Prognostic performance of disease severity scores in patients with septic shock presenting to the emergency department

the Korean Shock Society (KoSS) Investigators

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: An accurate disease severity score that can quickly predict the prognosis of patients with sepsis in the emergency department (ED) can aid clinicians in distributing resources appropriately or making decisions for active resuscitation measures. This study aimed to compare the prognostic performance of quick sequential organ failure assessment (qSOFA) with that of other disease severity scores in patients with septic shock presenting to an ED. Methods: We performed a prospective, observational, registry-based study. The discriminative ability of each disease severity score to predict 28-day mortality was evaluated in the overall cohort (which included patients who fulfilled previously defined criteria for septic shock), the newly defined sepsis subgroup, and the newly defined septic shock subgroup. Results: A total of 991 patients were included. All disease severity scores had poor discriminative ability for 28-day mortality. The sequential organ failure assessment and acute physiology and chronic health evaluation II scores had the highest area under the receiver-operating characteristic curve (AUC) values, which were significantly higher than the AUC values of other disease severity scores in the overall cohort and the sepsis and septic shock subgroups. The discriminative ability of each disease severity score decreased as the mortality rate of each subgroup increased. Conclusions: All disease severity scores, including qSOFA, did not display good discrimination for 28-day mortality in patients with serious infection and refractory hypotension or hypoperfusion; additionally, none of the included scoring tools in this study could consistently predict 28-day mortality in the newly defined sepsis and septic shock subgroups.

Original languageEnglish
JournalAmerican Journal of Emergency Medicine
DOIs
Publication statusAccepted/In press - 2018 Jan 1

Fingerprint

Septic Shock
Hospital Emergency Service
Aptitude
Sepsis
Mortality
Area Under Curve
Resuscitation Orders
APACHE
ROC Curve
Hypotension
Registries
Decision Making
Infection

Keywords

  • Mortality
  • Prognosis
  • Sepsis
  • Shock

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Prognostic performance of disease severity scores in patients with septic shock presenting to the emergency department. / the Korean Shock Society (KoSS) Investigators.

In: American Journal of Emergency Medicine, 01.01.2018.

Research output: Contribution to journalArticle

@article{f8a2899905744522b40a32bf3c52a740,
title = "Prognostic performance of disease severity scores in patients with septic shock presenting to the emergency department",
abstract = "Background: An accurate disease severity score that can quickly predict the prognosis of patients with sepsis in the emergency department (ED) can aid clinicians in distributing resources appropriately or making decisions for active resuscitation measures. This study aimed to compare the prognostic performance of quick sequential organ failure assessment (qSOFA) with that of other disease severity scores in patients with septic shock presenting to an ED. Methods: We performed a prospective, observational, registry-based study. The discriminative ability of each disease severity score to predict 28-day mortality was evaluated in the overall cohort (which included patients who fulfilled previously defined criteria for septic shock), the newly defined sepsis subgroup, and the newly defined septic shock subgroup. Results: A total of 991 patients were included. All disease severity scores had poor discriminative ability for 28-day mortality. The sequential organ failure assessment and acute physiology and chronic health evaluation II scores had the highest area under the receiver-operating characteristic curve (AUC) values, which were significantly higher than the AUC values of other disease severity scores in the overall cohort and the sepsis and septic shock subgroups. The discriminative ability of each disease severity score decreased as the mortality rate of each subgroup increased. Conclusions: All disease severity scores, including qSOFA, did not display good discrimination for 28-day mortality in patients with serious infection and refractory hypotension or hypoperfusion; additionally, none of the included scoring tools in this study could consistently predict 28-day mortality in the newly defined sepsis and septic shock subgroups.",
keywords = "Mortality, Prognosis, Sepsis, Shock",
author = "{the Korean Shock Society (KoSS) Investigators} and Arom Choi and Park, {Yoo Seok} and Shin, {Tae Gun} and Han, {Kap Su} and Kim, {Won Young} and Kang, {Gu Hyun} and Kyuseok Kim and Choi, {Sung Hyuk} and Lim, {Tae Ho} and Suh, {Gil Joon}",
year = "2018",
month = "1",
day = "1",
doi = "10.1016/j.ajem.2018.08.046",
language = "English",
journal = "American Journal of Emergency Medicine",
issn = "0735-6757",
publisher = "W.B. Saunders Ltd",

