Validation of prognostic accuracy of the SOFA score, SIRS criteria, and qSOFA score for in‐hospital mortality among cardiac‐, thoracic‐, and vascular‐surgery patients admitted to a cardiothoracic intensive care unit

Sepsis‐3 DefinitionSepsis is defined as life‐threatening organ dysfunction due to a dysregulated host response to infection. The clinical criteria of sepsis include organ dysfunction, which is defined as an increase of two points or more on the sequential organ failure assessment (SOFA). For patient...

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Main Authors: ZHANG, Yuchong, LUO, Haidong, WANG, Hai, ZHENG, Zhichao, OOI, Oon Cheong
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Online Access:https://ink.library.smu.edu.sg/lkcsb_research/6488
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spelling sg-smu-ink.lkcsb_research-74872020-01-16T09:24:03Z Validation of prognostic accuracy of the SOFA score, SIRS criteria, and qSOFA score for in‐hospital mortality among cardiac‐, thoracic‐, and vascular‐surgery patients admitted to a cardiothoracic intensive care unit ZHANG, Yuchong LUO, Haidong WANG, Hai ZHENG, Zhichao OOI, Oon Cheong Sepsis‐3 DefinitionSepsis is defined as life‐threatening organ dysfunction due to a dysregulated host response to infection. The clinical criteria of sepsis include organ dysfunction, which is defined as an increase of two points or more on the sequential organ failure assessment (SOFA). For patients with infection, an increase of 2 SOFA points yields an overall mortality rate of 10%. Patients with suspected infection who are likely to have a prolonged intensive care unit (ICU) stay or to have in‐hospital mortality can be promptly identified at the bedside with a quick SOFA (qSOFA) score of 2 or higher.ImportanceThe sepsis‐3 criteria have emphasized the value of a change of two or more points on the SOFA, introduced the qSOFA, and removed the systemic inflammatory response syndrome (SIRS) criteria from the sepsis definition.ObjectiveTo externally validate and assess the discriminatory capacities of an increase in the SOFA score by two or more points, the presence of two or more SIRS criteria, or a qSOFA score of 2 or more points for outcomes in 5109 patients, the vast majority of whom were postcardiac surgery patients who were admitted to a Cardiothoracic Surgical ICU in Singapore.Design, Setting, and ParticipantsA retrospective cohort analysis of 5109 patients with an infection‐related primary admission diagnosis in the cardiothoracic intensive care unit (CTICU) at the National University Hospital (NUH) in Singapore from 2010 to 2016.ExposuresThe SOFA, qSOFA, and SIRS criteria were applied to the data representing the worst condition within 24 hours of ICU admission.Main Outcomes and MeasuresThe primary outcome was in‐hospital mortality. Discrimination was assessed using the area under the receiver operating characteristic curve (AUROC).ResultsIn 5109 patients, the average mortality of patients with an increase in the SOFA scores of less than 2 points was 3.5% (n = 64), and it was 6% (n = 199) for those with an increase in the SOFA scores of 2 or more points. The mortality of patients with an increase in the qSOFA scores of less than 2 points was 2.6% (n = 7), and it was 5.3% (n = 256) for those with an increase in the qSOFA scores of 2 or more points. The mortality of patients with an increase in the SIRS criteria of less than 2 points was 3.6% (n = 30), and it was 5.4% (n = 233) for those with an increase in the SIRS criteria of 2 or more points. The AUROC of in‐hospital mortality of patients with an increase in the SOFA, qSOFA, and SIRS criteria of 2 or more points was 0.96, 0.95, and 0.95, respectively.Conclusions and RelevanceIn adults with suspected infection admitted to the CTICU in NUH, the change in in‐hospital mortality between patients with an increase in SOFA scores of less than 2 and those with an increase of 2 or more was 2.5 percentage points. In contrast to other studies, the absolute change in mortality was nearly the same compared to the qSOFA and SIRS criteria, and the qSOFA score had the greatest percentage increase of 104%, compared to 71% for the SOFA score and 50% for the SIRS criteria. Besides, from the perspective of discriminatory capacities, an increase in SOFA scores of 2 or more did not demonstrate significantly greater prognostic accuracy for in‐hospital mortality than equivalent increases in qSOFA scores or SIRS criteria. These findings suggest distinctive characteristics of the study population in the CTICU that are different from the general population. 2019-11-11T08:00:00Z text https://ink.library.smu.edu.sg/lkcsb_research/6488 info:doi/10.1111/jocs.14331 Research Collection Lee Kong Chian School Of Business eng Institutional Knowledge at Singapore Management University Operations Research, Systems Engineering and Industrial Engineering
institution Singapore Management University
building SMU Libraries
continent Asia
country Singapore
Singapore
content_provider SMU Libraries
collection InK@SMU
language English
topic Operations Research, Systems Engineering and Industrial Engineering
spellingShingle Operations Research, Systems Engineering and Industrial Engineering
ZHANG, Yuchong
LUO, Haidong
WANG, Hai
ZHENG, Zhichao
OOI, Oon Cheong
