Puntuación S-S.M.A.R.T para la predicción de mortalidad en sepsis: Análisis comparativo con qSOFA y un novedoso...

Early risk stratification in sepsis is essential for guiding timely clinical decisions in the emergency department (ED). While several prognostic scores exist, many rely on laboratory parameters that may not be immediately available at triage.

To evaluate the prognostic performance of the S-S.M.A.R.T score for predicting 30-day mortality in patients with Sepsis-3-defined sepsis and to assess whether incorporating comorbidity and biomarker data enhances predictive accuracy.

This prospective observational study included adult patients (≥18 years) presenting to a ED with sepsis defined by Sepsis-3 criteria. Demographic, clinical, and laboratory data were collected at ED presentation. The S-S.M.A.R.T score, SOFA score, and a novel SSMART-MC model (S-S.M.A.R.T plus malignancy and CRP) were calculated. Logistic regression identified independent predictors of 30-day mortality. Prognostic performance was assessed using area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and overall accuracy.

Among 180 patients, 104 (57.8%) died within 30 days. Median S-S.M.A.R.T and SOFA scores were higher in non-survivors (3 vs. 2 and 9 vs. 6; p < .001). S-S.M.A.R.T predicted 30-day mortality with an AUC of 0.718, similar to SOFA (AUC 0.735; p = .701). Incorporating malignancy and CRP, the SSMART-MC model achieved an AUC of 0.867, with 87.3% sensitivity, 72.0% specificity, and 80.8% overall accuracy.

In this Sepsis-3 cohort, the S-S.M.A.R.T score showed performance comparable to qSOFA for predicting 30-day mortality. The incorporation of malignancy and CRP appeared to improve prognostic accuracy. However, given the limited sample size and lack of external validation, the SSMART-MC model should be considered a promising tool that requires confirmation in larger, multicenter studies before routine clinical use.