Abstract
Objectives
To determine and compare the accuracies of the quick Sequential (Sepsis-related) Organ
Failure Assessment (qSOFA) and Modified and National Early Warning Scores (NEWS and
MEWS) to identify sepsis in older inpatients with suspected infection.
Design
Prospective diagnostic accuracy study.
Setting and Participants
Patients admitted to an acute geriatric unit of an Italian University Hospital with
at least one sepsis risk factor and suspected infection defined as antibiotic prescription
and associated culture test during hospital stay.
Methods
Sepsis diagnosis was defined as the presence on discharge documents of International
Classification of Diseases, Ninth revision, Clinical Modification codes for severe
sepsis, septic shock, or for infection and acute organ disfunction. For each patient,
clinical parameters were evaluated at least twice daily throughout hospital stay;
qSOFA, NEWS, and MEWS were derived, and worst scores recorded. Positive cutoffs were
set at ≥2, ≥7, and ≥5, respectively. Sensitivity, specificity, positive and negative
predictive values (PPV and NPV, respectively), and positive and negative likelihood
ratios, as well as areas under the receiver operating characteristic curve (AUROCs)
were calculated.
Results
Among 230 geriatric patients with suspected infection at risk for sepsis (median age
86 years, 49% women), 30.9% had a sepsis diagnosis. A qSOFA ≥2 was recorded in 111
(48.3%) patients, a MEWS ≥5 in 65 (28.3%), and a NEWS ≥7 in 115 (50.0%). The qSOFA
showed the highest sensitivity [81.7%, 95% confidence interval (CI) 71.7%–89.5%],
but low specificity (66.7%, 95% CI 59.1%–73.7%), resulting in a high NPV (89.1%; 95%
CI 82.7%–93.8%) and poor PPV (52.3%, 95% CI 43.0%–61.4%). The AUROC for qSOFA was
0.76 (95% CI 0.69–0.83), comparable with that of NEWS (0.74, 95% CI 0.67–0.81, P = .44), but significantly higher than that of MEWS (0.70, 95% CI 0.63–0.77, P = .04).
Conclusions and Implications
Repeated qSOFA determinations are useful to rule out sepsis in geriatric inpatients
with suspected infection, but poorly support its diagnosis due to low specificity.
More complex MEWS and NEWS do not perform better. Implementation of clinical scores
to reliably identify sepsis in older patients is urgently needed.
Keywords
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Article info
Publication history
Published online: October 04, 2021
Footnotes
Dr. Brunetti is currently a Research Assistant at the Department of Medical Sciences, University of Turin. This research did not receive any direct funding from agencies in the public, commercial, or not-for-profit sectors.
The authors report no conflicts of interest with the present study.
Identification
Copyright
© 2021 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
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