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Early variation of quick sequential organ failure assessment score to predict in-hospital mortality in emergency department patients with suspected infection

Lemachatti, Najlaa,b; Ortega, Marm; Penaloza, Andreao; Le Borgne, Pierrickh; Claret, Pierre-Géraudi; Occelli, Célinej; Truchot, Jenniferc; Dumas, Florenced; Feral-Pierssens, Anne-Lauree; Andrianjafy, Héryk; Beaune, Sebastienf; Yordanov, Youria,g; Hausfater, Pierrea,b; Riou, Brunoa,b; Bloom, Benn; Krastinova, Evguenial; Freund, Yonathana,b for the French Society of Emergency Medicine Collaborators Group and the INFURGSEMES Group

doi: 10.1097/MEJ.0000000000000551
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Background The quick sequential organ failure assessment (qSOFA) score showed good prognostic performance in patients with suspicion of infection in the emergency department (ED). However, previous studies only assessed the performance of individual values of qSOFA during the ED stay. As this score may vary over short timeframes, the optimal time of measurement, and the prognostic value of its variation are unclear. The objective of the present study was to prospectively assess the prognostic value of the change in qSOFA over the first 3 h (ΔqSOFA=qSOFA at 3 h−qSOFA at inclusion).

Patients and methods This is an international prospective cohort study conducted in 17 EDs in France, Belgium, and Spain. From November 2016 to March 2017, patients with a suspected infection and a qSOFA score of 2 or higher were included and followed up until death or hospital discharge. qSOFA was measured at inclusion, 1 h and 3 h. Primary end point was in-hospital mortality, truncated at 28 days.

Results Of 534 recruited patients, 512 were included in the analysis. The qSOFA was improved at 3 h (ΔqSOFA<0) in 287 (55%) patients. Overall in-hospital mortality was 27%: 44% when ΔqSOFA greater than 0, 36% when ΔqSOFA=0, and 18% when ΔqSOFA less than 0. A positive ΔqSOFA was independently associated with reduced in-hospital mortality (adjusted hazard ratio of 0.48, 95% confidence interval: 0.34–0.68). After modeling qSOFA kinetics in the first 3 h, there was a significant difference in adjusted slopes between patients who died and those who survived (0.15, 95% confidence interval: 0.09–0.22, P<0.001).

Conclusion In patients with suspected infection presenting to the ED with a qSOFA of 2 or higher, the early change in qSOFA is a strong independent predictor of mortality.

aSorbonne Université, GRC 14 BIOSFAST and UMR INSERM 1166, IHU ICAN

bEmergency Department, Hôpital Pitie-Salpêtrière

cEmergency Department, Hôpital Lariboisière

dEmergency Department, Hôpital Cochin

eEmergency Department, Hôpital Européen Georges Pompidou

fEmergency Department, Hôpital Ambroise Paré, Paris Diderot University

gEmergency Department, Hôpital Saint-Antoine, Assistance Publique – Hôpitaux de Paris (APHP), Paris

hEmergency Department, Hôpitaux universitaires de Strasbourg, Strasbourg

iEmergency Department, Centre Hospitalo-universitaire, Nîmes

jEmergency Department, Hôpital Pasteur, Nice

kEmergency Department, Centre hospitalier des deux vallées, Longjumeau

lDepartment of Public Heatlth, Centre Hospitalier Intercommunal, Créteil

mEmergency Department, Hospital Clinic, Universidad de Barcelona, Barcelona, Spain

nEmergency Department, Barts Health NHS Trust, Queen Mary University, London, UK

oEmergency Department, Cliniques Universitaires St Luc, Bruxelles, Belgium

Correspondence to Yonathan Freund, MD, PhD, Service d’accueil des Urgences, Hôpital Pitié-Salpêtrière, 83 Boulevard de l’hôpital, 75013 Paris, France Tel: +33 184 827 129; fax: +33 142 177 249; e-mail: yonathan.freund@aphp.fr

Received January 4, 2018

Accepted March 11, 2018

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