}

TY - JOUR

T1 - Prognostic performance of disease severity scores in patients with septic shock presenting to the emergency department

AU - the Korean Shock Society (KoSS) Investigators

AU - Choi, Arom

AU - Park, Yoo Seok

AU - Shin, Tae Gun

AU - Han, Kap Su

AU - Kim, Won Young

AU - Kang, Gu Hyun

AU - Kim, Kyuseok

AU - Choi, Sung Hyuk

AU - Lim, Tae Ho

AU - Suh, Gil Joon

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: An accurate disease severity score that can quickly predict the prognosis of patients with sepsis in the emergency department (ED) can aid clinicians in distributing resources appropriately or making decisions for active resuscitation measures. This study aimed to compare the prognostic performance of quick sequential organ failure assessment (qSOFA) with that of other disease severity scores in patients with septic shock presenting to an ED. Methods: We performed a prospective, observational, registry-based study. The discriminative ability of each disease severity score to predict 28-day mortality was evaluated in the overall cohort (which included patients who fulfilled previously defined criteria for septic shock), the newly defined sepsis subgroup, and the newly defined septic shock subgroup. Results: A total of 991 patients were included. All disease severity scores had poor discriminative ability for 28-day mortality. The sequential organ failure assessment and acute physiology and chronic health evaluation II scores had the highest area under the receiver-operating characteristic curve (AUC) values, which were significantly higher than the AUC values of other disease severity scores in the overall cohort and the sepsis and septic shock subgroups. The discriminative ability of each disease severity score decreased as the mortality rate of each subgroup increased. Conclusions: All disease severity scores, including qSOFA, did not display good discrimination for 28-day mortality in patients with serious infection and refractory hypotension or hypoperfusion; additionally, none of the included scoring tools in this study could consistently predict 28-day mortality in the newly defined sepsis and septic shock subgroups.

AB - Background: An accurate disease severity score that can quickly predict the prognosis of patients with sepsis in the emergency department (ED) can aid clinicians in distributing resources appropriately or making decisions for active resuscitation measures. This study aimed to compare the prognostic performance of quick sequential organ failure assessment (qSOFA) with that of other disease severity scores in patients with septic shock presenting to an ED. Methods: We performed a prospective, observational, registry-based study. The discriminative ability of each disease severity score to predict 28-day mortality was evaluated in the overall cohort (which included patients who fulfilled previously defined criteria for septic shock), the newly defined sepsis subgroup, and the newly defined septic shock subgroup. Results: A total of 991 patients were included. All disease severity scores had poor discriminative ability for 28-day mortality. The sequential organ failure assessment and acute physiology and chronic health evaluation II scores had the highest area under the receiver-operating characteristic curve (AUC) values, which were significantly higher than the AUC values of other disease severity scores in the overall cohort and the sepsis and septic shock subgroups. The discriminative ability of each disease severity score decreased as the mortality rate of each subgroup increased. Conclusions: All disease severity scores, including qSOFA, did not display good discrimination for 28-day mortality in patients with serious infection and refractory hypotension or hypoperfusion; additionally, none of the included scoring tools in this study could consistently predict 28-day mortality in the newly defined sepsis and septic shock subgroups.

KW - Mortality

KW - Prognosis

KW - Sepsis

KW - Shock

UR - http://www.scopus.com/inward/record.url?scp=85053162017&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85053162017&partnerID=8YFLogxK

U2 - 10.1016/j.ajem.2018.08.046

DO - 10.1016/j.ajem.2018.08.046

M3 - Article

C2 - 30220642

AN - SCOPUS:85053162017

JO - American Journal of Emergency Medicine

JF - American Journal of Emergency Medicine

SN - 0735-6757

ER -