Highlights
Introduction
Material and methods
Recorded variables
Risk scales
Systemic inflammatory response syndrome (SIRS)
Quick sequential organ failure assesment (qSOFA)
National early warning score 2 (NEWS2)
Sequential organ failure assesment (SOFA)
Amplified risk scales
Statistical analysis
Results
Characteristics of the study population
Total (%) | Alive (%) | In-Hospital Mortality (%) | Mortality in 3 Months (%)** | p value6 | |
TOTAL (201)* | 201 (100,0) | 113 (56,5) | 63 (31,5) | 24 (12,0) | |
GENDER (male) (201)* | 108 (53,7) | 55 (27,3) | 34 (16,9) | 19 (9,5) | NS |
AGE (SD) (201)* | 77 (11,9) | 72,7 (10,9) | 81,3 (12,3) | 81,2 (11,3) | 0,029 |
TERCILES OF AGE | |||||
Group 1 (15 to 74 years old) | 80 (39,8) | 58 (28,9) | 15 (7,5) | 7 (3,5) | |
Mean ± SD | 65,2 ± 8,2 | 65,3 ± 7,8 | 64,1 ± 9,9 | 67,1 ± 8,3 | |
Group 2 (76 to 84 years old) | 60 (29,9) | 37 (18,4) | 18 (9,0) | 5 (2,5) | |
Mean ± SD | 79,9 ± 3,0 | 79,9 ± 3,1 | 79,6 ± 2,8 | 80,8 ± 3,8 | |
Groupo 3 (≥ 85 years old) | 61 (30,3) | 18 (9,0) | 30 (14,9) | 12 (6,0) | |
Mean ± SD | 89,8 ± 4,16 | 88,3 ± 3,54 | 90,97 ± 4,16 | 89,5 ± 4,58 | |
DIABETES (201)* | 74 (37,0) | 41 (20,5) | 26 (13,0) | 7 (3,5) | NS |
DEPENDENCE LEVEL (195)* | <0,001 | ||||
-TOTAL | 69 (35,4) | 23 (11,8) | 35 (17,9) | 11 (5,6) | |
-PARTIAL | 32 (16,4) | 18 (9,2) | 11 (5,6) | 3 (1,5) | |
-INDEPENDENT | 94 (48,2) | 69 (3,4) | 16 (8,2) | 9 (4,6) | |
INFECTION SOURCE (200)* | NS | ||||
Respiratory | 56 (28,0) | 27 (13,4) | 20 (10,0) | 9 (4,5) | |
Urinary | 102 (51,2) | 64 (32,0) | 26 (13,0) | 12 (6,0) | |
Abdominal | 19 (9,5) | 11 (5,5) | 6 (3,0) | 2 (1,0) | |
Soft tissue | 9 (4,5) | 5 (2,5) | 4 (2,0) | 0 (0,0) | |
Urinary and respiratory | 3 (1,5) | 0 (0,0) | 2 (1,0) | 1 (0,5) | |
Mucositis | 1 (0,5) | 1 (0,5) | 0 (0,0) | 0 (0,0) | |
Arthritic | 1 (0,5) | 1 (0,5) | 0 (0,0) | 0 (0,0) | |
Unknown | 9 (4,5) | 4 (2,0) | 5 (2,5) | 0 (0,0) | |
GRAM-NEGATIVE (150)* | 44 (32,0) | 33 (22,0) | 11 (7,3) | 4 (2,7) | NS |
VITAL SIGNS: | |||||
TEMPERATURE (193)* | 37,2 ± 13,0 | 37,5 ± 1,4 | 36,9 ± 1,6 | 36.9 ± 1,2 | 0,021 |
SaO2 mmHg (192)* | 91,9 ± 6,1 | 94,0 ± 5,0 | 90,0 ± 6,0 | 89,0 ± 9,0 | 0,011 |
FiO2 mmHg (192)* | 0,26 ± 0,1 | 0,24 ± 0,11 | 0,29 ± 0,17 | 0,28 ± 0,14 | 0,016 |
SYSTOLIC BP (mmHg) (199)* | 107± 29 | 109 ± 29 | 102 ± 30 | 109,0 ± 28,0 | NS |
