JHSM
Journal of Health Sciences and Medicine

Journal of Health Sciences and Medicine (JHSM) is an unbiased, peer-reviewed, and open access international medical journal. The Journal publishes interesting clinical and experimental research conducted in all fields of medicine, interesting case reports, and clinical images, invited reviews, editorials, letters, comments, and related knowledge.

ISSN: Active
eISSN: 2636-8579
Creative Commons CC BY-NC-ND 4.0 International License.
EndNote Style

Submit Manuscript

Index
Original Article
Comparison of early warning and sepsis scores for mortality prediction in patients with suspected infection admitted to medical intensive care units
Abstract
Aims: To compare the mortality prediction efficiency of the Modified Early Warning Score (MEWS), Systemic Inflammatory Response Syndrome (SIRS), Sepsis Related Organ Failure Assessment (SOFA), and Quick Sepsis Related Organ Failure Assessment (qSOFA) calculated within 48 hours before ICU admission.
Methods: A prospective, noninterventional, observational cohort study enrolled adult patients admitted to medical intensive care units (ICU) with suspected infection in a tertiary care medical center. MEWS SIRS, SOFA, and qSOFA scores were calculated at four different time points: 48, 24, and 8 hours before and at the time of the ICU admission (0. hour). The scores were analyzed for hospital mortality.
Results: A total of 120 patients were included. The median age was 68 (IQR 59.8-79) years, and 44.2% of patients were male. Of the study population, 75.8% were admitted to the medical ICU from the emergency department, while the remaining were from the medical wards. Considering the scores observed 48 hours before ICU admission, Odds Ratio (OR) of SIRS?2 and SOFA?2 showed a value of 7.6 (95% CI: 1.5-38.0) and 13.2 (95% CI: 2.3-74.3), respectively, while no increase in risk was observed for MEWS and the qSOFA score. Receiver operating characteristic analysis (ROC) performed with the highest scores observed at any time within 48 hours before ICU admission (ICU admission values were omitted) regarding hospital mortality yielded area under the curve (AUC) values (95% CI) of 0.80 (0.72-0.89) for SOFA, 0.66 (0.54-0.76) for MEWS, 0.63 (0.51-0.74) for qSOFA, and 0.61 (0.49-0.73) for SIRS. SOFA had the highest sensitivity of 92.6% (82.7-100.0), whereas qSOFA had the highest specificity of 63.0% (49.1-77.0) for hospital mortality.
Conclusion: SOFA score is the most sensitive scoring system to predict hospital mortality in patients admitted to the medical ICU with suspected infection compared to MEWS, SIRS, and qSOFA. Nevertheless, the sepsis and early warning scores should be combined in clinical practice whenever possible.

Keywords : Early warning score, qSOFA, critical care, sepsis, SOFA, systemic inflammatory response syndrome

