Combining qSOFA criteria with initial lactate levels: Improved screening of septic patients for critical illness - 20/06/20
, John C. Greenwood, MD b , Kristin Lewis, MD c , Thomas J. Nuckton, MD, MS d , Bryan Darger, MD c , Frances S. Shofer, PhD e , Dawn Troeger, MSN-Ed d , Soo Y. Jung, MD e , J. Hope Kilgannon, MD a , Robert M. Rodriguez, MD c Abstract |
Objective |
To determine if the addition of lactate to Quick Sequential Organ Failure Assessment (qSOFA) scoring improves emergency department (ED) screening of septic patients for critical illness.
Methods |
This was a multicenter retrospective cohort study of consecutive adult patients admitted to the hospital from the ED with infectious disease-related illnesses. We recorded qSOFA criteria and initial lactate levels in the first 6 h of ED stay. Our primary outcome was a composite of hospital death, vasopressor use, and intensive care unit stay ≤72 h of presentation. Diagnostic test characteristics were determined for: 1) lactate levels ≥2 and ≥4; 2) qSOFA scores ≥1, ≥2, and =3; and 3) combinations of these.
Results |
Of 3743 patients, 2584 had a lactate drawn ≤6 h of ED stay and 18% met the primary outcome. The qSOFA scores were ≥1, ≥2, and =3 in 59.2%, 22.0%, and 5.3% of patients, respectively, and 34.4% had a lactate level ≥2 and 7.9% had a lactate level ≥4. The combination of qSOFA ≥1 OR Lactate ≥2 had the highest sensitivity, 94.0% (95% CI: 91.3–95.9).
Conclusions |
The combination of qSOFA ≥1 OR Lactate ≥2 provides substantially improved sensitivity for the screening of critical illness compared to isolated lactate and qSOFA thresholds.
Le texte complet de cet article est disponible en PDF.Abbreviations : qSOFA, ED, ICU, SIRS, AUROC
Keywords : Sepsis, lactic acid, mortality, intensive care units, mass screening
Plan
Vol 38 - N° 5
P. 883-889 - mai 2020 Retour au numéro
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