DYASTOLIC BP (mmHg) (199)* | 61 ± 18 | 62 ± 18 | 61 ± 19 | 60 ± 17 | NS |
HEART RATE (beats/min) (193)* | 103 ± 25 | 101 ± 22 | 109 ± 29 | 98 ± 25 | 0,034 |
RESPIRATORY RATE ≥ 22 (resp/min) (136)* | 72 (52,9) | 33 (24,3) | 29 (21,32) | 10 (5,6) | 0,013 |
GLASGOW scale ≤ 13 (180)* | 64 (35,6) | 20 (11,1) | 34 (18,9) | 10 (5,6) | <0,001 |
OTHER: | |||||
ICU need (200)* | 28 (14,0) | 13 (6,5) | 15 (7,5) | 15 (7,5) | 0,009 |
Days ICU (200)* | 0,5 ± 1,6 | 0,0 ± 1,0 | 1,0 ± 2,0 | 0,0 ± 0,0 | 0,041 |
Days HOSPITAL (199)* | 9 ± 11 | 12 ± 14 | 5 ± 4 | 9 ± 5 | <0,001 |
Total (%) | Alive (%) | In-Hospital Mortality (%) | Mortality in 3 Months (%)** | p value6 | |
GASOMETRY | |||||
paCO2 mmHg (158)* | 36,2 ± 8,7 | 37,4 ± 8,0 | 33,3 ± 8,7 | 38,8 ± 10,4 | 0,004 |
paO2 mmHg (101)* | 64,1 ± 21 | 62,6 ± 14,2 | 66 ± 28,5 | 63,7 ± 19,6 | NS |
paO2/FiO2 (100)* | 261,40 ± 94,00 | 275,30 ± 71,50 | 240,19 ± 111,85 | 263,4 ± 110,6 | NS |
PH (179)* | 7,40 ± 0,10 | 7,43 ± 0,06 | 7,40 ± 0,10 | 7,41 ± 0,09 | NS |
CELLS BLOOD COUNT: | |||||
WBCs x103/ml(200)* | 15,84 ± 10,38 | 16,08 ± 10,89 | 16,33 ± 10,31 | 13,44 ± 8,15 | NS |
Neutrofils x103/ml (200)* | 13,82 ± 9,97 | 14,14 ± 10,43 | 14,33 ± 9,88 | 11,07 ± 7,89 | NS |
Platelets x103/ml ((198)* | 235 ± 128 | 230 ± 119 | 248 ± 153 | 219 ± 101 | NS |
BLOOD LEVELS | |||||
Glucose (mg/dl) (199)* | 170 ± 100 | 164 ± 92 | 192 ± 119 | 144 ± 75 | 0,043 |
Creatinine (mg/dl) (200)* | 1,90 ± 1,30 | 1,67 ± 1,15 | 2,21 ± 1,31 | 2,42 ± 13,40 | 0,032 |
Bilirrubine (mg/dl) (131)* | 0,80 ± 1,90 | 0,71 ± 1,21 | 1,07 ± 3,10 | 0,68 ± 0,93 | NS |
Lactate (mEq/L) (174)* | 3,0 ± 2,6 | 2,4 ± 1,8 | 4,2 ± 3,3 | 2,6 ± 2,1 | <0,001 |
Procalcitonin (microg/L) (104)* | 15,36 ± 26,85 | 14,88 ± 26,02 | 16,80 ± 28,53 | 4,80 ± 4,80 | NS |
CRP (mg/L) (198)* | 116,42 ± 133,3 | 165,04 ± 142,06 | 175,39 ± 125’07 | 142,27 ± 107,13 | NS |
In-hospital mortality related factors
TOTAL (%) | ALIVE (%) | IN-HOSPITAL MORTALITY (%) | MORTALITY IN 3 MONTHS (%)** | p value6 | |
TOTAL (201)* | 201 (100,0) | 113 (56,5) | 63 (31,5) | 24 (12,0) | |
SCALES | |||||
SIRS ≥ 2 (179)* | 149 (83,2) | 82 (45,8) | 51 (28,5) | 16 (8,9) | NS |
Quantitative SIRS (179)* | 2,4 ± 0,9 | 2,0 ± 1,0 | 3,0 ± 1,0 | 2,0 ±1,0 | NS |
qSOFA ≥ 2 (158)* | 63 (39,9) | 24 (15,2) | 28 (17,7) | 11 (6,9) | <0,001 |
