A quick Sequential Organ Failure Assessment–negative result at triage is associated with low compliance with sepsis bundles: a retrospective analysis of a multicenter prospective registry

박희수,Shin Tae Gun,Kim Won Young,조유환,Hwang Yoon Jung,최성혁,Lim Tae Ho,Han Kap Su,Shin Jonghwan,Suh Gil Joon,Kang Gu Hyun,Kim Kyung Su 대한응급의학회 2022 Clinical and Experimental Emergency Medicine Vol.9 No.2

Objective We investigated the effects of a quick Sequential Organ Failure Assessment (qSOFA)–negative result (qSOFA score <2 points) at triage on the compliance with sepsis bundles among patients with sepsis who presented to the emergency department (ED).Methods Prospective sepsis registry data from 11 urban tertiary hospital EDs between October 2015 and April 2018 were retrospectively reviewed. Patients who met the Third International Consensus Definitions for Sepsis and Septic Shock criteria were included. Primary exposure was defined as a qSOFA score ≥2 points at ED triage. The primary outcome was defined as 3-hour bundle compliance, including lactate measurement, blood culture, broad-spectrum antibiotics administration, and 30 mL/kg crystalloid administration. Multivariate logistic regression analysis to predict 3-hour bundle compliance was performed.Results Among the 2,250 patients enrolled in the registry, 2,087 fulfilled the sepsis criteria. Only 31.4% (656/2,087) of the sepsis patients had qSOFA scores ≥2 points at triage. Patients with qSOFA scores <2 points had lower lactate levels, lower SOFA scores, and a lower 28-day mortality rate. Rates of compliance with lactate measurement (adjusted odds ratio [aOR], 0.47; 95% confidence interval [CI], 0.29–0.75), antibiotics administration (aOR, 0.64; 95% CI, 0.52–0.78), and 30 mL/kg crystalloid administration (aOR, 0.62; 95% CI, 0.49–0.77) within 3 hours from triage were significantly lower in patients with qSOFA scores <2 points. However, the rate of compliance with blood culture within 3 hours from triage (aOR, 1.66; 95% CI, 1.33–2.08) was higher in patients with qSOFA scores <2 points.Conclusion A qSOFA-negative result at ED triage is associated with low compliance with lactate measurement, broad-spectrum antibiotics administration, and 30 mL/kg crystalloid administration within 3 hours in sepsis patients.

Acute-on-chronic liver failure as a major predictive factor for mortality in patients with variceal bleeding

신종범,Jung Hwan Yu,Young-Joo Jin,Hyung Joon Yim,Young Kul Jung,Jin Mo Yang,Do Seon Song,Young Seok Kim,Sang Gyune Kim,김동준,석기태,Eileen L. Yoon,Sang Soo Lee,Chang-Wook Kim,Hee Yeon Kim,Jae Young Jang,Soung 대한간학회 2020 Clinical and Molecular Hepatology(대한간학회지) Vol.26 No.4

Background/Aims: This study examined the risk factors associated with mortality in cirrhotic patients hospitalized with variceal bleeding, and evaluated the effects of acute-on-chronic liver failure (ACLF) on the prognosis of these patients. Methods: This study was retrospectively conducted on patients registered in the Korean acute-on-chronic liver failure study cohort, and on 474 consecutive cirrhotic patients hospitalized with variceal bleeding from January 2013 to December 2013 at 21 university hospitals. ACLF was defined as described by the European Association for the Study of Liver-Chronic Liver Failure Consortium. Results: Among a total of 474 patients, 61 patients were diagnosed with ACLF. The cumulative overall survival (OS) rate was lower in the patients with ACLF than in those without (P<0.001), and patients with higher ACLF grades had a lower OS rate (P<0.001). The chronic liver failure-sequential organ failure assessment (CLIF-SOFA) score was identified as a significant prognostic factor in patients hospitalized with variceal bleeding (hazard ratio [HR], 1.40; 95% confidence interval [CI], 1.30–1.50; P<0.001), even in ACLF patients with variceal bleeding (HR, 1.32; 95% CI, 1.19–1.46, P<0.001). Concerning the prediction of the mortality risk at 28- and 90-day using CLIF-SOFA scores, c-statistics were 0.895 (95% CI, 0.829–0.962) and 0.897 (95% CI, 0.842–0.951), respectively, and the optimal cut-off values were 6.5 and 6.5, respectively. Conclusions: In cirrhotic patients hospitalized with variceal bleeding, the prognosis was poor when accompanied by ACLF, especially depending upon CLIF-SOFA score. CLIF-SOFA model well predicted the 28-day or 90-day mortality for cirrhotic patients who experienced variceal bleeding.