Download Article


1. Chiu C, Legrand M. Epidemiology of sepsis and septic shock.Curr Opin Anaesthesiol. 2021;34(2):71-76.
2. Weng L, Xu Y, Yin P, et al. National incidence and mortality ofhospitalized sepsis in China. Crit Care. 2023;27(1):84.
3. Zhang Z, Chen L, Xu P, et al. Effectiveness of automated alertingsystem compared to usual care for the management of sepsis. NPJDigital Med. 2022;5(1):101.
4. Jacobi J. The pathophysiology of sepsis-2021 update: part 2,organ dysfunction and assessment. Am J Health Syst Pharm.2022;79(6):424-436.
5. Yan MY, Gustad LT, Nytrø Ø. Sepsis prediction, early detection,and identification using clinical text for machine learning: asystematic review. J Am Med Inform Assoc. 2022;29(3):559-575.
6. Durusu Tanrıöver M, Halaçlı B, Sait B, Öcal S, Topeli A. Dailysurveillance with early warning scores help predicthospitalmortality in medical wards. Turk J Med Sci. 2016;46(6):1786-1791.
7. Rababa M, Bani Hamad D, Hayajneh AA. Sepsis assessment andmanagement in critically Ill adults: a systematic review. PLoS One.2022;17(7):e0270711.
8. Schertz AR, Lenoir KM, Bertoni AG, Levine BJ, Mongraw-ChaffinM, Thomas KW. Sepsis prediction model for determining sepsis vsSIRS, qSOFA, and SOFA. JAMA Netw Open. 2023;6(8):e2329729.
9. Lan L, Zhou M, Chen X, Dai M, Wang L, Lih. Prognostic accuracyof SOFA, MEWS, and SIRS criteria in predicting the mortality rateof patients with sepsis: a meta-analysis. Nurs Crit Care. 2023;1-13.doi:10.1111/nicc.13016
10. Jones D, Ludikhuize J. Improving outcomes from sepsis duringrapid response team review. Aust Crit Care. 2022;35(4):332-333.
11. Evans L, Rhodes A, Alhazzani W, et al. Surviving sepsis campaign:ınternational guidelines for management of sepsis and septicshock 2021. Crit Care Med. 2021;49(11):e1063-e1143.
12. Andreassen S, Møller JK, Eliakim-Raz N, Lisby G, Ward L.A comparison of predictors for mortality and bacteraemia inpatients suspected of infection. BMC Infect Dis. 2021;21:864.
13. Chen QH, Shao J, Liu WL, et al. Predictive accuracy of sepsis-3definitions for mortality among adult critically ill patients withsuspected infection. Chin Med J. 2019;132(10):1147-1153.
14. Freund Y, Lemachatti N, Krastinova E, et al. Prognostic accuracyof sepsis-3 criteria for ın-hospital mortality among patients withsuspected ınfection presenting to the emergency department.JAMA. 2017;317(3):301.
15. Gaini S, Relster MM, Pedersen C, Johansen IS. Prediction of 28-days mortality with sequential organ failure assessment (SOFA),quick SOFA (qSOFA) and systemic inflammatory responsesyndrome (SIRS) — a retrospective study of medical patients withacute infectious disease. Int J Infect Dis. 2019;78:1-7.
16. de Freitas Garbero R, Simões AA, Martins GA, da Cruz LV, vonZuben VGM. SOFA and qSOFA at admission to the emergencydepartment: diagnostic sensitivity and relation with prognosis inpatients with suspected infection. Turk J Emerg Med. 2019;19(3):106-110.
17. Khwannimit B, Bhurayanontachai R, Vattanavanit V. Comparisonof the accuracy of three early warning scores with SOFA scorefor predicting mortality in adult sepsis and septic shock patientsadmitted to intensive care unit. Heart Lung. 2019;48(3):240-244.
18. Kim KS, Suh GJ, Kim K, et al. Quick sepsis-related organfailure assessment score is not sensitive enough to predict 28-day mortality in emergency department patients with sepsis: aretrospective review. Clin Exp Emerg Med. 2019;6(1):77-83.
19. Kovach CP, Fletcher GS, Rudd KE, Grant RM, Carlbom DJ.Comparative prognostic accuracy of sepsis scores for hospitalmortality in adults with suspected infection in non-ICU and ICUat an academic public hospital. PLoS One. 2019;14(9):e0222563.
20. Machado FR, Cavalcanti AB, Monteiro MB, et al. Predictiveaccuracy of the quick sepsis-related organ failure assessmentscore in Brazil. a prospective multicenter study. Am J Respir CritCare Med. 2020;201(7):789-798.
21. Songsangjinda T, Khwannimit B. Comparison of severity scoremodels based on different sepsis definitions to predict in-hospitalmortality among sepsis patients in the intensive care unit. MedIntensiva. 2020;44(4):226-232.
22. Tanrıöver MD, Yıldırım G. Does the implementation of modifiedearly warning scores spare workforce by decreasing the frequencyof nurse assessments? Acta Med. 2014;45(1):80-83.
