dc.description.abstract | Sepsis is a severe clinical syndrome owing to its high mortality. Quick Sequential Organ Failure Assessment (qSOFA) score has been proposed for the prediction of fatal outcomes in sepsis syndrome in emergency departments. Due to the low predictive performance of the qSOFA score, we propose a modification to the score by adding age. We conducted a multicenter, retrospective cohort study among regional referral centers from various regions of the country. Participants recruited data of patients admitted to emergency departments and obtained a diagnosis of sepsis syndrome. Crude in-hospital mortality was the primary endpoint. A generalized mixed-effects model with random intercepts produced estimates for adverse outcomes. Model-based recursive partitioning demonstrated the effects and thresholds of significant covariates. Scores were internally validated. The H measure compared performances of scores. A total of 580 patients from 22 centers were included for further analysis. Stages of sepsis, age, time to antibiotics, and administration of carbapenem for empirical treatment were entered the final model. Among these, severe sepsis (OR, 4.40; CIs, 2.35-8.21), septic shock (OR, 8.78; CIs, 4.37-17.66), age (OR, 1.03; CIs, 1.02-1.05) and time to antibiotics (OR, 1.05; CIs, 1.01-1.10) were significantly associated with fatal outcomes. A decision tree demonstrated the thresholds for age. We modified the quick Sequential Organ Failure Assessment (mod-qSOFA) score by adding age (> 50 years old = one point) and compared this to the conventional score. H-measures for qSOFA and mod-qSOFA were found to be 0.11 and 0.14, respectively, whereas AUCs of both scores were 0.64. We propose the use of the modified qSOFA score for early risk assessment among sepsis patients for improved triage and management of this fatal syndrome. | en_US |
dc.department-temp | [Cag, Yasemin -- Caskurlu, Hulya -- Vahaboglu, Haluk] Istanbul Medeniyet Univ, Tip Fak, Enfeksiyon Hastaliklari & Klin Mikrobiyoloji Dept, Istanbul, Turkey -- [Karabay, Oguz] Sakarya Univ, Tip Fak, Enfeksiyon Hastaliklari & Klin Mikrobiyol Dept, Sakarya, Turkey -- [Sipahi, Oguz Resat -- Onal, Ugur] Ege Univ, Tip Fak, Enfeksiyon Hastaliklari & Klin Mikrobiyol Dept, Izmir, Turkey -- [Aksoy, Firdevs] Karadeniz Tech Univ, Tip Fak, Enfeksiyon Hastaliklari & Klin Mikrobiyol Dept, Trabzon, Turkey -- [Durmus, Gul] Bursa Sevket Yilmaz Egitim & Arastirma Hastanesi, Enfeksiyon Hastaliklari & Klin Mikrobiyol Dept, Bursa, Turkey -- [Batirel, Ayse -- Ak, Oznur] Dr Lutfi Kirdar Kartal Egitim & Arastirma Hastane, Enfeksiyon Hastaliklari & Klin Mikrobiyol Dept, Istanbul, Turkey -- [Kocak-Tufan, Zeliha] Yildirim Beyazit Univ, Ankara Ataturk Egitim & Arastirma Hastanesi, Enfeksiyon Hastaliklari & Klin Mikrobiyol Dept, Ankara, Turkey -- [Atilla, Aynur] Samsun Egitim & Arastirma Hastanesi, Enfeksiyon Hastaliklari & Klin Mikrobiyol Dept, Samsun, Turkey -- [Piskin, Nihal] Bulent Ecevit Univ, Enfeksiyon Hastaliklari & Klin Mikrobiyol Dept, Tip Fak, Zonguldak, Turkey -- [Akbas, Turkay -- Cesur, Sinem] Duzce Univ, Tip Fak, Ic Hastaliklari Dept, Yogun Bakim Sect, Istanbul, Turkey -- [Erol, Serpil -- Ozturk-Engin, Derya -- Dogru, Arzu] Haydarpasa Numune Egitim & Arastirma Hastanesi, Enfeksiyon Hastaliklari & Klin Mikrobiyol Dept, Istanbul, Turkey -- [Erdogan, Haluk] Baskent Univ, Alanya Egitim & Arastirma Hastanesi, Enfeksiyon Hastaliklari & Klin Mikrobiyol Dept, Antalya, Turkey -- [Demirel, Aslihan] Istanbul Bilim Univ, Tip Fak, Enfeksiyon Hastaliklari & Klin Mikrobiyol Dept, Istanbul, Turkey -- [Harman, Rezan] Ozel Sani Konukoglu Hastanesi, Gaziantep, Turkey -- [Hamidi, Aziz Ahmad] Sisli Hamidiye Etfal Egitim & Arastirma Hastanesi, Enfeksiyon Hastaliklari & Klin Mikrobiyol Dept, Istanbul, Turkey -- [Karasu, Derya] Bursa Sevket Yilmaz Egitim & Arastirma Hastanesi, Anestezi & Reanimasyon Dept, Bursa, Turkey -- [Korkmaz, Fatime] Konya Egitim & Arastirma Hastanesi, Enfeksiyon Hastaliklari & Klin Mikrobiyol Dept, Konya, Turkey -- [Korkmaz, Pinar] Dumlupinar Univ, Tip Fak, Enfeksiyon Hastaliklari & Klin Mikrobiyol Dept, Kutahya, Turkey -- [Eser, Fatma Civelek] Ankara Diskapi Yildirim Beyazit Egitim & Arastirm, Enfeksiyon Hastaliklari & Klin Mikrobiyol Dept, Ankara, Turkey -- [Onem, Yalcin -- Salmanogiu, Musa] Sultan Abdulhamid Han Egitim & Arastirma Hastanes, Ic Hastaliklari Dept, Istanbul, Turkey -- [Erdem, Ilknur] Namik Kemal Univ, Tip Fak, Enfeksiyon Hastaliklari & Klin Mikrobiyol Dept, Tekirdag, Turkey -- [Diktas, Husrev] Tatvan Mil Hosp, Enfeksiyon Hastaliklari & Klin Mikrobiyol Dept, Van, Turkey | en_US |