Prognostic Accuracy of the Quick Sequential Organ Failure Assessment for Outcomes Among Patients with Trauma in the Emergency Department: A Comparison with the Modified Early Warning Score, Revised Trauma Score, and Injury Severity Score

( Min Woo Kang ),( Seo Young Ko ),( Sung Wook Song ),( Woo Jeong Kim ),( Young Joon Kang ),( Kyeong Won Kang ),( Hyun Soo Park ),( Chang Bae Park ),( Jeong Ho Kang ),( Ji Hwan Bu ),( Sung Kgun Lee ) 대한외상학회 2021 大韓外傷學會誌 Vol.34 No.1

Purpose: To evaluate the severity of trauma, many scoring systems and predictive models have been presented. The quick Sequential Organ Failure Assessment (qSOFA) is a simple scoring system based on vital signs, and we expect it to be easier to apply to trauma patients than other trauma assessment tools. Methods: This study was a cross-sectional study of trauma patients who visited the emergency department of Jeju National University Hospital. We excluded patients under the age of 18 years and unknown outcomes. We calculated the qSOFA, the Modified Early Warning Score (mEWS), Revised Trauma Score (RTS), and Injury Severity Score (ISS) based on patients’ initial vital signs and assessments performed in the emergency department (ED). The primary outcome was mortality within 14 days of trauma. We analyzed qSOFA scores using multivariate logistic regression analysis and compared the predictive accuracy of these scoring systems using the area under the receiver operating characteristic curve (AUROC). Results: In total, 27,764 patients were analyzed. In the multivariate logistic regression analysis of the qSOFA, the adjusted odds ratios with 95% confidence interval (CI) for mortality relative to a qSOFA score of 0 were 27.82 (13.63-56.79) for a qSOFA score of 1, 373.31 (183.47-759.57) for a qSOFA score of 2, and 494.07 (143.75-1698.15) for a qSOFA score of 3. In the receiver operating characteristic (ROC) curve analysis for the qSOFA, mEWS, ISS, and RTS in predicting the outcomes, for mortality, the AUROC for the qSOFA (AUROC [95% CI]; 0.912 [0.871-0.952]) was significantly greater than those for the ISS (0.700 [0.608-0.793]) and RTS (0.160 [0.108-0.211]). Conclusions: The qSOFA was useful for predicting the prognosis of trauma patients evaluated in the ED.

중환자실에 입원하는 혈액종양 환자의 예후 예측에 있어 Simplified Acute Physiology Score 2 (SAPS 2)와 Sequential Organ Failure Assessment (SOFA) Score의 유용성

박성훈,고원중,정만표,김호중,권오정,강원기,정철원,안진석,서지영 대한중환자의학회 2009 Acute and Critical Care Vol.24 No.1

Background: The prognosis of hemato-oncology (HMO) patients admitted to the intensive care unit (ICU) is poor and predicting the mortality is important for decision making at the time of ICU admission and for administering aggressive treatment. Methods: We retrospectively reviewed 309 patients who were admitted to the medical ICU (MICU) at Samsung Medical Center from July in 2005 to June in 2006. We calculated their Simplified Acute Physiology Score II (SAPS II) and the Sequential Organ Failure Assessment (SOFA) score at the time of ICU admission and we investigated the relationship between the two scoring systems and the hospital mortality. Results: Among the 309 patients, the hospital mortality was 41.2%, and the mean SAPS II/SOFA score at ICU admission was 45.4±19.5/8.1±4.6. Seventy-nine (25.6%) patients had hemato-oncological diseases. Their hospital mortality was 65.8%, and the mean SAPS II/SOFA score at the time of ICU admission was 53.9±18.6/9.7±4.4, which was higher than that of the non-HMO patients (p=0.00). The area under the receiver operating characteristic (ROC) curves for the SAPS II/SOFA score for predicting the mortality was 0.794±0.05/0.785±0.051 (p=0.00/p=0.00) for the HMO patients. There was no significant difference in discrimination ability between the two scoring systems (p>0.05). None of the HMO patients with a SAPS II/SOFA score of 70/14 or higher survived. Conclusions: Both the SAPS II and SOFA scores at the time of ICU admission were similarly effective for predicting the hospital mortality. The two scoring systems could be useful tools for decision making at the time of ICU admission and for administering aggressive treatment.

