Prognostic Value of Severity Score Change for Septic Shock in the Emergency Room

The vital signs or laboratory test results of sepsis patients may change before clinical deterioration. This study examined the differences in prognostic performance when systemic inflammatory response syndrome (SIRS), Sequential Organ Failure Assessment (SOFA), quick SOFA (qSOFA) scores, National Early Warning Score (NEWS), and lactate levels were repeatedly measured. Scores were obtained at arrival to triage, 1 h after fluid resuscitation, 1 h after vasopressor prescription, and before leaving the emergency room (ER) in 165 patients with septic shock. The relationships between score changes and in-hospital mortality, mechanical ventilation, admission to the intensive care unit, and mortality within seven days were compared using areas under receiver operating characteristic curve (AUROCs). Scores measured before leaving the ER had the highest AUROCs across all variables (SIRS score 0.827 [0.737-0.917], qSOFA score 0.754 [0.627-0.838], NEWS 0.888 [0.826-0.950], SOFA score 0.835 [0.766-0.904], and lactate 0.872 [0.805-0.939]). When combined, SIRS + lactate (0.882 [0.804-0.960]), qSOFA + lactate (0.872 [0.808-0.935]), NEWS + lactate (0.909 [0.855-0.963]), and SOFA + lactate (0.885 [0.832-0.939]) showed improved AUROCs. In patients with septic shock, scoring systems show better predictive performances at the timepoints reflecting changes in vital signs and laboratory test results than at the time of arrival, and combining them with lactate values increases their predictive powers.