New sepsis definition (Sepsis-3) and community-acquired pneumonia mortality: A validation and clinical decision-making study
| Autor: | Miquel Ferrer, Albert Gabarrus, Gianluigi Li Bassi, Catia Cilloniz, Raúl Méndez, Elena Prina, Antoni Torres, Adrian Ceccato, Rosario Menéndez, Otavio T. Ranzani, Enric Barbeta |
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| Přispěvatelé: | Universitat de Barcelona |
| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty Community-acquired pneumonia Pneumonia severity index Critical Care and Intensive Care Medicine Pneumònia adquirida a la comunitat Sepsis sepsis 03 medical and health sciences 0302 clinical medicine medicine Mortalitat pneumonia 030212 general & internal medicine Septicèmia Mortality Intensive care medicine validation business.industry Septicemia Retrospective cohort study Emergency department medicine.disease quick Sequential (Sepsis-related) Organ Failure Assessment Systemic inflammatory response syndrome Pneumonia systemic inflammatory response syndrome 030228 respiratory system business Cohort study |
| Zdroj: | Recercat. Dipósit de la Recerca de Catalunya instname AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE r-IIS La Fe. Repositorio Institucional de Producción Científica del Instituto de Investigación Sanitaria La Fe Dipòsit Digital de la UB Universidad de Barcelona |
| ISSN: | 1073-449X |
| Popis: | Rationale: The Sepsis-3 Task Force updated the clinical criteria for sepsis, excluding the need for systemic inflammatory response syndrome (SIRS) criteria. The clinical implications of the proposed flowchart including the quick Sequential (Sepsis-related) Organ Failure Assessment (qSOFA) and SOFA scores are unknown. Objectives: To perform a clinical decision-making analysis of Sepsis-3 in patients with community-acquired pneumonia. Methods: This was a cohort study including adult patients with community-acquired pneumonia from two Spanish university hospitals. SIRS, qSOFA, the Confusion, Respiratory Rate and Blood Pressure (CRB) score, modified SOFA (mSOFA), the Confusion, Urea, Respiratory Rate, Blood Pressure and Age (CURB-65) score, and Pneumonia Severity Index (PSI) were calculated with data from the emergency department. We used decision-curve analysis to evaluate the clinical usefulness of each score and the primary outcome was in-hospital mortality. Measurements and Main Results: Of 6,874 patients, 442 (6.4%) died in-hospital. SIRS presented the worst discrimination, followed by qSOFA, CRB, mSOFA, CURB-65, and PSI. Overall, overestimation of in-hospital mortality and miscalibration was more evident for qSOFA and mSOFA. SIRS had lower net benefit than qSOFA and CRB, significantly increasing the risk of over-treatment and being comparable with the "treat-all" strategy. PSI had higher net benefit than mSOFA and CURB-65 for mortality, whereas mSOFA seemed more applicable when considering mortality/intensive care unit admission. Sepsis-3 flowchart resulted in better identification of patients at high risk of mortality. Conclusions: qSOFA and CRB outperformed SIRS and presented better clinical usefulness as prompt tools for patients with community-acquired pneumonia in the emergency department. Among the tools for a comprehensive patient assessment, PSI had the best decision-aid tool profile. |
| Databáze: | OpenAIRE |
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