NEWS2 Is Superior to qSOFA in Detecting Sepsis with Organ Dysfunction in the Emergency Department
Abstract
:1. Introduction
2. Methods
2.1. Patients
2.1.1. Cohort A
2.1.2. Cohort B
2.2. Definitions
2.3. Statistical Methods
3. Results
3.1. Cohort A—Patients with Suspected Infection
3.1.1. Patient Demographics
3.1.2. Performances of the Risk Stratification Scores for the Composite Outcome and Mortality
3.1.3. The Effect of Adding Biomarkers to qSOFA and NEWS2
3.1.4. Sensitivity Analyses—Outcome
3.1.5. Sensitivity Analyses—Missing Data
3.2. Cohort B—Patients, with and without Infection
3.2.1. Patient Demographics
3.2.2. Performance of the Risk Stratification Scores for the Composite Outcome and Mortality
3.2.3. The Effect of Adding Biomarkers to qSOFA and NEWS2
3.2.4. Sensitivity Analyses—Outcome
3.2.5. Sensitivity Analyses—Missing Data
3.2.6. Sensitivity Analyses—Inclusion Bias
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Conflicts of Interest
References
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System | Values |
---|---|
Cardiovascular | SBP < 90 mmHg ∆SBP > −40 MAP < 70 Vasopressor |
Respiratory, Cohort A | SaO2 < 90% |
Respiratory, Cohort B | SaO2 < 90% For COPD SaO2 < 87% For SaO2 90%–94% and O2 PaO2/FiO2 ratio < 300 with COPD and SaO2 87%–95% PaO2/FiO2 ratio < 250 |
Renal | creatinine increase > 44 µmol/L urinary output < 0.5mL/kg/h for >2 h initiation of dialysis |
Hepatic | bilirubin > 35 μmol/L |
Haematologic | platelet count < 100 × 109/L INR > 1.5 unless use of anticoagulants |
Metabolic | lactate > 3.2 mmol/L |
Cohort A, n = 526 | Cohort B, n = 645 | |||||
---|---|---|---|---|---|---|
With Composite Outcome n = 238 | Without Composite Outcome n = 288 | p | With Composite Outcome n = 191 | Without Composite Outcome n = 454 | p | |
Age, median | 70 | 52 | <0.01 | 76 | 71 | <0.01 |
Female, n (%) | 109 (46) | 125 (43) | 0.60 | 94 (49) | 218 (48) | 0.80 |
Comorbidities n (%) | ||||||
Diabetes | 48 (20) | 30 (10) | <0.01 | 43 (23) | 80 (18) | 0.16 |
Cardiovascular disease | 80 (34) | 34 (12) | <0.01 | 99 (52) | 205 (45) | 0.14 |
Renal disease | 16 (6) | 32 (13) | <0.01 | 56 (29) | 111 (24) | 0.20 |
Liver disease | 1 (0) | 3 (1) | 0.63 | 12 (6) | 13 (3) | 0.05 |
Malignancy | 24 (10) | 21 (7) | 0.28 | 31 (16) | 57 (13) | 0.21 |
Immunodeficiency | 9 (4) | 10 (4) | 1 | 8 (4) | 6 (1) | 0.04 |
Respiratory disease | 32 (13) | 22 (8) | 0.03 | 32 (17) | 50 (11) | 0.05 |
No comorbidities | 98 (41) | 195 (68) | <0.01 | 31 (16) | 148 (33) | <0.01 |
Sepsis-2 organ dysfunction, n (%) | ||||||
No organ dysfunction | 5 (2) | 281 (98) | <0.01 | 0 (0) | 212 (47) | <0.01 |
Neurologic | 30 (13) | 7 (2) | <0.01 | 52 (27) | 91 (20) | 0.05 |
Cardiovascular | 174 (91) | - | - | 126 (66) | 130 (29) | <0.01 |
Respiratory | 63 (27) | - | - | 112 (59) | 83 (18) | <0.01 |
Renal | 28 (12) | - | - | 50 (26) | 33 (7) | <0.01 |
Haematological | 25 (11) | - | - | 19 (10) | 26 (6) | 0.05 |
Hepatic | 9 (4) | - | - | 7 (4) | 6 (1) | 0.06 |
Intensive Care, n (%) | 14 (6) | - | - | 18 (10) | 30 (7) | 0.25 |
Three-days mortality, n (%) | 3 (1) | - | - | 7 (4) | 18 (4) | 0.86 |
qSOFA | NEWS2 | |||
---|---|---|---|---|
≥2 | <2 | ≥ 5 | <5 | |
Cohort A (n = 526) | ||||
Composite outcome + | 40 | 198 | 155 | 83 |
Composite outcome – | 8 | 280 | 57 | 231 |
Sensitivity | 0.17 (0.12–0.22) | 0.65 (0.59–0.71) | ||
Specificity | 0.97 (0.95–0.99) | 0.80 (0.75–0.85) | ||
AUC | 0.71 (0.66–0.75) | 0.80 (0.75–0.83) | ||
p compared to qSOFA | reference | <0.01 | ||
30-days mortality + | 6 | 7 | 9 | 4 |
