Comparison of qSOFA, SIRS and National Early Warning Score in predicting mortality in patients with septicemia at Rattanaburi Hospital Emergency Department Surin Province

Abstract

Background: Selecting an effective screening tool to predict death in infected patients presenting to the emergency department will aid in quickly assessing sepsis, facilitating effective treatment, and reducing mortality.
Objective: This study aimed Comparison of Quick Sequential Organ Failure Assessment (qSOFA), Systemic Inflammatory Response Syndrome (SIRS), and National Early Warning Score (NEWS) and identify factors predicting death in patients with Septicemia.
Methods: This retrospective study involved 216 patients with Septicemia at the emergency department from January 1, 2020, to December 31, 2022. The analysis included sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio, negative likelihood ratio, and the area under the receiver operating characteristic curve (AUROC). And Logistic regression
Results: Among the 216 patients studied, 56 experienced septic shock (25%). Culture results were positive, and 94 patients (43.5%) died within ten days, with 8.8% (n = 19) died within 30 days. The 30-day mortality in septic shock patients was 15.7% (n = 34), with 35.3% (n = 12) mortality. The sensitivity of qSOFA ≥ 2, SIRS ≥ 2, and NEWS ≥ 5 in predicting 30-day mortality was 64.7%, 97.1%, and 97.1%, respectively. Specificity values were 82.4%, 15.9%, and 60.4%, respectively. When comparing appropriate cutoff points, the area under the ROC curve (AUC) was 0.74, 0.56, and 0.79, respectively. To forecast death within 30 days, the cutoff points of qSOFA ≥ 1.5, SIRS ≥ 2.5, and NEWS ≥ 7.5 had AUC values of 0.74, 0.64, and 0.92, respectively. In analyzing factors affecting death in patients infected with septic within 30 days, the study found that each 1-year increase in age (OR 1.02, 95% CI 1.00-1.05), NEWS score (OR 3.46, 95% CI 2.19-5.47), SIRS score (OR 2.24, 95% CI 1.44-3.49), and qSOFA score (OR 5.03, 95% CI 2.76-9.19) were significant. Only variables with a p-value <0.05 were analyzed using the multiple logistic regression. It was found that NEWS affected death (adj. OR 3.67, 95% CI 2.22-6.09, P value <0.01).
Conclusion: The National Early Warning Score (NEWS) demonstrated superior accuracy in predicting 10- and 30-day mortality compared to qSOFA and SIRS. Additionally, NEWS emerged as a significant factor influencing 30-day mortality in patients with Septicemia.