Sanguanwit Pitsucha, Yuksen Chaiyaporn, Khorana Jiraporn, Sutham Krongkarn, Phootothum Yuranun, Damdin Siriporn
Department of Emergency Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand.
Division of Pediatric Surgery, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand.
Arch Acad Emerg Med. 2024 Jun 29;12(1):e56. doi: 10.22037/aaem.v12i1.2269. eCollection 2024.
Sepsis is a significant and common cause of death and burden among critically ill patients, which has increasing incidence and mortality in adults over 60 and advanced age. This study aimed to develop an easy-to-use clinical tool for assessing 28-day mortality risk in older sepsis patients upon their initial assessment in the emergency department (ED).
A retrospective cohort study was conducted using electronic medical records of older (≥60 years) ED patients with suspected sepsis from August 1, 2018, to December 31, 2018. A new prediction score was formulated based on the logistic coefficients of clinical predictors through multivariable regression analyses. Then, the score's screening performance was evaluated and compared to existing scoring systems; Systemic Inflammatory Response Syndrome (SIRS), quick Sequential Organ Failure Assessment (qSOFA), National early warning score (NEWS), and The Ramathibodi early warning score (REWS); using receiver operating characteristic curve analysis (AuROC).
The study included 599 patients with the mean age of 77.13 (range: 60-101) years (56.43% male) and an overall 28-day mortality rate of 7.01%. The newly developed prediction score had seven independent predictors of 28-day mortality: malignancy, dependent status, heart rate, respiratory rate, oxygen saturation, consciousness, and lactate, which demonstrated excellent discriminative ability (AuROC: 0.87, 95% confidence interval (CI): 0.82 - 0.92), significantly outperforming SIRS (AuROC: 0.62), qSOFA (AuROC: 0.72), NEWS (AuROC: 0.74), and REWS (AuROC: 0.71), all with p-values <0.01. The score allowed risk stratification into low-risk (positive likelihood ratio (LR+): 0.37, 95% CI: 0.24 - 0.58) and high-risk (LR+: 4.14, 95% CI: 3.14 - 5.44) groups with sensitivity of 69.0% and specificity of 83.3% at a cut-off point of 6.
The novel prediction score demonstrates a remarkable ability to predict 28-day mortality risk in older sepsis patients during their initial ED assessment, offering potential for improved risk stratification and treatment guidance in older patients.
脓毒症是重症患者死亡和负担的一个重要且常见原因，在60岁及以上的成年人和高龄人群中，其发病率和死亡率呈上升趋势。本研究旨在开发一种易于使用的临床工具，用于评估老年脓毒症患者在急诊科（ED）初次评估时的28天死亡风险。
采用回顾性队列研究，使用2018年8月1日至2018年12月31日期间年龄≥60岁、疑似脓毒症的ED患者的电子病历。通过多变量回归分析，根据临床预测指标的逻辑系数制定了一个新的预测评分。然后，评估该评分的筛查性能，并与现有评分系统进行比较；全身炎症反应综合征（SIRS）、快速序贯器官衰竭评估（qSOFA）、国家早期预警评分（NEWS）和拉玛蒂博迪早期预警评分（REWS）；使用受试者工作特征曲线分析（AuROC）。
该研究纳入了599例患者，平均年龄为77.13岁（范围：60 - 101岁）（男性占56.43%），28天总死亡率为7.01%。新开发的预测评分有7个28天死亡的独立预测因素：恶性肿瘤、依赖状态、心率、呼吸频率、血氧饱和度、意识和乳酸，其显示出优异的判别能力（AuROC：0.87，95%置信区间（CI）：0.82 - 0.92），显著优于SIRS（AuROC：0.62）、qSOFA（AuROC：0.72）、NEWS（AuROC：0.74）和REWS（AuROC：0.71），所有p值均<0.01。该评分可将风险分层为低风险（阳性似然比（LR+）：0.37，95% CI：0.24 - 0.58）和高风险（LR+：4.14，95% CI：3.14 - 5.44）组，在截断点为6时，敏感性为69.0%，特异性为83.3%。
该新型预测评分在老年脓毒症患者初次ED评估时，显示出预测28天死亡风险的卓越能力，为改善老年患者的风险分层和治疗指导提供了潜力。
