qSOFA score: Predictive validity in Enterobacteriaceae bloodstream infections.

Area of Science:

• Critical Care Medicine
• Infectious Diseases
• Clinical Prognostication

Background:

• Sepsis remains a leading cause of mortality worldwide.
• The quick Sequential Organ Failure Assessment (qSOFA) is a clinical tool used for sepsis prognostication.
• Enterobacteriaceae are common causes of sepsis, and appropriate antimicrobial therapy is crucial.

Purpose of the Study:

• To evaluate the predictive validity of the qSOFA score in patients diagnosed with Enterobacteriaceae sepsis.
• To determine if initial appropriate antimicrobial therapy influences the qSOFA score's predictive power for mortality.

Main Methods:

• A retrospective cohort study was conducted at Barnes-Jewish Hospital.
• Data from 510 patients with Enterobacteriaceae sepsis receiving appropriate initial antimicrobial therapy (2009-2013) were analyzed.
• Outcomes were compared based on qSOFA scores and sepsis classification.

Main Results:

• Mortality was significantly higher in patients with qSOFA scores of 2 or 3 compared to those with scores of 0 or 1 (42.4% and 13.3% vs. 1.8% and 5.1%).
• Altered mental status (AMS) and a qSOFA score ≥2 were independent predictors of mortality (ORs 8.01 and 5.39, respectively).
• AMS was more prevalent in non-survivors than survivors, irrespective of sepsis severity.

Conclusions:

• The qSOFA score, AMS, and sepsis severity are valuable bedside tools for initial patient assessment and prognostication in sepsis.
• qSOFA demonstrated retained predictive validity in this cohort, indicating it is reliable even with appropriate initial antimicrobial treatment.
• Appropriate initial antimicrobial therapy does not appear to modify the prognostic value of the qSOFA score in Enterobacteriaceae sepsis.