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. 2018 Apr 3;8(1):44.
doi: 10.1186/s13613-018-0389-3.

Mortality and detailed characteristics of pre-ICU qSOFA-negative patients with suspected sepsis: an observational study

Izumi Nakayama  1 , Junichi Izawa  2   3 , Hideyuki Mouri  4 , Tetsuhisa Kitamura  5 , Junji Shiotsuka  4
Affiliations

Mortality and detailed characteristics of pre-ICU qSOFA-negative patients with suspected sepsis: an observational study

Izumi Nakayama et al. Ann Intensive Care. .

Abstract

Background: Recent studies have suggested that quick Sequential Organ Failure Assessment (qSOFA) scores have limited utility in early prognostication in high-mortality populations. The purpose of this study was to investigate the association between pre-ICU qSOFA scores and in-hospital mortality among patients admitted to the ICU with suspected sepsis. This study also aimed to describe detailed clinical characteristics of qSOFA-negative (< 2) patients.

Methods: This single center, observational study, conducted in a Japanese tertiary care teaching hospital between May 2012 and June 2016, enrolled all consecutive adult patients admitted to the ICU with suspected sepsis. We assessed pre-ICU qSOFA scores with the most abnormal vital signs during the 24-h period before ICU admission. The primary outcome was in-hospital mortality censored at 90 days. We analyzed the association between pre-ICU qSOFA scores and in-hospital mortality.

Results: Among 185 ICU patients with suspected sepsis, 14.1% (26/185) of patients remained qSOFA-negative at the time of ICU admission and 29.2% (54/185) of patients died while in hospital. In-hospital mortality was similar between the groups (qSOFA-positive [≥ 2]: 30.2% [48/159] vs qSOFA-negative: 23.1% [6/26], p = 0.642). The Cox proportional hazard regression model revealed that being qSOFA-positive was not significantly associated with in-hospital mortality (adjusted hazard ratio 1.35, 95% confidence interval 0.56-3.22, p = 0.506). Bloodstream infection, immunosuppression, and hematologic malignancy were observed more frequently in qSOFA-negative patients.

Conclusions: Among ICU patients with suspected sepsis, we could not find a strong association between pre-ICU qSOFA scores and in-hospital mortality. Our study suggested high mortality and bacterial diversity in pre-ICU qSOFA-negative patients.

Keywords: Bacteremia; Critical care; Infection; Intensive care unit; Mortality; Sepsis; quick Sequential Organ Failure Assessment (qSOFA) score.

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Figures

Fig. 1
Fig. 1
Flow of patients admitted to the ICU with suspected sepsis from 2012 to 2016. ICU denotes intensive care unit, qSOFA quick Sequential Organ Failure Assessment
Fig. 2
Fig. 2
Kaplan–Meier curves of in-hospital mortality censored at 90 days stratified as pre-ICU qSOFA-positive or qSOFA-negative. aAdjusted for age, the presence of rigor (‘shaking chills’), prior location to the ICU and chronic health condition with immunosuppression. CI confidence interval, HR hazard ratio, ICU intensive care unit, qSOFA quick Sequential Organ Failure Assessment. The vertical tick marks on the curves denote censoring due to survival discharge
See this image and copyright information in PMC

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