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Comparative Study
. 2024 Sep 4;24(1):161.
doi: 10.1186/s12873-024-01078-8.

Comparison of Modified Early Warning Score (MEWS), Simplified Acute Physiology Score II (SAPS II), Sequential Organ Failure Assessment (SOFA), and Acute Physiology and Chronic Health Evaluation II (APACHE II) for early prediction of septic shock in diabetic patients in Emergency Departments

Wijittra Liengswangwong  1 , Ranchana Siriwannabhorn  1 , Sittichok Leela-Amornsin  2 , Chaiyaporn Yuksen  1 , Pitsucha Sanguanwit  1 , Chonthicha Duangsri  1 , Nusara Kusonkhum  1 , Parnthap Saelim  1
Affiliations
Comparative Study

Comparison of Modified Early Warning Score (MEWS), Simplified Acute Physiology Score II (SAPS II), Sequential Organ Failure Assessment (SOFA), and Acute Physiology and Chronic Health Evaluation II (APACHE II) for early prediction of septic shock in diabetic patients in Emergency Departments

Wijittra Liengswangwong et al. BMC Emerg Med. .

Abstract

Introduction: Sepsis is a severe medical condition that can be life-threatening. If sepsis progresses to septic shock, the mortality rate increases to around 40%, much higher than the 10% mortality observed in sepsis. Diabetes increases infection and sepsis risk, making management complex. Various scores of screening tools, such as Modified Early Warning Score (MEWS), Simplified Acute Physiology Score (SAPS II), Sequential Organ Failure Assessment Score (SOFA), and Acute Physiology and Chronic Health Evaluation (APACHE II), are used to predict the severity or mortality rate of disease. Our study aimed to compare the effectiveness and optimal cutoff points of these scores. We focused on the early prediction of septic shock in patients with diabetes in the Emergency Department (ED).

Methods: We conducted a retrospective cohort study to collect data on patients with diabetes. We collected prediction factors and MEWS, SOFA, SAPS II and APACHE II scores to predict septic shock in these patients. We determined the optimal cutoff points for each score. Subsequently, we compared the identified scores with the gold standard for diagnosing septic shock by applying the Sepsis-3 criteria.

Results: Systolic blood pressure (SBP), peripheral oxygen saturation (SpO2), Glasgow Coma Scale (GCS), pH, and lactate concentrations were significant predictors of septic shock (p < 0.001). The SOFA score performed well in predicting septic shock in patients with diabetes. The area under the receiver operating characteristics (ROC) curve for the SOFA score was 0.866 for detection within 48 h and 0.840 for detection after 2 h of admission to the ED, with the optimal cutoff score of ≥ 6.

Conclusion: SBP, SpO2, GCS, pH, and lactate concentrations are crucial for the early prediction of septic shock in patients with diabetes. The SOFA score is a superior predictor for the onset of septic shock in patients with diabetes compared with MEWS, SAPS II, and APACHE II scores. Specifically, a cutoff of ≥ 6 in the SOFA score demonstrates high accuracy in predicting shock within 48 h post-ED visit and as early as 2 h after ED admission.

Keywords: Diabetes; Emergency department; Score; Sepsis; Septic shock.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Study flow
Fig. 2
Fig. 2
Diagnostic accuracy of MEWS, SAPS II, SOFA, and APACHE II scores to predict shock in patients with diabetes within 48 h after visiting the ED
Fig. 3
Fig. 3
Diagnostic accuracy of MEWS, SAPS II, SOFA, and APACHE II scores to predict shock in patients with diabetes 2 h after an ED visit (n = 130)
See this image and copyright information in PMC

References

    1. Thiel SW, Rosini JM, Shannon W, Doherty JA, Micek ST, Kollef MH. Early prediction of septic shock in hospitalized patients. J Hosp Med. 2010;5(1):19–25. 10.1002/jhm.530 - DOI - PubMed
    1. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The Third International Consensus definitions for Sepsis and septic shock (Sepsis-3). JAMA. 2016;315(8):801–10. 10.1001/jama.2016.0287 - DOI - PMC - PubMed
    1. Churpek MM, Snyder A, Han X, Sokol S, Pettit N, Howell MD, et al. Quick Sepsis-related Organ failure Assessment, systemic inflammatory response syndrome, and early warning scores for detecting clinical deterioration in infected patients outside the Intensive Care Unit. Am J Respir Crit Care Med. 2017;195(7):906–11. 10.1164/rccm.201604-0854OC - DOI - PMC - PubMed
    1. Costantini E, Carlin M, Porta M, Brizzi MF. Type 2 diabetes mellitus and sepsis: state of the art, certainties and missing evidence. Acta Diabetol. 2021;58(9):1139–51. 10.1007/s00592-021-01728-4 - DOI - PMC - PubMed
    1. Wang Z, Ren J, Wang G, Liu Q, Guo K, Li J. Association between Diabetes Mellitus and outcomes of patients with Sepsis: a Meta-analysis. Med Sci Monit. 2017;23:3546–55. 10.12659/MSM.903144 - DOI - PMC - PubMed

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