Development and validation of a modified quick SOFA scale for risk assessment in sepsis syndrome
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Tarih
2018Yazar
Erdogan, Haluk
Cag, Yasemin
Karabay, Oguz
Sipahi, Oguz Resat
Aksoy, Firdevs
Durmus, Gul
Batirel, Ayse
Ak, Oznur
Kocak-Tufan, Zeliha
Atilla, Aynur
Piskin, Nihal
Akbas, Turkay
Erol, Serpil
Ozturk-Engin, Derya
Caskurlu, Hulya
Onal, Ugur
Demirel, Aslihan
Dogru, Arzu
Harman, Rezan
Hamidi, Aziz Ahmad
Karasu, Derya
Korkmaz, Fatime
Korkmaz, Pinar
Eser, Fatma Civelek
Onem, Yalcin
Cesur, Sinem
Salmanogiu, Musa
Erdem, Ilknur
Diktas, Husrev
Vahabaroglu, Haluk
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Sepsis is a severe clinical syndrome owing to its high mortality. Quick Sequential Organ Failure Assessment (qSOFA) score has been proposed for the prediction of fatal outcomes in sepsis syndrome in emergency departments. Due to the low predictive performance of the qSOFA score, we propose a modification to the score by adding age. We conducted a multicenter, retrospective cohort study among regional referral centers from various regions of the country. Participants recruited data of patients admitted to emergency departments and obtained a diagnosis of sepsis syndrome. Crude in-hospital mortality was the primary endpoint. A generalized mixed-effects model with random intercepts produced estimates for adverse outcomes. Model-based recursive partitioning demonstrated the effects and thresholds of significant covariates. Scores were internally validated. The H measure compared performances of scores. A total of 580 patients from 22 centers were included for further analysis. Stages of sepsis, age, time to antibiotics, and administration of carbapenem for empirical treatment were entered the final model. Among these, severe sepsis (OR, 4.40; CIs, 2.35-8.21), septic shock (OR, 8.78; CIs, 4.37-17.66), age (OR, 1.03; CIs, 1.02-1.05) and time to antibiotics (OR, 1.05; CIs, 1.01-1.10) were significantly associated with fatal outcomes. A decision tree demonstrated the thresholds for age. We modified the quick Sequential Organ Failure Assessment (mod-qSOFA) score by adding age (> 50 years old = one point) and compared this to the conventional score. H-measures for qSOFA and mod-qSOFA were found to be 0.11 and 0.14, respectively, whereas AUCs of both scores were 0.64. We propose the use of the modified qSOFA score for early risk assessment among sepsis patients for improved triage and management of this fatal syndrome.
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https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0204608&type=printablehttp://hdl.handle.net/11727/3137