New Sepsis Definition (Sepsis-3) and Community-acquired Pneumonia Mortality. A Validation and Clinical Decision-Making Study

The Sepsis-3 Task Force updated the clinical criteria for sepsis, excluding the need for systemic inflammatory response syndrome (SIRS) criteria. The clinical implications of the proposed flowchart including the quick Sequential (Sepsis-related) Organ Failure Assessment (qSOFA) and SOFA scores are u...

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Bibliographic Details
Published in:American journal of respiratory and critical care medicine 2017-11, Vol.196 (10), p.1287-1297
Main Authors: Ranzani, Otavio T, Prina, Elena, Menéndez, Rosario, Ceccato, Adrian, Cilloniz, Catia, Méndez, Raul, Gabarrus, Albert, Barbeta, Enric, Bassi, Gianluigi Li, Ferrer, Miquel, Torres, Antoni
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Blood pressure
Clinical Decision-Making
Cohort Studies
Community-Acquired Infections - classification
Community-Acquired Infections - mortality
Community-acquired pneumonia
Critical care
Decision making
Emergency Service, Hospital - statistics & numerical data
Female
Hospital Mortality
Hospitals, University
Humans
Infections
Intensive care
Intensive Care Units - statistics & numerical data
Male
Middle Aged
Mortalitat
Mortality
Organ Dysfunction Scores
Pneumonia
Pneumonia - mortality
Pneumònia adquirida a la comunitat
Retrospective Studies
Sepsis
Sepsis - classification
Sepsis - mortality
Septicemia
Septicèmia
Spain
Task forces
Ultrasonic imaging
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Summary:The Sepsis-3 Task Force updated the clinical criteria for sepsis, excluding the need for systemic inflammatory response syndrome (SIRS) criteria. The clinical implications of the proposed flowchart including the quick Sequential (Sepsis-related) Organ Failure Assessment (qSOFA) and SOFA scores are unknown. To perform a clinical decision-making analysis of Sepsis-3 in patients with community-acquired pneumonia. This was a cohort study including adult patients with community-acquired pneumonia from two Spanish university hospitals. SIRS, qSOFA, the Confusion, Respiratory Rate and Blood Pressure (CRB) score, modified SOFA (mSOFA), the Confusion, Urea, Respiratory Rate, Blood Pressure and Age (CURB-65) score, and Pneumonia Severity Index (PSI) were calculated with data from the emergency department. We used decision-curve analysis to evaluate the clinical usefulness of each score and the primary outcome was in-hospital mortality. Of 6,874 patients, 442 (6.4%) died in-hospital. SIRS presented the worst discrimination, followed by qSOFA, CRB, mSOFA, CURB-65, and PSI. Overall, overestimation of in-hospital mortality and miscalibration was more evident for qSOFA and mSOFA. SIRS had lower net benefit than qSOFA and CRB, significantly increasing the risk of over-treatment and being comparable with the "treat-all" strategy. PSI had higher net benefit than mSOFA and CURB-65 for mortality, whereas mSOFA seemed more applicable when considering mortality/intensive care unit admission. Sepsis-3 flowchart resulted in better identification of patients at high risk of mortality. qSOFA and CRB outperformed SIRS and presented better clinical usefulness as prompt tools for patients with community-acquired pneumonia in the emergency department. Among the tools for a comprehensive patient assessment, PSI had the best decision-aid tool profile.
ISSN:1073-449X
1535-4970
DOI:10.1164/rccm.201611-2262oc