Secondary Logo

Institutional members access full text with Ovid®

Share this article on:

Investigating the Impact of Different Suspicion of Infection Criteria on the Accuracy of Quick Sepsis-Related Organ Failure Assessment, Systemic Inflammatory Response Syndrome, and Early Warning Scores*

Churpek, Matthew M. MD, MPH, PhD1; Snyder, Ashley MPH1; Sokol, Sarah PharmD2; Pettit, Natasha N. PharmD2; Edelson, Dana P. MD, MS1

doi: 10.1097/CCM.0000000000002648
Feature Articles
Editor's Choice

Objective: Studies in sepsis are limited by heterogeneity regarding what constitutes suspicion of infection. We sought to compare potential suspicion criteria using antibiotic and culture order combinations in terms of patient characteristics and outcomes. We further sought to determine the impact of differing criteria on the accuracy of sepsis screening tools and early warning scores.

Design: Observational cohort study.

Setting: Academic center from November 2008 to January 2016.

Patients: Hospitalized patients outside the ICU.

Interventions: None.

Measurements and Main Results: Six criteria were investigated: 1) any culture, 2) blood culture, 3) any culture plus IV antibiotics, 4) blood culture plus IV antibiotics, 5) any culture plus IV antibiotics for at least 4 of 7 days, and 6) blood culture plus IV antibiotics for at least 4 of 7 days. Accuracy of the quick Sepsis-related Organ Failure Assessment score, Sepsis-related Organ Failure Assessment score, systemic inflammatory response syndrome criteria, the National and Modified Early Warning Score, and the electronic Cardiac Arrest Risk Triage score were calculated for predicting ICU transfer or death within 48 hours of meeting suspicion criteria. A total of 53,849 patients met at least one infection criteria. Mortality increased from 3% for group 1 to 9% for group 6 and percentage meeting Angus sepsis criteria increased from 20% to 40%. Across all criteria, score discrimination was lowest for systemic inflammatory response syndrome (median area under the receiver operating characteristic curve, 0.60) and Sepsis-related Organ Failure Assessment score (median area under the receiver operating characteristic curve, 0.62), intermediate for quick Sepsis-related Organ Failure Assessment (median area under the receiver operating characteristic curve, 0.65) and Modified Early Warning Score (median area under the receiver operating characteristic curve 0.67), and highest for National Early Warning Score (median area under the receiver operating characteristic curve 0.71) and electronic Cardiac Arrest Risk Triage (median area under the receiver operating characteristic curve 0.73).

Conclusions: The choice of criteria to define a potentially infected population significantly impacts prevalence of mortality but has little impact on accuracy. Systemic inflammatory response syndrome was the least predictive and electronic Cardiac Arrest Risk Triage the most predictive regardless of how infection was defined.

1Department of Medicine, University of Chicago, Chicago, IL.

2Department of Pharmacy, University of Chicago, Chicago, IL.

*See also p. 1946.

Dr. Edelson has received research support from Philips Healthcare and Early Sense. She has ownership interest in Quant HC, which is developing products for risk stratification of hospitalized patients.

Dr. Churpek’s institution received funding from an ATS Foundation Recognition Award for Outstanding Early Career Investigators grant and from the National Heart, Lung, and Blood Institute (K08 HL121080); he received funding from CHEST (honoraria for invited speaking engagements); and he received support for article research from the National Institutes of Health. Drs. Chupek and Edelson disclosed having a patent pending (ARCD. P0535US.P2) for risk-stratification algorithms for hospitalized patients. Dr. Edelson’s institution received funding in the form of research support from Philips Healthcare (Andover, MA) and EarlySense (Tel Aviv, Israel), and she received funding from QuantHC (Chicago, IL) (ownership interest). The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: matthew.churpek@uchospitals.edu

Copyright © by 2017 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.