Sepsis-Related Mortality with SOFA and qSOFA in Emergency Department Patients

Abstract

Aim: Prediction of sepsis-related mortality in the emergency department (ED) is important. In this study, we aimed to assess the predictive power of the newly defined scoring systems in sepsis-related mortality and reduce it in the ED. Materials and Methods: A prospective cohort study was conducted on a sample of patients who presented to the ED with sepsis. Patients aged <18 years and those with shock from non-septic causes were excluded. Age, vital signs, laboratory findings on admission, culture time, time of empiric antibiotic therapy, results of scoring systems, duration of ED stay and hospitalization, focus of infection and clinical outcome were recorded. Results: A total of 48 patients were enrolled in the study. SOFA scores were higher in patients who died (p = 0.001, 95% CI, 0.639-0.902). The best cut-off point for diagnostic performance was a SOFA score of 4.5. At this point, sensitivity was 82.61%, specificity was 56.0%, positive predictive value was 63.3% and negative predictive value was 77.8%. Discussion: qSOFA and SIRS cannot provide adequate prognostic information in the ED, whereas, SOFA reliably predicted mortality. Our results indicate that vital signs are more flexible and efficient data sources. Although it is presently not precisely understood how RDW is associated with clinical outcomes but patients with increased RDW levels should be more aggressively treated and admission RDW could also be used for prognostic purposes, particularly in busy EDs. Also, lactate levels were correlated with SOFA and qSOFA scores and that the former could predict mortality (p= 0.012) is consistent with previous studies of infection Conclusion: In conclusion, qSOFA had poor performance for the prediction of sepsis-related mortality in the ED. SOFA had the best performance.