Predicting in-hospital mortality for sepsis: a comparison between qSOFA and modified qSOFA in a 2-year single-centre ret
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ORIGINAL ARTICLE
Predicting in-hospital mortality for sepsis: a comparison between qSOFA and modified qSOFA in a 2-year single-centre retrospective analysis Matteo Guarino 1 & Edoardo Gambuti 1 & Franco Alfano 1 & Alfredo De Giorgi 2 & Elisa Maietti 3,4 & Andrea Strada 5 & Francesco Ursini 1 & Stefano Volpato 1 & Giacomo Caio 1 & Carlo Contini 6 & Roberto De Giorgio 1 Received: 19 July 2020 / Accepted: 23 October 2020 # The Author(s) 2020
Abstract Sepsis is a life-threating organ dysfunction caused by a dysregulated host response to infection. This study proposed a new tool, i.e. modified qSOFA, for the early prognostic assessment of septic patients. All cases of sepsis/septic shock consecutively observed in 2 years (January 2017–December 2018), at St. Anna University Hospital of Ferrara, Italy, were included. Each patient was evaluated with qSOFA and a modified qSOFA (MqSOFA), i.e. adding a SpO2/FiO2 ratio to qSOFA. Logistic regression and survival analyses were applied to compare the two scores. A total number of 1137 consecutive cases of sepsis and septic shock were considered. Among them 136 were excluded for incomplete report of vital parameters. A total number of 668 patients (66.7%) were discharged, whereas 333 (33.3%) died because of sepsis-related complications. Data analysis showed that MqSOFA (AUC 0.805, 95% C.I. 0.776–0.833) had a greater ability to detect in-hospital mortality than qSOFA (AUC 0.712, 95% C.I. 0.678–0.746) (p < 0.001). Eighty-five patients (8.5%) were reclassified as high-risk (qSOFA< 2 and MqSOFA≥ 2) resulting in an improvement of sensitivity with a minor reduction in specificity. A significant difference of in-hospital mortality was observed between low-risk and reclassified high-risk (p < 0.001) and low-risk vs. high-risk groups (p < 0.001). We demonstrated that MqSOFA provided a better predictive score than qSOFA regarding patient’s outcome. Since sepsis is an underhanded and time-dependent disease, physicians may rely upon the herein proposed simple score, i.e. MqSOFA, to establish patients’ severity and outcome. Keywords Sepsis . Septic shock . SpO2/FiO2 . In-hospital mortality . Patients’ outcome . MqSOFA Supplementary Information The online version contains supplementary material available at https://doi.org/10.1007/s10096-02004086-1. * Roberto De Giorgio [email protected] 1
Department of Morphology, Surgery and Experimental Medicine, St. Anna University Hospital, University of Ferrara, Via A. Moro, 844124, Cona, Ferrara, Italy
2
Department of Internal Medicine, St. Anna University Hospital, University of Ferrara, Cona, Ferrara, Italy
3
Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
4
Centre of Clinical Epidemiology, Department of Medical Science, University of Ferrara, Ferrara, Italy
5
Department of Emergency Medicine, St. Anna University Hospital, University of Ferrara, Cona, Ferrara, Italy
6
Department of Infectious and Dermatology Diseases, St. Anna University Hospital, University of Ferrara, Cona, Ferrara, Italy
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