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. 2023 Apr 18:10:1149736.
doi: 10.3389/fmed.2023.1149736. eCollection 2023.

Prehospital qSOFA, mSOFA, and NEWS2 performance for sepsis prediction: A prospective, multi-center, cohort study

Laura Melero-Guijarro  1 , Ancor Sanz-García  2   3 , Francisco Martín-Rodríguez  3   4   5 , Vivian Lipari  6   7 , Cristina Mazas Perez Oleaga  6   8   9 , Stefanía Carvajal Altamiranda  6   9   10 , Nohora Milena Martínez López  6   7   10 , Irma Domínguez Azpíroz  6   7   11 , Miguel A Castro Villamor  1   2   3 , Irene Sánchez Soberón  5 , Raúl López-Izquierdo  3   4   12
Affiliations

Prehospital qSOFA, mSOFA, and NEWS2 performance for sepsis prediction: A prospective, multi-center, cohort study

Laura Melero-Guijarro et al. Front Med (Lausanne). .

Abstract

Background: Nowadays, there is no gold standard score for prehospital sepsis and sepsis-related mortality identification. The aim of the present study was to analyze the performance of qSOFA, NEWS2 and mSOFA as sepsis predictors in patients with infection-suspected in prehospital care. The second objective is to study the predictive ability of the aforementioned scores in septic-shock and in-hospital mortality.

Methods: Prospective, ambulance-based, and multicenter cohort study, developed by the emergency medical services, among patients (n = 535) with suspected infection transferred by ambulance with high-priority to the emergency department (ED). The study enrolled 40 ambulances and 4 ED in Spain between 1 January 2020, and 30 September 2021. All the variables used in the scores, in addition to socio-demographic data, standard vital signs, prehospital analytical parameters (glucose, lactate, and creatinine) were collected. For the evaluation of the scores, the discriminative power, calibration curve and decision curve analysis (DCA) were used.

Results: The mSOFA outperformed the other two scores for mortality, presenting the following AUCs: 0.877 (95%CI 0.841-0.913), 0.761 (95%CI 0.706-0.816), 0.731 (95%CI 0.674-0.788), for mSOFA, NEWS, and qSOFA, respectively. No differences were found for sepsis nor septic shock, but mSOFA's AUCs was higher than the one of the other two scores. The calibration curve and DCA presented similar results.

Conclusion: The use of mSOFA could provide and extra insight regarding the short-term mortality and sepsis diagnostic, backing its recommendation in the prehospital scenario.

Keywords: early warning scores; mSOFA; point-of-care testing; prehospital; sepsis; septic shock.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flowchart study population.
Figure 2
Figure 2
Scores values vs. real and predicted probability for mortality (A) mSOFA, (B) NEWS2, (C) qSOFA. The solid line shows the predicted probability of the outcome; area between dashed lines shows the 95% confidence interval.
Figure 3
Figure 3
Discrimination capacity of each model. Solid line shows the receiver operating characteristic (ROC) curve for mortality (A), sepsis (B), and septic shock (C). black line = mSOFA, red line = NEWS2, blue lines = qSOFA.
Figure 4
Figure 4
Decision curve analysis for each model. Solid line shows the decision (ROC) curve for mortality (A), sepsis (B), and septic shock (C). black line = mSOFA, red line = NEWS2, blue lines = qSOFA.
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