Quick Sequential Organ Failure Assessment Score and the Modified Early Warning Score for Predicting Clinical Deterioration in General Ward Patients Regardless of Suspected Infection

Ko Ryoung-Eun,Kwon Oyeon,Cho Kyung-Jae,Lee Yeon Joo,Kwon Joon-myoung,Park Jinsik,Kim Jung Soo,Kim Ah Jin,Jo You Hwan,Lee Yeha,Jeon Kyeongman 대한의학회 2022 Journal of Korean medical science Vol.37 No.16

Background: The quick sequential organ failure assessment (qSOFA) score is suggested to use for screening patients with a high risk of clinical deterioration in the general wards, which could simply be regarded as a general early warning score. However, comparison of unselected admissions to highlight the benefits of introducing qSOFA in hospitals already using Modified Early Warning Score (MEWS) remains unclear. We sought to compare qSOFA with MEWS for predicting clinical deterioration in general ward patients regardless of suspected infection. Methods: The predictive performance of qSOFA and MEWS for in-hospital cardiac arrest (IHCA) or unexpected intensive care unit (ICU) transfer was compared with the areas under the receiver operating characteristic curve (AUC) analysis using the databases of vital signs collected from consecutive hospitalized adult patients over 12 months in five participating hospitals in Korea. Results: Of 173,057 hospitalized patients included for analysis, 668 (0.39%) experienced the composite outcome. The discrimination for the composite outcome for MEWS (AUC, 0.777; 95% confidence interval [CI], 0.770–0.781) was higher than that for qSOFA (AUC, 0.684; 95% CI, 0.676–0.686; P < 0.001). In addition, MEWS was better for prediction of IHCA (AUC, 0.792; 95% CI, 0.781–0.795 vs. AUC, 0.640; 95% CI, 0.625–0.645; P < 0.001) and unexpected ICU transfer (AUC, 0.767; 95% CI, 0.760–0.773 vs. AUC, 0.716; 95% CI, 0.707–0.718; P < 0.001) than qSOFA. Using the MEWS at a cutoff of ≥ 5 would correctly reclassify 3.7% of patients from qSOFA score ≥ 2. Most patients met MEWS ≥ 5 criteria 13 hours before the composite outcome compared with 11 hours for qSOFA score ≥ 2. Conclusion: MEWS is more accurate that qSOFA score for predicting IHCA or unexpected ICU transfer in patients outside the ICU. Our study suggests that qSOFA should not replace MEWS for identifying patients in the general wards at risk of poor outcome.

Clinical Use of Procalcitonin in the Diagnosis of Sepsis: Evaluation of PCT–qSOFA

김반석,임현선,김영아 대한진단검사의학회 2021 Laboratory Medicine Online Vol.11 No.1

Background: Sepsis is a life-threatening medical condition, and the diagnosis of sepsis should be conducted rapidly and accurately. The purpose of this study was to evaluate the diagnostic performance of a combination of procalcitonin (PCT) levels and quick sequential organ failure assessment (qSOFA), namely PCT–qSOFA, for the diagnosis of sepsis. Methods: A total of 204 patients were grouped according to the results of blood culture and systemic inflammatory response syndrome criteria (≥ 2/4) into the bacterial sepsis group (N = 67), the blood culture-negative sepsis group (N = 37), the blood culture-positive group without corresponding clinical symptoms or signs of sepsis (N = 35), and the control group without evidence of sepsis (N = 65). The diagnostic performance of PCT–qSOFA was assessed using the post-test probability analysis. Results: Compared with qSOFA, PCT–qSOFA demonstrated improved post-test probability (from 0.772 to 0.884) and a positive likelihood ratio (from 1.59 to 3.55) when it was applied to all subjects, including those in the intensive care unit (ICU). However, this improvement in diagnostic performance was not observed when PCT–qSOFA was applied to patients outside the ICU. Conclusions: The combined use of PCT and qSOFA can help clinicians identify patients with sepsis, including those in an ICU setting

중환자실에 입원한 환자의 장기부전 및 예후 평가를 위한 SOFA 점수체계의 의의

김수호 ( Su Ho Kim ),이명구 ( Myung Goo Lee ),박상면 ( Sang Myeon Park ),박용범 ( Young Bum Park ),장승훈 ( Seung Hun Jang ),김철홍 ( Cheol Hong Kim ),전만조 ( Man Jo Jeon ),신태림 ( Tae Rim Shin ),엄광석 ( Kwang Seok Eom ),현인규 대한결핵 및 호흡기학회 2004 Tuberculosis and Respiratory Diseases Vol.57 No.4

Acute Physiology and Chronic Health Evaluation II Score and Sequential Organ Failure Assessment Score as Predictors for Severe Trauma Patients in the Intensive Care Unit

이민아,최강국,유병철,박재정,박영은,곽지훈,이정남,전양빈,마대성,이길재 대한중환자의학회 2017 Acute and Critical Care Vol.32 No.4

