A modified Rapid Emergency Medicine Score incorporating C-reactive protein for mortality prediction in septic shock

The aim of this study was to evaluate the prognostic performance of the Rapid Emergency Medicine Score incorporating C-reactive protein for predicting 30-day mortality in patients with septic shock and to compare its performance with the Rapid Emergency Medicine Score, National Early Warning Score, Modified Early Warning Score, quick Sequential Organ Failure Assessment, and Sequential Organ Failure Assessment.

This retrospective observational study included 124 adult patients diagnosed with septic shock in a tertiary emergency department. Rapid Emergency Medicine Score incorporating C-reactive protein was calculated as Rapid Emergency Medicine Score +(C-reactive protein /50), using an a priori clinically determined C-reactive protein scaling factor.

The median age was 63 years, 52.4% of patients were female, and 76 patients (61.3%) died within 30 days. Rapid Emergency Medicine Score incorporating C-reactive protein had the highest numerical AUC (0.770), corresponding to moderate discrimination, followed by National Early Warning Score (0.755), Modified Early Warning Score (0.746), quick Sequential Organ Failure Assessment (0.688), Rapid Emergency Medicine Score (0.638), and Sequential Organ Failure Assessment (0.593). Rapid Emergency Medicine Score incorporating C-reactive protein had significantly higher AUCs than Rapid Emergency Medicine Score (ΔAUC=0.132, p<0.001) and Sequential Organ Failure Assessment (ΔAUC=0.177, p=0.049), whereas differences compared with National Early Warning Score, Modified Early Warning Score, and quick Sequential Organ Failure Assessment were not statistically significant. In the Firth-penalized logistic regression model, Rapid Emergency Medicine Score incorporating C-reactive protein remained associated with 30-day mortality (OR per 1-point increase, 1.22; 95%CI 1.11-1.36; p<0.001).

Rapid Emergency Medicine Score incorporating C-reactive protein showed moderate discrimination for 30-day mortality in this exploratory development cohort but did not demonstrate superior discrimination compared with National Early Warning Score, Modified Early Warning Score, or quick Sequential Organ Failure Assessment. Because Rapid Emergency Medicine Score incorporating C-reactive protein was developed and evaluated in the same cohort, these findings should be considered hypothesis-generating. Independent external validation is required before its clinical utility can be established.