Please use this identifier to cite or link to this item: https://doi.org/10.1111/jocs.14331
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dc.titleValidation of prognostic accuracy of the SOFA score, SIRS criteria, and qSOFA score for in-hospital mortality among cardiac-, thoracic-, and vascular-surgery patients admitted to a cardiothoracic intensive care unit
dc.contributor.authorZhang, Yuchong
dc.contributor.authorLuo, Haidong
dc.contributor.authorWang, Hai
dc.contributor.authorZheng, Zhichao
dc.contributor.authorOoi, Oon Cheong
dc.date.accessioned2022-12-01T01:22:54Z
dc.date.available2022-12-01T01:22:54Z
dc.date.issued2019-11-11
dc.identifier.citationZhang, Yuchong, Luo, Haidong, Wang, Hai, Zheng, Zhichao, Ooi, Oon Cheong (2019-11-11). Validation of prognostic accuracy of the SOFA score, SIRS criteria, and qSOFA score for in-hospital mortality among cardiac-, thoracic-, and vascular-surgery patients admitted to a cardiothoracic intensive care unit. JOURNAL OF CARDIAC SURGERY 35 (1) : 118-127. ScholarBank@NUS Repository. https://doi.org/10.1111/jocs.14331
dc.identifier.issn0886-0440
dc.identifier.issn1540-8191
dc.identifier.urihttps://scholarbank.nus.edu.sg/handle/10635/235031
dc.description.abstractSepsis-3 Definition: Sepsis is defined as life-threatening organ dysfunction due to a dysregulated host response to infection. The clinical criteria of sepsis include organ dysfunction, which is defined as an increase of two points or more on the sequential organ failure assessment (SOFA). For patients with infection, an increase of 2 SOFA points yields an overall mortality rate of 10%. Patients with suspected infection who are likely to have a prolonged intensive care unit (ICU) stay or to have in-hospital mortality can be promptly identified at the bedside with a quick SOFA (qSOFA) score of 2 or higher. Importance: The sepsis-3 criteria have emphasized the value of a change of two or more points on the SOFA, introduced the qSOFA, and removed the systemic inflammatory response syndrome (SIRS) criteria from the sepsis definition. Objective: To externally validate and assess the discriminatory capacities of an increase in the SOFA score by two or more points, the presence of two or more SIRS criteria, or a qSOFA score of 2 or more points for outcomes in 5109 patients, the vast majority of whom were postcardiac surgery patients who were admitted to a Cardiothoracic Surgical ICU in Singapore. Design, Setting, and Participants: A retrospective cohort analysis of 5109 patients with an infection-related primary admission diagnosis in the cardiothoracic intensive care unit (CTICU) at the National University Hospital (NUH) in Singapore from 2010 to 2016. Exposures: The SOFA, qSOFA, and SIRS criteria were applied to the data representing the worst condition within 24 hours of ICU admission. Main Outcomes and Measures: The primary outcome was in-hospital mortality. Discrimination was assessed using the area under the receiver operating characteristic curve (AUROC). Results: In 5109 patients, the average mortality of patients with an increase in the SOFA scores of less than 2 points was 3.5% (n = 64), and it was 6% (n = 199) for those with an increase in the SOFA scores of 2 or more points. The mortality of patients with an increase in the qSOFA scores of less than 2 points was 2.6% (n = 7), and it was 5.3% (n = 256) for those with an increase in the qSOFA scores of 2 or more points. The mortality of patients with an increase in the SIRS criteria of less than 2 points was 3.6% (n = 30), and it was 5.4% (n = 233) for those with an increase in the SIRS criteria of 2 or more points. The AUROC of in-hospital mortality of patients with an increase in the SOFA, qSOFA, and SIRS criteria of 2 or more points was 0.96, 0.95, and 0.95, respectively. Conclusions and Relevance: In adults with suspected infection admitted to the CTICU in NUH, the change in in-hospital mortality between patients with an increase in SOFA scores of less than 2 and those with an increase of 2 or more was 2.5 percentage points. In contrast to other studies, the absolute change in mortality was nearly the same compared to the qSOFA and SIRS criteria, and the qSOFA score had the greatest percentage increase of 104%, compared to 71% for the SOFA score and 50% for the SIRS criteria. Besides, from the perspective of discriminatory capacities, an increase in SOFA scores of 2 or more did not demonstrate significantly greater prognostic accuracy for in-hospital mortality than equivalent increases in qSOFA scores or SIRS criteria. These findings suggest distinctive characteristics of the study population in the CTICU that are different from the general population.
dc.language.isoen
dc.publisherWILEY
dc.sourceElements
dc.subjectScience & Technology
dc.subjectLife Sciences & Biomedicine
dc.subjectCardiac & Cardiovascular Systems
dc.subjectSurgery
dc.subjectCardiovascular System & Cardiology
dc.subjectquick sequential organ failure assessment
dc.subjectsepsis
dc.subjectsepsis definition
dc.subjectSepsis-3
dc.subjectsequential organ failure assessment
dc.subjectsystemic inflammatory response syndrome
dc.subjectINTERNATIONAL CONSENSUS DEFINITIONS
dc.subjectORGAN FAILURE ASSESSMENT
dc.subjectSEPSIS
dc.typeArticle
dc.date.updated2022-11-30T09:57:25Z
dc.contributor.departmentDEPT OF SURGERY
dc.description.doi10.1111/jocs.14331
dc.description.sourcetitleJOURNAL OF CARDIAC SURGERY
dc.description.volume35
dc.description.issue1
dc.description.page118-127
dc.published.statePublished
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