Verma Ankur, Farooq Aasiya, Jaiswal Sanjay, Haldar Meghna, Sheikh Wasil Rasool, Khanna Palak, Vishen Amit, Ahuja Rinkey, Khatai Abbas Ali, Prasad Nilesh
Department of Emergency Medicine, Max Super Specialty Hospital, New Delhi, India.
Department of Statistics, Amity Institute of Applied Sciences, Amity University, Noida, Uttar Pradesh, India.
Int J Crit Illn Inj Sci. 2023 Jan-Mar;13(1):26-31. doi: 10.4103/ijciis.ijciis_41_22. Epub 2023 Mar 24.
High in-hospital mortality in sepsis patients remains challenging for clinicians worldwide. Early recognition, prognostication, and aggressive management are essential for treating septic patients. Many scores have been formulated to guide clinicians to predict the early deterioration of such patients. Our objective was to compare predictive values of quick Sequential Organ Failure Assessment (qSOFA) and National Early Warning Score 2 (NEWS2) with respect to in-hospital mortality.
This prospective observational study was conducted in a tertiary care center in India. Adults with suspected infection with at least two Systemic Inflammatory Response Syndrome criteria presenting to the emergency department (ED) were enrolled. NEWS2 and qSOFA scores were calculated, and patients were followed until their primary outcome of mortality or hospital discharge. The diagnostic accuracy of qSOFA and NEWS2 for predicting mortality was analyzed.
Three hundred and seventy-three patients were enrolled. Overall mortality was 35.12%. A majority of patients had LOS between 2 and 6 days (43.70%). NEWS2 had higher area under curve at 0.781 (95% confidence interval [CI] (0.59, 0.97)) than qSOFA at 0.729 (95% CI [0.51, 0.94]), with < 0.001. Sensitivity, specificity, and diagnostic efficiency to predict mortality by NEWS2 were 83.21% (95% CI [83.17%, 83.24%]); 57.44% (95% CI [57.39%, 57.49%]); and 66.48% (95% CI [66.43%, 66.53%]), respectively. qSOFA score had sensitivity, specificity, and diagnostic efficiency to predict mortality of 77.10% (95% CI [77.06%, 77.14%]); 42.98% (95% CI [42.92%, 43.03%]); and 54.95% (95% CI [54.90%, 55.00%]), respectively.
NEWS2 is superior to qSOFA in predicting in-hospital mortality for sepsis patients presenting to the ED in India.
脓毒症患者的高院内死亡率对全球临床医生来说仍然是一项挑战。早期识别、预后评估和积极治疗对于脓毒症患者的治疗至关重要。已经制定了许多评分系统来指导临床医生预测此类患者的早期病情恶化。我们的目的是比较快速序贯器官衰竭评估（qSOFA）和国家早期预警评分2（NEWS2）对院内死亡率的预测价值。
这项前瞻性观察性研究在印度的一家三级医疗中心进行。纳入了至少符合两项全身炎症反应综合征标准且疑似感染的急诊科成年患者。计算NEWS2和qSOFA评分，并对患者进行随访，直至其出现死亡或出院的主要结局。分析qSOFA和NEWS2预测死亡率的诊断准确性。
共纳入373例患者。总体死亡率为35.12%。大多数患者的住院时间在2至6天之间（43.70%）。NEWS2的曲线下面积为0.781（95%置信区间[CI]（0.59，0.97）），高于qSOFA的0.729（95%CI[0.51，0.94]），P<0.001。NEWS2预测死亡率的敏感性、特异性和诊断效率分别为83.21%（95%CI[83.17%，83.24%]）；57.44%（95%CI[57.39%，57.49%]）；和66.48%（95%CI[66.43%，66.53%]）。qSOFA评分预测死亡率的敏感性、特异性和诊断效率分别为77.10%（95%CI[77.06%，77.14%]）；42.98%（95%CI[42.92%，43.03%]）；和54.95%（95%CI[54.90%，55.00%]）。
在预测印度急诊科脓毒症患者的院内死亡率方面，NEWS2优于qSOFA。
