Introduction
Methods
Study population
Study design
Statistical analysis
Results
Patients and diagnosis
Management
Outcome
Variables | Total patients | Dead | Survivors | RR | p value |
---|---|---|---|---|---|
n 3137 | n 280 | n 2857 | |||
(100%) | (8.9%) | (91.1%) | |||
Age > 80 years | 246 (7.8) | 72 (25.7) | 174 (6.1) | 4.07 (3.22–5.14) | < 0.001 |
Immunodeficiency | 240 (7.7) | 56 (20.0) | 184 (6.4) | 3.02 (2.32–3.92) | < 0.001 |
Malignancy | 333 (10.6) | 83 (29.6) | 250 (8.8) | 3.55 (2.82–4.46) | < 0.001 |
Severe cardiovascular disease | 406 (12.9) | 106 (37.9) | 300 (10.5) | 4.10 (3.30–5.10) | < 0.001 |
Diabetes | 400 (12.8) | 76 (27.1) | 324 (11.3) | 2.55 (2.00–3.25) | < 0.001 |
Severe CKD | 141 (4.5) | 52 (18.6) | 89 (3.1) | 4.85 (3.78–6.22) | < 0.001 |
Severe COPD | 186 (5.9) | 60 (21.4) | 126 (4.4) | 4.33 (3.39–5.52) | < 0.001 |
Core temperature (°C) | |||||
< 36.0 | 85 (2.7) | 23 (8.2) | 62 (2.2) | 3.21 (2.22–4.64) | < 0.001 |
36.0–38.0 | 2292 (73.1) | 185 (66.1) | 2107 (73.7) | 0.72 (0.57–0.91) | < 0.05 |
> 38.0 | 760 (24.2) | 72 (25.7) | 688 (24.1) | 1.08 (0.84–1.40) | 0.54 |
Hearth rate (bpm) | |||||
< 60 | 8 (0.3) | 1 (0.4) | 7 (0.2) | 1.40 (0.22–8.80) | 0.72 |
60–100 | 1919 (61.2) | 117 (41.8) | 1802 (63.1) | 0.46 (0.36–0.57) | < 0.001 |
> 100 | 1210 (38.6) | 162 (57.9) | 1048 (36.7) | 2.19 (1.74–2.74) | < 0.001 |
Systolic blood pressure (mmHg) | |||||
< 90 | 138 (4.4) | 49 (17.5) | 89 (3.1) | 4.61 (3.57–5.96) | < 0.001 |
90–100 | 388 (12.4) | 70 (25.0) | 318 (11.1) | 2.36 (1.84–3.03) | < 0.001 |
> 100 | 2610 (83.2) | 161 (57.5) | 2449 (85.7) | 0.27 (0.22–0.34) | < 0.001 |
Respiratory rate (breaths/min) | |||||
< 22 | 2244 (71.5) | 124 (44.3) | 2120 (74.2) | 0.32 (0.25–0.40) | < 0.001 |
22–29 | 684 (21.8) | 97 (34.6) | 587 (20.5) | 1.90 (1.50–2.39) | < 0.001 |
30–35 | 154 (4.9) | 39 (13.9) | 115 (4.0) | 3.13 (2.33–4.21) | < 0.001 |
> 35 | 55 (1.8) | 20 (7.1) | 35 (1.2) | 4.31 (2.98–6.23) | < 0.001 |
AVPU responsiveness scale | |||||
Alert | 2917 (93.0) | 187 (66.8) | 2730 (95.6) | 0.15 (0.12–0.19) | < 0.001 |
Voice | 123 (3.9) | 54 (19.3) | 69 (2.4) | 5.85 (4.62–7.41) | < 0.001 |
Pain | 74 (2.4) | 23 (8.2) | 51 (1.8) | 3.70 (2.59–5.30) | < 0.001 |
Unresponsive | 23 (0.7) | 16 (5.7) | 7 (0.2) | 8.21 (6.12–11.01) | < 0.001 |
