Sequential organ failure assessment and modified early warning score system versus quick SOFA score to predict the length of hospital stay in sepsis patients – accuracy scoring study.

Abstract

INTRODUCTION: : Sepsis is a global healthcare challenge, and accurate scores are required to identify and stratify patients' risk. The current study aimed to compare the prognostic accuracy of quick SOFA (qSOFA) with comparison to SOFA and MEWS scores in order to identify the length of hospital stay and outcomes among patients with sepsis who presented to emergency department (EMD). MATERIAL AND METHODS: Between July and November 2018, 77 adult patients with sepsis were treated at EMD. The area under the receiver operating characteristic curve (AUROC) of quick SOFA (qSOFA), SOFA, and MEWS scores was used to compare prognostic accuracy for the outcome of hospital mortality and length of stay. RESULTS: The majority of patients (68%) were over the age of 50. Systemic Hypertension is the most common comorbid condition, accounting for 38.9% (n=30). Pneumonia is the most common diagnosis in 27.3 percent of cases (n=21). Patients required vasoactive support in 45.5 percent (n=35) of cases, and ventilator support in 50.6 percent (n=39) of cases. Mortality was observed in 34.1 percent (n=27) of the cases. Patients on vasopressor and ventilator support have a higher mortality rate [8(19%) vs. 21(50%)]. The mortality rate in patients with a qSOFA score of 3 is 71.4 percent. Patients with a SOFA score of >15 had higher mortality rate. The mortality rate in patients with MEWS score > 5 is 48.9%. A qSOFA score of 3 is associated with an increased risk of death, and the majority died in less than three days. Because of increased mortality, most patients with a SOFA score of 7 have a length of stay of 3 days. Most patients with a Mews score of 5 or higher have a length of stay of 3 days due to mortality. The AUC value for qSOFA is 0.721, the AUC value for SOFA is 0.714, and the AUC value for MEWS is 0.693, indicating that qSOFA is more sensitive in predicting the outcome than SOFA and MEWS. CONCLUSIONS: In all prediction scores, qSOFA outperformed than SOFA and MEWS in terms of hospital mortality and length of hospital stay. qSOFA is a simple, rapid bedside tool that does not require laboratory parameters and can be used to predict the prognosis of patients with sepsis in the EMD.

Keywords

• sepsis
• prognostic accuracy
• sofa score
• qsofa score
• mews score.