Evaluation of the predicting effect of quick Sequential Organ Failure Assessment on septic shock_West China Medical Journal

Authors：

WEI Wei , XIA Yiqin ,  CAO Yu

Emergency Department, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

CAO Yu, Email: yuyuer@126.com

Keywords：

Sepsis; Septic shock; Lactate; Procalcitonin; Quick Sequential Organ Failure Assessment

DOI：

10.7507/1002-0179.201705085

Video：

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Objective To evaluate the predicting effect of quick Sequential Organ Failure Assessment (qSOFA) on septic shock, and investigate the probability of improving the predicting effect. Methods Patients with sepsis diagnosed in Emergency Department from July 2015 to June 2016 were enrolled. They were divided into shock group and non-shock group based on whether or not they had septic shock during 72 hours after admission. The multivariate logistic regression analysis was used to find out the independent risk factors affecting the incidence of septic shock. Receiver operating characteristic (ROC) curve was used to analyze those risk factors. Modified Early Warning Score (MEWS), Mortality in Emergency Department Sepsis Score (MEDS), Sequential Organ Failure Assessment (SOFA), Acute Physiology and Chronic HealthEvaluation (APACHE)Ⅱ and qSOFA were also compared with ROC curve analysis. The possibility of improvement of qSOFA predicting effect was discussed. Results A total of 821 patients were enrolled, with 108 in septic shock group and 713 in non-septic shock. The result of multivariate logistic regression analysis indicated that respiratory rate, systolic blood pressure, pH value, oxygenation index, lactate, albumin, Glasgow Coma Score and procalcitonin were the independent risk factors (P<0.05). The result of ROC analysis showed that the area under curve (AUC) of pH value, lactate and procalcitonin was 0.695, 0.678 and 0.694, respectively. Lactate had the highest value of specificity (0.868), positive predictive value (0.356) and positive likelihood ratio (3.644), while the sensitivity (0.889) and negative predictive value (0.961) of procalcitonin were the highest. MEWS, MEDS, SOFA, APACHEⅡ and qSOFA were compared with ROC. SOFA had the best predicting effect with the statistical results of AUC (0.833), sensitivity (0.835), specificity (0.435), positive predictive value (0.971), negative predictive value (0.971), and positive likelihood ratio (5.048); and MEWS had the highest negative likelihood ratio (0.581). qSOFA did not show a best predicting value. Conclusion qSOFA is not the best choice to predict the possibility of septic shock, but its predicting value might be improved when combined with pH value, lactate and procalcitonin.

Citation： WEI Wei, XIA Yiqin, CAO Yu. Evaluation of the predicting effect of quick Sequential Organ Failure Assessment on septic shock. West China Medical Journal, 2017, 32(6): 812-818. doi: 10.7507/1002-0179.201705085 Copy

