Screening tools for predicting mortality of adults with suspected sepsis: an international sepsis cohort validation study.

Autor:	Blair PW; Austere environments Consortium for Enhanced Sepsis Outcomes (ACESO), Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USA PBLAIR6@JHMI.EDU., Mehta R; Austere environments Consortium for Enhanced Sepsis Outcomes (ACESO), Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USA., Oppong CK; Emergency Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana., Tin S; Takeo Provincial Referral Hospital, Takeo, Cambodia., Ko E; Duke University School of Medicine, Durham, North Carolina, USA., Tsalik EL; Duke University School of Medicine, Durham, North Carolina, USA.; Danaher Diagnostics, Washington, D.C, USA., Chenoweth J; Austere environments Consortium for Enhanced Sepsis Outcomes (ACESO), Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USA., Rozo M; Austere environments Consortium for Enhanced Sepsis Outcomes (ACESO), Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USA., Adams N; Naval Medical Research Center Infectious Diseases Directorate, Bethesda, Maryland, USA., Beckett C; Naval Medical Research Center Infectious Diseases Directorate, Bethesda, Maryland, USA., Woods CW; Duke University School of Medicine, Durham, North Carolina, USA.; Duke Global Health Institute, Durham, North Carolina, USA., Striegel DA; Austere environments Consortium for Enhanced Sepsis Outcomes (ACESO), Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USA., Salvador MG; Austere environments Consortium for Enhanced Sepsis Outcomes (ACESO), Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USA., Brandsma J; Austere environments Consortium for Enhanced Sepsis Outcomes (ACESO), Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USA., McKean L; Austere environments Consortium for Enhanced Sepsis Outcomes (ACESO), Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USA., Mahle RE; Duke University School of Medicine, Durham, North Carolina, USA., Hulsey WR; Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USA., Krishnan S; Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USA., Prouty M; US Naval Medical Research Unit No 2, Phnom Penh, Cambodia., Letizia A; Naval Medical Research Unit-3 Ghana Detachment, Accra, Ghana., Fox A; Naval Medical Research Unit-3 Ghana Detachment, Accra, Ghana., Faix D; US Naval Medical Research Unit No 2, Phnom Penh, Cambodia., Lawler JV; Global Center for Health Security, University of Nebraska Medical Center, Omaha, Nebraska, USA.; Department of Internal Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA., Duplessis C; Austere environments Consortium for Enhanced Sepsis Outcomes (ACESO), Biological Defense Research Directorate, Naval Medical Research Center-Frederick, Frederick, Maryland, USA., Gregory MG; Austere environments Consortium for Enhanced Sepsis Outcomes (ACESO), Biological Defense Research Directorate, Naval Medical Research Center-Frederick, Frederick, Maryland, USA., Vantha T; Takeo Provincial Referral Hospital, Takeo, Cambodia., Owusu-Ofori AK; Department of Clinical Microbiology, Komfo Anokye Teaching Hospital, Kumasi, Ghana., Ansong D; Emergency Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana., Oduro G; Komfo Anokye Teaching Hospital, Kumasi, Ghana., Schully KL; Austere environments Consortium for Enhanced Sepsis Outcomes (ACESO), Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USA., Clark DV; Austere environments Consortium for Enhanced Sepsis Outcomes (ACESO), Henry M Jackson Foundation for the Advancement of Military Medicine Inc, Bethesda, Maryland, USA.
Jazyk:	angličtina
Zdroj:	BMJ open [BMJ Open] 2023 Feb 20; Vol. 13 (2), pp. e067840. Date of Electronic Publication: 2023 Feb 20.
DOI:	10.1136/bmjopen-2022-067840
Abstrakt:	Objectives: We evaluated the performance of commonly used sepsis screening tools across prospective sepsis cohorts in the USA, Cambodia and Ghana. Design: Prospective cohort studies. Setting and Participants: From 2014 to 2021, participants with two or more SIRS (Systemic Inflammatory Response Syndrome) criteria and suspected infection were enrolled in emergency departments and medical wards at hospitals in Cambodia and Ghana and hospitalised participants with suspected infection were enrolled in the USA. Cox proportional hazards regression was performed, and Harrell's C-statistic calculated to determine 28-day mortality prediction performance of the quick Sequential Organ Failure Assessment (qSOFA) score ≥2, SIRS score ≥3, National Early Warning Score (NEWS) ≥5, Modified Early Warning Score (MEWS) ≥5 or Universal Vital Assessment (UVA) score ≥2. Screening tools were compared with baseline risk (age and sex) with the Wald test. Results: The cohorts included 567 participants (42.9% women) including 187 participants from Kumasi, Ghana, 200 participants from Takeo, Cambodia and 180 participants from Durham, North Carolina in the USA. The pooled mortality was 16.4% at 28 days. The mortality prediction accuracy increased from baseline risk with the MEWS (C-statistic: 0.63, 95% CI 0.58 to 0.68; p=0.002), NEWS (C-statistic: 0.68; 95% CI 0.64 to 0.73; p<0.001), qSOFA (C-statistic: 0.70, 95% CI 0.64 to 0.75; p<0.001), UVA score (C-statistic: 0.73, 95% CI 0.69 to 0.78; p<0.001), but not with SIRS (0.60; 95% CI 0.54 to 0.65; p=0.13). Within individual cohorts, only the UVA score in Ghana performed better than baseline risk (C-statistic: 0.77; 95% CI 0.71 to 0.83; p<0.001). Conclusions: Among the cohorts, MEWS, NEWS, qSOFA and UVA scores performed better than baseline risk, largely driven by accuracy improvements in Ghana, while SIRS scores did not improve prognostication accuracy. Prognostication scores should be validated within the target population prior to clinical use. Competing Interests: Competing interests: ET has held equity and consulted for Predigen and Biomeme, and he is an employee of Danaher Diagnostics. All other authors declared no competing interests. (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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