Objective: To determine the association between 30-day mortality with Systemic Inflammatory Response Syndrome (SIRS), Sequential Organ Failure Assessment (SOFA), and quick SOFA (qSOFA) in emergency department patients with pneumonia. Secondary outcomes included the association of sepsis scores with hospital admission and direct ICU admission.
Methods: This is a secondary analysis of a pneumonia population conducted in the emergency department of 3 tertiary care medical centers and 4 community hospitals. Adult immunocompetent patients diagnosed with pneumonia were included from 3 twelve-month periods spanning December 2009 to October 2015. We generated area under the receiver operating characteristic curve (AUC) values for each sepsis score for our primary outcome of 30-day mortality and secondarily for hospital admission and direct ICU admission. We also created logistic regression models to assess associations of individual score components to the outcomes.
Results:We studied 6931 patients with mean (SD) age 58 (20) years, and 30 day all-cause mortality rate 7%. Hospital and ICU admission rate was 63% and 16% respectively. Sepsis by SIRS was present in 70% of patients. Only respiratory rate and white blood count of the SIRS criteria were associated with 30-day mortality (OR=2.42 [1.94, 3.03] and 2.06 [1.68, 2.54] respectively, both p
Conclusions: In emergency department patients with pneumonia, qSOFA outperformed SIRS in relation to 30-day mortality. Secondary outcomes also showed better performance of qSOFA in hospital and ICU admission compared to SIRS. SOFA performed better than qSOFA and SIRS for all outcomes except ICU admission.
Intermountain Research and Medical Foundation
Mecham, Ian D.; Dean, Nathan C.; Wilson, Emily L.; Jephson, Al R.; and Lanpsa, Michael J.
"The Association of qSOFA, SOFA, and SIRS with Mortality in Emergency Department Pneumonia,"
The University of Louisville Journal of Respiratory Infections: Vol. 2
, Article 4.
Available at: https://ir.library.louisville.edu/jri/vol2/iss2/4
Table 1 Patient Characteristics and Outcomes for total population and by qSOFA criteria while in the emergency department. SIRS, systemic inflammatory response syndrome. SOFA, sequential organ failure assessment. ICU, intensive care unit
Table 2 no title.pdf (194 kB)
Table 2 Odds Ratios for 30-day All-Cause Mortality by Individual Sepsis Score Criterion.
Table 3 no title.pdf (204 kB)
Table 3 Hospital and Direct Intensive Care Unit Admission by Individual Sepsis Score Criterion
Figure 1.eps (278 kB)
Fig. 1 Derivation of Study Population. Final groups show the number of patients included for analysis, based on having values for sepsis score criteria. ED, emergency department. HIV, human immunodeficiency virus. AIDS, acquired immunodeficiency syndrome.
Figure 2.eps (8 kB)
Fig. 2 Receiver Operating Characteristic Curves for 30-day All-Cause Mortality. Area under the curve (AUC) values based on observed data for each sepsis score. qSOFA and SOFA significantly outperformed SIRS (p<0.001). SOFA had greater association with mortality than qSOFA (p=0.002).
jri045_supplement-FINAL.pdf (315 kB)
qsofa efigure1 v2.eps (664 kB)
Supplement Figure 1
qsofa efigure2 v2.eps (663 kB)
Supplement Figure 2
qsofa etable 1.pdf (336 kB)
Supplement Table 1
qsofa etable2.pdf (336 kB)
Supplement Table 2
etable 3 qsofa.pdf (548 kB)
Supplement Table 3
etable 4 qsofa.pdf (547 kB)
Supplement Table 4
etable 5 qsofa.pdf (551 kB)
Supplement Table 5