30-days mortality – | 42 | 471 | 203 | 310 |
AUC 30-days mortality | 0.72 (0.54–0.90) | 0.75 (0.60–0.90) | ||
Cohort B (n = 645) | ||||
Composite outcome + | 67 | 124 | 160 | 31 |
Composite outcome – | 75 | 379 | 287 | 167 |
Sensitivity | 0.35 (0.28–0.42) | 0.84 (0.78–0.89) | ||
Specificity | 0.83 (0.80–0.87) | 0.37 (0.32–0.41) | ||
AUC | 0.62 (0.57–0.67) | 0.70 (0.65–0.74) | ||
p compared to qSOFA | reference | 0.02 | ||
30-days mortality + | 18 | 32 | 45 | 5 |
30-days mortality – | 79 | 338 | 289 | 128 |
AUC 30-days mortality | 0.62 (0.53–0.70) | 0.70 (0.63–0.70) |
qSOFA | qSOFA Incl Lactate | qSOFA Incl HBP | NEWS2 | NEWS2 Incl Lactate | NEWS2 Incl HBP | |
---|---|---|---|---|---|---|
Cohort A, n = 485 | ||||||
Composite outcome excl lactate and CNS OD | ||||||
AUC | 0.70 (0.66–0.75) | 0.73 (0.68–0.77) | 0.78 (0.74–0.82) | 0.79 (0.75–0.83) | 0.80 (0.76–0.84) | 0.81 (0.78–0.85) |
p compared to qSOFA | reference | 0.37 | 0.01 | <0.01 | <0.01 | <0.01 |
p compared to NEWS2 | <0.01 | 0.06 | 0.74 | reference | 0.73 | 0.73 |
Composite outcome incl lactate excl CNS OD | ||||||
AUC | 0.71 (0.66–0.75) | 0.74 (0.70–0.78) | 0.78 (0.74–0.82) | 0.79 (0.75–0.83) | 0.80 (0.76–0.84) | 0.82 (0.78–0.85) |
p compared to qSOFA | reference | 0.47 | 0.03 | 0.01 | <0.01 | <0.01 |
p compared to NEWS2 | 0.01 | 0.11 | 0.73 | reference | 0.73 | 0.30 |
Composite outcome incl lactate and CNS OD | ||||||
AUC | 0.72 (0.68–0.77) | 0.76 (0.71–0.80) | 0.80 (0.76–0.84) | 0.81 (0.77–0.85) | 0.82 (0.78–0.86) | 0.83 (0.80–0.87) |
p compared to qSOFA | reference | 0.21 | 0.01 | <0.01 | <0.01 | <0.01 |
p compared to NEWS2 | <0.01 | 0.09 | 0.73 | reference | 0.72 | 0.47 |
Cohort B, n = 358 | ||||||
Composite outcome excl lactate and CNS OD | ||||||
AUC | 0.62 (0.55–0.68) | 0.64 (0.58–0.70) | 0.66 (0.60–0.73) | 0.67 (0.61–0.73) | 0.68 (0.62–0.73) | 0.69 (0.63–0.75) |
p compared to qSOFA | reference | 0.66 | 0.37 | 0.26 | 0.18 | 0.11 |
p compared to NEWS2 | 0.26 | 0.50 | 0.82 | reference | 0.82 | 0.65 |
Composite outcome incl lactate excl CNS OD | ||||||
AUC | 0.62 (0.55–0.68) | 0.64 (0.58–0.70) | 0.66 (0.60–0.73) | 0.67 (0.61–0.73) | 0.68 (0.62–0.73) | 0.69 (0.63–0.75) |
p compared to qSOFA | reference | 0.66 | 0.37 | 0.26 | 0.18 | 0.11 |
p compared to NEWS2 | 0.26 | 0.50 | 0.82 | reference | 0.82 | 0.65 |
Composite outcome incl lactate and CNS OD | ||||||
AUC | 0.62 (0.56–0.68) | 0.64 (57–0.70) | 0.67 (0.61–0.73) | 0.68 (0.62–0.74) | 0.68 (0.62–0.74) | 0.69 (0.63–0.75) |
p compared to qSOFA | reference | 0.66 | 0.26 | 0.18 | 0.18 | 0.11 |
p compared to NEWS2 | 0.18 | 0.36 | 0.82 | reference | 1 | 0.82 |
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Mellhammar, L.; Linder, A.; Tverring, J.; Christensson, B.; Boyd, J.H.; Sendi, P.; Åkesson, P.; Kahn, F. NEWS2 Is Superior to qSOFA in Detecting Sepsis with Organ Dysfunction in the Emergency Department. J. Clin. Med. 2019, 8, 1128. https://doi.org/10.3390/jcm8081128
Mellhammar L, Linder A, Tverring J, Christensson B, Boyd JH, Sendi P, Åkesson P, Kahn F. NEWS2 Is Superior to qSOFA in Detecting Sepsis with Organ Dysfunction in the Emergency Department. Journal of Clinical Medicine. 2019; 8(8):1128. https://doi.org/10.3390/jcm8081128
Chicago/Turabian StyleMellhammar, Lisa, Adam Linder, Jonas Tverring, Bertil Christensson, John H. Boyd, Parham Sendi, Per Åkesson, and Fredrik Kahn. 2019. "NEWS2 Is Superior to qSOFA in Detecting Sepsis with Organ Dysfunction in the Emergency Department" Journal of Clinical Medicine 8, no. 8: 1128. https://doi.org/10.3390/jcm8081128