NRS | |||||
0–3 | 80 (2.6) | 16 (5.7) | 64 (2.2) | 2.32 (1.47–3.64) | < 0.001 |
4–6 | 1512 (48.2) | 112 (40.0) | 1400 (49.0) | 0.72 (0.57–0.90) | < 0.05 |
7–10 | 1112 (35.4) | 128 (45.7) | 984 (34.4) | 1.53 (1.23–1.92) | < 0.001 |
Not reported | 433 (13.8) | 24 (8.6) | 409 (14.3) | NA | NA |
qSOFA score | |||||
0 | 1367 (43.6) | 37 (13.2) | 1330 (46.6) | 0.20 (0.14–0.28) | < 0.001 |
1 | 1323 (42.2) | 109 (38.9) | 1214 (42.5) | 0.87 (0.96–1.10) | 0.25 |
2 | 353 (11.3) | 84 (30.0) | 269 (9.4) | 3.38 (2.68–4.26) | < 0.001 |
3 | 94 (3.0) | 50 (17.9) | 44 (1.5) | 7.04 (5.61–8.82) | < 0.001 |
Variables | Total patients | Dead | Survivors | RR | p value |
---|---|---|---|---|---|
n 3137 | n 280 | n 2857 | |||
(100%) | (8.9%) | (91.1%) | |||
Blood oxygen saturation level (SpO2) (%) in air | |||||
> 92 | 2782 (88.7) | 152 (54.3) | 2630 (92.1) | 0.15 (0.12–0.19) | < 0.001 |
90–91 | 198 (6.3) | 66 (23.6) | 132 (4.6) | 4.58 (3.62–5.79) | < 0.001 |
85–89 | 99 (3.1) | 41 (14.6) | 58 (2.0) | 5.26 (4.04–6.85) | < 0.001 |
< 85 | 21 (0.7) | 9 (3.2) | 12 (0.4) | 4.93 (2.97–8.18) | < 0.001 |
Not reported | 37 (1.2) | 12 (4.3) | 25 (0.9) | NA | NA |
WBC (cells/mm3) | |||||
> 12,000 | 1950 (62.2) | 182 (65.0) | 1768 (61.9) | 1.13 (0.89–1.43) | 0.30 |
4000–12,000 | 1043 (33.2) | 63 (22.5) | 980 (34.3) | 0.58 (0.44–0.76) | < 0.001 |
< 4000 | 94 (3.0) | 29 (10.4) | 65 (2.3) | 3.74 (2.70–5.18) | < 0.001 |
Not reported | 50 (1.6) | 6 (2.1) | 44 (1.5) | NA | NA |
Platelet count (cells/ mm3) | |||||
> 150,000 | 2606 (83.1) | 183 (65.4) | 2423 (84.8) | 0.38 (0.31–0.49) | < 0.001 |
50,000–1,500,000 | 387 (12.3) | 73 (26.1) | 314 (11.0) | 2.51 (1.96–3.20) | < 0.001 |
< 50,000 | 32 (1.0) | 18 (6.4) | 14 (0.5) | 6.67 (4.81–9.24) | < 0.001 |
Not reported | 112 (3.6) | 6 (2.1) | 106 (3.7) | NA | NA |
INR | |||||
> 3 | 23 (0.7) | 12 (4.3) | 11 (0.4) | 6.06 (4.03–9.11) | < 0.001 |
1.2–3 | 296 (9.4) | 72 (25.7) | 224 (7.8) | 3.32 (2.61–4.22) | < 0.001 |
< 1.2 | 1954 (62.3) | 149 (53.2) | 1805 (63.2) | 0.69 (0.55–0.86) | 0.001 |
Not reported | 864 (27.5) | 47 (16.8) | 817 (28.6) | NA | NA |
CRP (mg/l) | |||||
> 200 | 450 (14.3) | 70 (25.0) | 380 (13.3) | 1.99 (1.55–2.56) | < 0.001 |
101–200 | 462 (14.7) | 51 (18.2) | 411 (14.4) | 1.29 (0.97–1.72) | 0.08 |