23. Raith EP, Udy AA, Bailey M, et al. Prognostic accuracy of theSOFA score, SIRS criteria, and qSOFA score for in-hospitalmortality among adults with suspected infection admitted to theintensive care unit. JAMA. 2017;317(3):290-300.
24. Solligård E, Damås JK. SOFA criteria predict infection-related in-hospital mortality in ICU patients better than SIRS criteria andthe qSOFA score. BMJ Evidence Based Med. 2017;22:211
25. Guirgis FW, Puskarich MA, Smotherman C, et al. Developmentof a simple sequential organ failure assessment score for riskassessment of emergency department patients with sepsis. JIntensive Care Med. 2020;35(3):270-278.
26. Liu VX, Lu Y, Carey KA, et al. Comparison of early warningscoring systems for hospitalized patients with and withoutinfection at risk for in-hospital mortality and transfer to theintensive care unit. JAMA Netw Open. 2020;3(5):e205191.
27. Abdullah SOB, Sørensen RH, Nielsen FE. Prognostic accuracyof SOFA, qSOFA, and SIRS for mortality among emergencydepartment patients with infections. Infect Drug Resist. 2021;14:2763-2775.
28. Topeli A, Baspinar B, Ortac Ersoy E. In search of the ideal riskscore in sepsis. Am J Respir Crit Care Med. 2020;202(1):152-153.
29. Liu YC, Luo YY, Zhang X, et al. Quick sequential organ failureassessment as a prognostic factor for infected patients outside theintensive care unit: a systematic review and meta-analysis. InternEmerg Med. 2019;14(4):603-615.
30. Canet E, Taylor DM, Khor R, Krishnan V, Bellomo R. qSOFAas predictor of mortality and prolonged ICU admission inemergency department patients with suspected infection. J CritCare. 2018;48:118-123.
31. Vaittinada Ayar P, Delay M, Avondo A, et al. Prognostic valueof prehospital quick sequential organ failure assessment scoreamong patients with suspected infection. Eur J Emerg Med.2019;26(5):329-333.
32. Jiang J, Yang J, Mei J, Jin Y, Lu Y. Head-to-head comparison ofqSOFA and SIRS criteria in predicting the mortality of infectedpatients in the emergency department: a meta-analysis. Scand JTrauma Resusc Emerg Med. 2018;26(1):56.
33. Finkelsztein EJ, Jones DS, Ma KC, et al. Comparison of qSOFA andSIRS for predicting adverse outcomes of patients with suspicion ofsepsis outside the intensive care unit. Crit Care. 2017;21(1):73.
34. Zhang K, Zhang X, Ding W, et al. National early warning scoredoes not accurately predict mortality for patients with infectionoutside the intensive care unit: a systematic review and meta-analysis. Front Med. 2021;8:704358.
35. Azijli K, Minderhoud T, Mohammadi P, et al. A prospective,observational study of the performance of MEWS, NEWS, SIRSand qSOFA for early risk stratification for adverse outcomes inpatients with suspected infections at the emergency department.Acute Med. 2021;20(2):116-124.
36. Mignot-Evers L, Raaijmakers V, Buunk G, et al. Comparison ofSIRS criteria and qSOFA score for identifying culture-positivesepsis in the emergency department: a prospective cross-sectionalmulticentre study. BMJ Open. 2021;11(6):e041024.
37. Luo J, Jiang W, Weng L, et al. Usefulness of qSOFA and SIRSscores for detection of incipient sepsis in general ward patients: aprospective cohort study. J Crit Care. 2019;51:13-18.
38. Sabir L, Ramlakhan S, Goodacre S. Comparison of qSOFA andhospital early warning scores for prognosis in suspected sepsis inemergency department patients: a systematic review. Emerg MedJ. 2022;39(4):284-294.
39. Chen L, Zhengh, Chen L, Wu S, Wang S. National early warningscore in predicting severe adverse outcomes of emergencymedicine patients: a retrospective cohort study. J MultidiscipHealthc. 2021;14:2067-2078.
40. Usul E, Korkut S, Kayipmaz AE, Halici A, Kavalci C. The role ofthe quick sequential organ failure assessment score (qSOFA) andmodified early warning score (MEWS) in the pre-hospitalizationprediction of sepsis prognosis. Am J Emerg Med. 2021;41:158-162.
Article available in :
Volume 7, Issue 1, 2024
Page : 73-79
https://doi.org/10.32322/jhsm.1403054
Article Information
Received : 11 Ara 2023
Accepted : 27 Ara 2023
Published : 15 Oca 2024
Corresponding Author :

Batuhan Başpınar: Department of Gastroenterology, Ankara City Hospital, Ankara, Turkey

[email protected]
Citation : Başpınar B, Erdat EC, Ortaç Ersoy E, Topeli A. Comparison of early warning and sepsis scores for mortality prediction in patients with suspected infection admitted to medical intensive care units. J Health Sci Med. 2024;7(1):73-79.

Read: 114
Cited: 0
Download : 61
_Footer