Background: The Acute Physiology and Chronic Health Evaluation (APACHE) II scoring system and the Sequential Organ Failure Assessment (SOFA) scoring system are widely used for critically ill patients. We evaluated whether APACHE II score and SOFA score predict the outcome for trauma patients in the intensive care unit (ICU). Methods: We retrospectively analyzed trauma patients admitted to the ICU in a single trauma center between January 2014 and December 2015. The APACHE II score was figured out based on the data acquired from the first 24 hours of admission; the SOFA score was evaluated based on the first 3 days in the ICU. A total of 241 patients were available for analysis. Injury Severity score, APACHE II score, and SOFA score were evaluated. Results: The overall survival rate was 83.4%. The non-survival group had a significantly high APACHE II score (24.1 ± 8.1 vs. 12.3 ± 7.2, P < 0.001) and SOFA score (7.7 ± 1.7 vs. 4.3 ± 1.9, P < 0.001) at admission. SOFA score had the highest areas under the curve (0.904). During the first 3 days, SOFA score remained high in the non-survival group. In the non-survival group, cardiovascular system, neurological system, renal system, and coagulation system scores were significantly higher. Conclusions: In ICU trauma patients, both SOFA and APACHE II scores were good predictors of outcome, with the SOFA score being the most effective. In trauma ICU patients, the trauma scoring system should be complemented, recognizing that multi-organ failure is an important factor for mortality.

집중 치료실에 입실한 비대상성 간경변 환자의 예후 인자 분석

이길재,이정남,김나혜,김건국,이운기,백정흠,최상태,이원석,유병철,박연정 대한중환자의학회 2013 Acute and Critical Care Vol.28 No.2

Background: Patients with decompensated liver cirrhosis usually resulted in admission to the intensive care unit (ICU) during hospitalization. When admitted to the ICU, the mortality was high. The aim of this study is to identify multiple prognostic factors for mortality and to analyze the significance of prognostic survival model with each scoring system in patients with decompensated liver cirrhosis who was admitted to the ICU. Methods: From January 2008 to December 2008, 60 consecutive patients with decompensated liver cirrhosis were admitted in the ICU and retrospectively reviewed. Prognostic models used were Child-Turcotte-Pugh (CTP), model for end-stage liver disease (MELD), model for end-stage liver disease with incorporation of serum sodium (MELD-Na), acute physiology and chronic health evaluation (APACHE) II, and sequential organ failure assessment (SOFA). The predictive prognosis was analyzed using the area under the receiver’s operating characteristics curve (AUC). Results: The median follow up period was 20 months, and ICU mortality was 17% (n = 10). A total of 24 patients (40%) died during the study period. The average survival of five prognostic models was related with the severity of the disease. All of the five systems showed significant differences in the cumulative survival rate, according to the scores on admission, and the MELD-Na had the highest AUC (0.924). Multivariate analysis showed that bilirubin and albumin were significantly related to mortality. Conclusions: The CPT, MELD, MELD-Na, APACHE II, and SOFA may predict the prognosis of patients with decompensated liver cirrhosis. The MELD-Na could be a better prognostic predictor than other scoring systems.

지속성 급성호흡곤란증후군 환자에서 "저용량" 글루코코르티코이드 치료 효과에 대한 예비연구

남해성,박소영,김수아,송재욱,전경만,김호중,권오정,서지영,박맹렬,임소연 대한중환자의학회 2009 Acute and Critical Care Vol.24 No.2

Background: The role of glucocorticoids for treating persistent acute respiratory distress syndrome (ARDS) is matter of debate. In the previous studies, the side effects of moderate doses of glucocorticoids might have negated positive effects of glucocorticoids. This study aimed at determining the feasibility of administering "low-dose" glucocorticoid to treat the patients who suffer with persistent ARDS. Methods: We retrospectively reviewed the medical records of twelve patients with ARDS of at least seven days` duration and who were treated with "low-dose" glucocorticoid (starting dose of 1 mg/kg) between June 2007 to December 2008. The patients were divided by whether or not they were successfully weaned from the ventilator after glucocorticoid therapy. The baseline characteristics and physiologic parameters were recorded for up to 7 days after starting glucocorticoid therapy. Results: Five patients (42%) were included in the weaned group. There was no significant difference in the clinical characteristics and the physiologic parameters between the two groups on the day of ARDS. Yet the weaned group had a significantly lower Sequential Organ Failure Assessment (SOFA) score, as compared to that of the failed group [3 (3-6) vs 8 (5-12), p = 0.009)] at start of glucocorticoid treatment. After 3 days of glucocorticoid therapy, there was significant improvement in the PEEP, the PaO2/FIO2 ratio, the PCO2, the SOFA score and the Murray Lung Injury Score of the weaned group, as compared to that of the failed group. There were no major neuromuscular side effects from the therapy. Conclusions: This study suggests that the "low-dose" glucocorticoid therapy is feasible and that the SOFA score and the physiologic parameters may assist in determining whether or not to initiate and to continue glucocorticoid therapy for the patients who are suffering with persistent ARDS.