Validation of prognostic accuracy of the SOFA score, SIRS criteria, and qSOFA score for in‐hospital mortality among cardiac‐, thoracic‐, and vascular‐surgery patients admitted to a cardiothoracic intensive care unit
description Sepsis‐3 DefinitionSepsis is defined as life‐threatening organ dysfunction due to a dysregulated host response to infection. The clinical criteria of sepsis include organ dysfunction, which is defined as an increase of two points or more on the sequential organ failure assessment (SOFA). For patients with infection, an increase of 2 SOFA points yields an overall mortality rate of 10%. Patients with suspected infection who are likely to have a prolonged intensive care unit (ICU) stay or to have in‐hospital mortality can be promptly identified at the bedside with a quick SOFA (qSOFA) score of 2 or higher.ImportanceThe sepsis‐3 criteria have emphasized the value of a change of two or more points on the SOFA, introduced the qSOFA, and removed the systemic inflammatory response syndrome (SIRS) criteria from the sepsis definition.ObjectiveTo externally validate and assess the discriminatory capacities of an increase in the SOFA score by two or more points, the presence of two or more SIRS criteria, or a qSOFA score of 2 or more points for outcomes in 5109 patients, the vast majority of whom were postcardiac surgery patients who were admitted to a Cardiothoracic Surgical ICU in Singapore.Design, Setting, and ParticipantsA retrospective cohort analysis of 5109 patients with an infection‐related primary admission diagnosis in the cardiothoracic intensive care unit (CTICU) at the National University Hospital (NUH) in Singapore from 2010 to 2016.ExposuresThe SOFA, qSOFA, and SIRS criteria were applied to the data representing the worst condition within 24 hours of ICU admission.Main Outcomes and MeasuresThe primary outcome was in‐hospital mortality. Discrimination was assessed using the area under the receiver operating characteristic curve (AUROC).ResultsIn 5109 patients, the average mortality of patients with an increase in the SOFA scores of less than 2 points was 3.5% (n = 64), and it was 6% (n = 199) for those with an increase in the SOFA scores of 2 or more points. The mortality of patients with an increase in the qSOFA scores of less than 2 points was 2.6% (n = 7), and it was 5.3% (n = 256) for those with an increase in the qSOFA scores of 2 or more points. The mortality of patients with an increase in the SIRS criteria of less than 2 points was 3.6% (n = 30), and it was 5.4% (n = 233) for those with an increase in the SIRS criteria of 2 or more points. The AUROC of in‐hospital mortality of patients with an increase in the SOFA, qSOFA, and SIRS criteria of 2 or more points was 0.96, 0.95, and 0.95, respectively.Conclusions and RelevanceIn adults with suspected infection admitted to the CTICU in NUH, the change in in‐hospital mortality between patients with an increase in SOFA scores of less than 2 and those with an increase of 2 or more was 2.5 percentage points. In contrast to other studies, the absolute change in mortality was nearly the same compared to the qSOFA and SIRS criteria, and the qSOFA score had the greatest percentage increase of 104%, compared to 71% for the SOFA score and 50% for the SIRS criteria. Besides, from the perspective of discriminatory capacities, an increase in SOFA scores of 2 or more did not demonstrate significantly greater prognostic accuracy for in‐hospital mortality than equivalent increases in qSOFA scores or SIRS criteria. These findings suggest distinctive characteristics of the study population in the CTICU that are different from the general population.
format text
author ZHANG, Yuchong
LUO, Haidong
WANG, Hai
ZHENG, Zhichao
OOI, Oon Cheong
author_facet ZHANG, Yuchong
LUO, Haidong
WANG, Hai
ZHENG, Zhichao
OOI, Oon Cheong
author_sort ZHANG, Yuchong
title Validation of prognostic accuracy of the SOFA score, SIRS criteria, and qSOFA score for in‐hospital mortality among cardiac‐, thoracic‐, and vascular‐surgery patients admitted to a cardiothoracic intensive care unit
title_short Validation of prognostic accuracy of the SOFA score, SIRS criteria, and qSOFA score for in‐hospital mortality among cardiac‐, thoracic‐, and vascular‐surgery patients admitted to a cardiothoracic intensive care unit
title_full Validation of prognostic accuracy of the SOFA score, SIRS criteria, and qSOFA score for in‐hospital mortality among cardiac‐, thoracic‐, and vascular‐surgery patients admitted to a cardiothoracic intensive care unit
title_fullStr Validation of prognostic accuracy of the SOFA score, SIRS criteria, and qSOFA score for in‐hospital mortality among cardiac‐, thoracic‐, and vascular‐surgery patients admitted to a cardiothoracic intensive care unit
title_full_unstemmed Validation of prognostic accuracy of the SOFA score, SIRS criteria, and qSOFA score for in‐hospital mortality among cardiac‐, thoracic‐, and vascular‐surgery patients admitted to a cardiothoracic intensive care unit
title_sort validation of prognostic accuracy of the sofa score, sirs criteria, and qsofa score for in‐hospital mortality among cardiac‐, thoracic‐, and vascular‐surgery patients admitted to a cardiothoracic intensive care unit
publisher Institutional Knowledge at Singapore Management University
publishDate 2019
url https://ink.library.smu.edu.sg/lkcsb_research/6488
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