5–100 | 946 (30.2) | 69 (24.6) | 877 (30.7) | 0.76 (0.58–0.98) | 0.04 |
< 5 | 258 (8.2) | 3 (1.1) | 255 (8.9) | 0.12 (0.04–0.37) | < 0.001 |
Not reported | 1471 (46.9) | 157 (56.1) | 1314 (46.0) | NA | NA |
Procalcitonin (ng/ml) | |||||
> 10 | 85 (2.7) | 31 (11.1) | 54 (1.9) | 4.47 (3.30–6.06) | < 0.001 |
0.5–10 | 260 (8.3) | 42 (15.0) | 218 (7.6) | 1.96 (1.44–2.64) | < 0.001 |
< 0.5 | 100 (3.2) | 3 (1.1) | 97 (3.4) | 0.33 (0.11–1.01) | 0.03 |
Not reported | 2692 (85.8) | 204 (72.9) | 2488 (87.1) | NA | NA |
Lactate (mmol/l) | |||||
>4 | 139 (4.4) | 61 (21.8) | 78 (2.7) | 6.01 (4.79–7.54) | < 0.001 |
1–4 | 615 (19.6) | 86 (30.7) | 529 (18.5) | 1.82 (1.43–2.31) | < 0.001 |
< 1 | 136 (4.3) | 6 (2.1) | 130 (4.6) | 0.48 (0.22–1.07) | 0.06 |
Not reported | 2247 (71.6) | 127 (45.4) | 2120 (74.2) | NA | NA |
Variables | OR | 95% CI | p value |
---|---|---|---|
Age > 80 years | 2.11 | 1.43–3.10 | < 0.001 |
Malignancy | 3.02 | 2.15–4.24 | < 0.001 |
Severe cardiovascular disease | 2.76 | 1.97–3.87 | < 0.001 |
Severe chronic kidney disease | 3.33 | 2.12–5.23 | < 0.001 |
Respiratory rate ≥ 22 breaths/min | 3.38 | 2.23–5.13 | < 0.001 |
Systolic blood pressure < 100 mmHg | 2.18 | 1.58–3.00 | < 0.001 |
AVPU responsiveness scale voice or unresponsive | 3.07 | 2.10–4.51 | < 0.001 |
Blood oxygen saturation level (SpO2) < 90% in air | 2.67 | 1.64–4.32 | < 0.001 |
Platelet count < 50,000 cells/ mm3 | 4.81 | 2.07–11.20 | < 0.001 |
Lactate > 4 mmol/l | 4.00 | 2.58–6.23 | < 0.001 |
Developing the severity score
Variable | Estimate | SE | Wald test |
P
| OR | 95% CI | |
---|---|---|---|---|---|---|---|
LL | UL | ||||||
Age > 80 years | 0.97 | 0.19 | 25.91 | < 0.0001 | 2.63 | 1.81 | 3.89 |
Malignancy | 1.13 | 0.17 | 42.43 | < 0.0001 | 3.11 | 2.21 | 4.37 |
Severe CVD | 0.88 | 0.17 | 26.09 | < 0.0001 | 2.41 | 1.72 | 3.38 |
Severe CKD | 1.2 | 0.23 | 26.23 | < 0.0001 | 3.32 | 2.1 | 5.26 |
RR ≥ 22 breaths/min | 0.75 | 0.16 | 22.61 | < 0.0001 | 2.11 | 1.55 | 2.87 |
SBP < 100 mmHg | 0.86 | 0.17 | 27.29 | < 0.0001 | 2.37 | 1.71 | 3.27 |
AVPU responsiveness scale: not completely alert. | 1.35 | 0.2 | 47.98 | < 0.0001 | 3.86 | 2.63 | 5.65 |
Blood oxygen saturation level: SpO2 < 90% in air | 0.87 | 0.25 | 12.15 | < 0.0001 | 2.39 | 1.46 | 3.89 |
Constant | − 3.79 | 0.13 | 834.77 | < 0.0001 | 0.023 | – | – |