along with predicting sepsis by Quick- SOFA. MATERIALS AND METHODS The study was of an observational and prospective design, performed between May and November 2016 at a private tertiary care teaching hospital in Buenos Aires, Argentina. The study has been approved by the Hospital Ethics Committee and complies with Argentinean and international ethical norms, with Argentine Act 25326/Habeas Data as well as with norms of the Argentina Drugs Administration (ANMAT). Included patients were ≥18 years of age, who were presented to the ED and were admitted to a 15-bed observation area of ED, whose screening showed sepsis or infection, or any symptom consistent with an infection, including fever, cough, dysuria, diarrhoea, dyspnoea, sputum production, skin infection. Patients were excluded if they were <18-year-old, had neurological deterioration or cardio- respiratory disease, were on sedative or neuroleptic medication, including home medication treatment with benzodiazepines, suffered severe metabolic disorder, or an acid-base disorder. Patients with these pathologies were excluded as they may act as confounders and make identification of qSOFA variables difficult. The collected data included: age, sex, comorbidities (Charlson index), clinical and analytical data in the ED (altered metal status according to the Glasgow Coma Scale), heart rate (HR, per minute), JAVIER OSATNIK 1 , BÁRBARA TORT-ORIBEA 2 , JUAN FOLCO 3 , ARIEL SOSA 4 , DABIEL IVULICH 5 , MARÍA MERCEDES KLEINERT 6 , JAVIER EUGENIO ROBERTI 7 Keywords: Emergency department, qSOFA, Sepsis, SIRS ABSTRACT Introduction: The early identification and treatment of sepsis in emergency setting could improve patients’ survival. The Quick-SOFA score is a simple tool that could contribute to this identification. Aim: To evaluate mortality rate in Emergency Department along with predicting sepsis by Quick-SOFA. Materials and Methods: This was an observational, prospective study performed in an emergency department of an Argentine Hospital. The studied patients were ≥18 years of age, with infection or suspicion of infection. For qSOFA, 1 point was assigned for each of following: respiratory rate >21 breaths/ min, systolic arterial blood pressure ≤100 mm Hg, and altered mental status. A qSOFA score of ≥2 was considered positive. To assess the performances of the qSOFA and SIRS, sensitivity and specificity was calculated. Results: A total of 157 patients were included with mean age corresponding to 62.9±19.2 years out of which 76 (48.4%) patients were women. Upon admission, 58/157 (36.9%) patients showed a positive-qSOFA, and 120/157 (76.4%) patients were SIRS positive (≥2 signs). 69/157 (46%) cases developed sepsis; 22/157(14%) patients died during their stay. The discrimination of sepsis using qSOFA was comparable with the SIRS criteria (p=0.399) and the discrimination of in-hospital mortality using qSOFA was better than SIRS criteria (p=0.0488). A qSOFA Area Under the Curve (AUC) for predicting sepsis was 0.765 (95% CI 0.69-0.84) while qSOFA AUC for predicting in-hospital mortality was 0.71, (95% CI 0.59-0.83). Conclusion: The newly introduced qSOFA provided better discrimination than SIRS for predicting in-hospital mortality whereas both scores showed comparable discrimination for predicting sepsis in Emergency Department.