1.	Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA, 2016, 315(8): 801-810.
2.	Dellinger RP, Levy MM, Rhodes A, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med, 2013, 41(2): 580-637.
3.	Huang CT, Tsai YJ, Tsai PR, et al. Severe sepsis and septic shock: timing of septic shock onset matters. Shock, 2016, 45(5): 518-524.
4.	Shin TG, Jo IJ, Hwang SY, et al. Comprehensive interpretation of central venous oxygen saturation and blood lactate levels during resuscitation of patients with severe sepsis and septic shock in the emergency department. Shock, 2016, 45(1): 4-9.
5.	Seymour CW, Liu VX, Iwashyna TJ, et al. Assessment of clinical criteria for sepsis: for the third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA, 2016, 315(8): 762-774.
6.	Dorsett M, Kroll M, Smith CS, et al. qSOFA has poor sensitivity for prehospital identification of severe sepsis and septic shock. Prehosp Emerg Care, 2017, 25: 1-9.
7.	Raith EP, Udy AA, Bailey M, et al. Prognostic accuracy of the SOFA score, SIRS criteria, and qSOFA score for in-hospital mortality among adults with suspected infection admitted to the intensive care unit. JAMA, 2017, 317(3): 290-300.
8.	Levy MM, Fink MP, Marshall JC, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS international sepsis definition conference. Crit Care Med, 2003, 31(4): 1250-1256.
9.	Ghanem-Zoubi NO, Vardi M, Laor A, et al. Assessment of disease-severity scoring systems for patients with sepsis in general internal medicine departments. Crit Care, 2011, 15(2): R95.
10.	Giamarellos-Bourboulis EJ, Norrby-Teglund A, Mylona V, et al. Risk assessment in sepsis: a new prognostication rule by APACHEⅡ score and serum soluble urokinase plasminogen activator receptor. Crit Care, 2012, 16(4): R149.
11.	Lagu T, Rothberg MB, Shieh MS, et al. Hospitalizations, costs, and outcomes of severe sepsis in the United States 2003 to 2007. Crit Care Med, 2012, 40(3): 754-761.
12.	Rhodes A, Evans LE, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Crit Care Med, 2017, 45(3): 486-552.
13.	Talan DA, Moran GJ, Abrahamian FM. Severe sepsis and septic shock in the emergency department. Infect Dis Clin North Am, 2008, 22(1): 1-31.
14.	Donnelly JP, Safford MM, Shapiro NI, et al. Application of the third international consensus definitions for sepsis (sepsis-3) classification: a retrospective population-based cohort study. Lancet Infect Dis, 2017: S1473-3099(17)30117-2.
15.	Wang JY, Chen YX, Guo SB, et al. Predictive performance of quick sepsis-related organ failure assessment for mortality and ICU admission in patients with infection at the ED. Am J Emerg Med, 2016, 34(9): 1788-1793.
16.	Vincent JL, Moreno R, Takala J, et al. The SOFA (sepsis related organ failure assessment) score to describe organ dysfuntion/failure. On behalf of the working group on sepsis-related problems of the european society of intensive care medicine. Intensive Care Med, 1996, 22(7): 707-710.
17.	Cecconi M, De Backer D, Antonelli M, et al. Consensus on circulatory shock and hemodynamic monitoring. Task force of the european society of intensive care medicine. Intensive Care Med, 2014, 40(12): 1795-1815.
18.	Kellum JA, Song M, Subramanian S. Acidemia: good, bad or inconsequential?. Vincent//JL, 2002: 510-516.
19.	Kellum JA. Metabolic acidosis in patients with sepsis: epiphenomenon or part of the pathophysiology?. Crit Care Resusc, 2004, 6(3): 197-203.
20.	Jansen TC, van Bommel J, Schoonderbeek FJ, et al. Early lactate-guided therapy in intensive care unit patients: a multicenter, open-label, randomized controlled trial. Am J Respir Crit Care Med, 2010, 182(6): 752-761.
21.	Jones AE, Shapiro NI, Trzeciak S, et al. Lactate clearance vs central venous oxygen saturation as goals of early sepsis therapy: a randomized clinical trial. JAMA, 2010, 303(8): 739-746.
22.	吕晓春, 许强宏, 蔡国龙, 等. ScVO₂ 联合乳酸清除率指导脓毒症休克患者的容量复苏. 中华医学杂志, 2015, 95(7): 496-500.
23.	田焕焕, 韩沙沙, 吕长俊, 等. 早期目标乳酸清除率对肺部感染致脓毒性休克治疗的作用. 中华危重病急救医学, 2012, 24(1): 42-45.
24.	于斌, 田慧艳, 胡振杰, 等. 乳酸清除率和中心静脉血氧饱和度指导严重感染患者液体复苏效果的比较. 中华危重病急救医学, 2013, 25(10): 578-583.
25.	Gu WJ, Zhang ZH, Bakker J. Early lactate clearance-guided therapy in patients with sepsis: a meta-analysis with trial sequential analysis of randomized controlled trials. Intensive Care Med, 2015, 41(10): 1862-1863.
26.	Simpson SQ, Gaines M, Hussein Y, et al. Early goal-directed therapy for severe sepsis and septic shock: a living systematic review. J Crit Care, 2016, 36: 43-48.
27.	Kimmoun A, Novy E, Auchet T, et al. Hemodynamic consequences of severe lactic acidosis in shock states: from bench to bedside. Crit Care, 2015, 19: 175.
28.	Wacker C, Prkno A, Brunkhorst FM, et al. Procalcitonin as a diagnostic marker for sepsis: a systematic review and meta-analysis. Lancet Infect Dis, 2013, 13(5): 426-435.
29.	Azevedo JR, Torres OJ, Czeczko NG, et al. Procalcitonin as a prognostic biomarker of severe sepsis and septic shock. Rev Col Bras Cir, 2012, 39(6): 456-461.
30.	De Jong E, Van Oers JA, Beishuizen A, et al. Efficacy and safety of procalcitonin guidance in reducing the duration of antibiotic treatment in critically ill patients: a randomised, controlled, open-label trial. Lancet Infect Dis, 2016, 16(7): 819-827.

1. Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA, 2016, 315(8): 801-810.
2. Dellinger RP, Levy MM, Rhodes A, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med, 2013, 41(2): 580-637.
3. Huang CT, Tsai YJ, Tsai PR, et al. Severe sepsis and septic shock: timing of septic shock onset matters. Shock, 2016, 45(5): 518-524.
4. Shin TG, Jo IJ, Hwang SY, et al. Comprehensive interpretation of central venous oxygen saturation and blood lactate levels during resuscitation of patients with severe sepsis and septic shock in the emergency department. Shock, 2016, 45(1): 4-9.
5. Seymour CW, Liu VX, Iwashyna TJ, et al. Assessment of clinical criteria for sepsis: for the third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA, 2016, 315(8): 762-774.
6. Dorsett M, Kroll M, Smith CS, et al. qSOFA has poor sensitivity for prehospital identification of severe sepsis and septic shock. Prehosp Emerg Care, 2017, 25: 1-9.
7. Raith EP, Udy AA, Bailey M, et al. Prognostic accuracy of the SOFA score, SIRS criteria, and qSOFA score for in-hospital mortality among adults with suspected infection admitted to the intensive care unit. JAMA, 2017, 317(3): 290-300.
8. Levy MM, Fink MP, Marshall JC, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS international sepsis definition conference. Crit Care Med, 2003, 31(4): 1250-1256.
9. Ghanem-Zoubi NO, Vardi M, Laor A, et al. Assessment of disease-severity scoring systems for patients with sepsis in general internal medicine departments. Crit Care, 2011, 15(2): R95.
10. Giamarellos-Bourboulis EJ, Norrby-Teglund A, Mylona V, et al. Risk assessment in sepsis: a new prognostication rule by APACHEⅡ score and serum soluble urokinase plasminogen activator receptor. Crit Care, 2012, 16(4): R149.
11. Lagu T, Rothberg MB, Shieh MS, et al. Hospitalizations, costs, and outcomes of severe sepsis in the United States 2003 to 2007. Crit Care Med, 2012, 40(3): 754-761.
12. Rhodes A, Evans LE, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Crit Care Med, 2017, 45(3): 486-552.
13. Talan DA, Moran GJ, Abrahamian FM. Severe sepsis and septic shock in the emergency department. Infect Dis Clin North Am, 2008, 22(1): 1-31.
14. Donnelly JP, Safford MM, Shapiro NI, et al. Application of the third international consensus definitions for sepsis (sepsis-3) classification: a retrospective population-based cohort study. Lancet Infect Dis, 2017: S1473-3099(17)30117-2.
15. Wang JY, Chen YX, Guo SB, et al. Predictive performance of quick sepsis-related organ failure assessment for mortality and ICU admission in patients with infection at the ED. Am J Emerg Med, 2016, 34(9): 1788-1793.
16. Vincent JL, Moreno R, Takala J, et al. The SOFA (sepsis related organ failure assessment) score to describe organ dysfuntion/failure. On behalf of the working group on sepsis-related problems of the european society of intensive care medicine. Intensive Care Med, 1996, 22(7): 707-710.
17. Cecconi M, De Backer D, Antonelli M, et al. Consensus on circulatory shock and hemodynamic monitoring. Task force of the european society of intensive care medicine. Intensive Care Med, 2014, 40(12): 1795-1815.
18. Kellum JA, Song M, Subramanian S. Acidemia: good, bad or inconsequential?. Vincent//JL, 2002: 510-516.
19. Kellum JA. Metabolic acidosis in patients with sepsis: epiphenomenon or part of the pathophysiology?. Crit Care Resusc, 2004, 6(3): 197-203.
20. Jansen TC, van Bommel J, Schoonderbeek FJ, et al. Early lactate-guided therapy in intensive care unit patients: a multicenter, open-label, randomized controlled trial. Am J Respir Crit Care Med, 2010, 182(6): 752-761.
21. Jones AE, Shapiro NI, Trzeciak S, et al. Lactate clearance vs central venous oxygen saturation as goals of early sepsis therapy: a randomized clinical trial. JAMA, 2010, 303(8): 739-746.
22. 吕晓春, 许强宏, 蔡国龙, 等. ScVO₂ 联合乳酸清除率指导脓毒症休克患者的容量复苏. 中华医学杂志, 2015, 95(7): 496-500.
23. 田焕焕, 韩沙沙, 吕长俊, 等. 早期目标乳酸清除率对肺部感染致脓毒性休克治疗的作用. 中华危重病急救医学, 2012, 24(1): 42-45.
24. 于斌, 田慧艳, 胡振杰, 等. 乳酸清除率和中心静脉血氧饱和度指导严重感染患者液体复苏效果的比较. 中华危重病急救医学, 2013, 25(10): 578-583.
25. Gu WJ, Zhang ZH, Bakker J. Early lactate clearance-guided therapy in patients with sepsis: a meta-analysis with trial sequential analysis of randomized controlled trials. Intensive Care Med, 2015, 41(10): 1862-1863.
26. Simpson SQ, Gaines M, Hussein Y, et al. Early goal-directed therapy for severe sepsis and septic shock: a living systematic review. J Crit Care, 2016, 36: 43-48.
27. Kimmoun A, Novy E, Auchet T, et al. Hemodynamic consequences of severe lactic acidosis in shock states: from bench to bedside. Crit Care, 2015, 19: 175.
28. Wacker C, Prkno A, Brunkhorst FM, et al. Procalcitonin as a diagnostic marker for sepsis: a systematic review and meta-analysis. Lancet Infect Dis, 2013, 13(5): 426-435.
29. Azevedo JR, Torres OJ, Czeczko NG, et al. Procalcitonin as a prognostic biomarker of severe sepsis and septic shock. Rev Col Bras Cir, 2012, 39(6): 456-461.
30. De Jong E, Van Oers JA, Beishuizen A, et al. Efficacy and safety of procalcitonin guidance in reducing the duration of antibiotic treatment in critically ill patients: a randomised, controlled, open-label trial. Lancet Infect Dis, 2016, 16(7): 819-827.

West China Medical Journal

Evaluation of the predicting effect of quick Sequential Organ Failure Assessment on septic shock

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