Quantitative qSOFA (158)* | 1,3 ± 0,9 | 1,0 ± 1,0 | 2,0 ± 1,0 | 1,0 ± 1,0 | 0,013 |
SOFA ≥ 2 (186)* | 153 (82,3) | 82 (44,1) | 51 (27,4) | 20 (10,8) | 0,046 |
Quantitative SOFA (186)* | 3,4 ± 2,4 | 3,0 ± 2,0 | 5,0 ± 3,0 | 4,0 ± 2,0 | <0,001 |
NEWS2 ≥ 5 (193)* | 150 (77,7) | 78 (40,4) | 55 (28,5) | 17 (8,8) | <0,001 |
Quantitative NEWS2 (193)* | 7,5 ± 3,8 | 6,0 ± 3,0 | 10,0 ± 3,0 | 8,0 ± 4,0 | <0,001 |
AMPLIFIED (amp) SCALES | |||||
qSOFA-amp ≥ 4 (126)* | 31 (24,6) | 12 (9,5) | 17 (11,9) | 2 (1,6) | <0,001 |
Quantitative QSOFA-amp (126)* | 2,5 ± 1,6 | 2,0 ± 1,0 | 3,0 ± 2,0 | 2,0 ± 1,0 | <0,001 |
NEWS2-amp ≥ 6 (193)* | 139 (72,0) | 62 (32,1) | 57 (29,5) | 20 (10,4) | <0,001 |
Quantitative NEWS2-amp (193)* | 8,6 ± 4,2 | 7,0 ± 4,0 | 11,0 ± 4,0 | 9,0 ± 4,0 | <0,001 |
Predictive value of hospital mortality
Cut-off values | ROC curve [IC95%] | Sensitivity [IC95%] | Specificity [IC95%] | PPV [IC95%] | NPV [IC95%] | |
QSOFA | ≥2 | [0,48–0,72] | 0,62 [0,48-0,76] | 0,70 [0,61-0,78] | 0,45 [0,33-0,58] | 0,82 [0,75-0,90] |
qSOFA amp | ≥4 | [0,56–0,80] | 0,52 [0,35-0,69] | 0,85 [0,78-0,92] | 0,55 [0,37-0,72] | 0,83 [0,76-0.91] |
NEWS2 | ≥5 | [0,51–0,72] | 0,93 [0,87-0,99] | 0,34 [0,26-0,42] | 0,40 [0,32-0,48] | 0,92 [0,84-0,99] |
NEWS2amp | ≥6 | [0,54–0,74] | 0,93 [0,87-0,99] | 0,38 [0,30-0,46] | 0,41 [0,33-0,49] | 0,93 [0,85-0,99] |
Scales | Area ± SD | IC 95% | Asintotic Signification |
SCALES | |||
SIRS | 0,566 ± 0,060 | [0,449 - 0,683] | 0,274 |
SOFA | 0,666 ± 0,054 | [0,560 – 0,771] | 0,006 |
qSOFA | 0,647 ± 0,057 | [0,536 – 0,759] | 0,015 |
NEWS2 | 0,699 ± 0,055 | [0,592 – 0,806] | 0,001 |
AMPLIFIED (AMP) SCALES | |||
qSOFA-amp | 0,719 ± 0,058 | [0,606 – 0,832] | <0,001 |
NEWS2-amp | 0,727 ± 0,054 | [0,620 – 0,833] | <0,001 |
SCALES | AREA ± SD | IC 95% | ASINTOTIC SIGNIFICATION |
SCALES | |||
SIRS ≥ 2 | 0,517 ± 0,060 | [0,400 – 0,635] | 0,778 |
SOFA ≥ 2 | 0,572 ± 0,057 | [0,460 – 0,684] | 0,233 |
qSOFA ≥ 2 | 0,602 ± 0,060 | [0,484 – 0,719] | 0,093 |
NEWS2 ≥ 5 | 0,617 ± 0,054 | [0,511 – 0,724] | 0,053 |
AMPLIFIED (AMP) SCALES | |||
qSOFA-amp ≥ 2 | 0,586 ± 0,057 | [0,474 – 0,698] | 0,156 |
qSOFA-amp ≥ 3 | 0,614 ± 0,056 | [0,530 – 0,752] | 0,020 |
qSOFA-amp ≥ 4 | 0,678 ± 0,060 | [0,560 – 0,795] | 0,003 |
qSOFA-amp ≥ 5 | 0,633 ± 0,063 | [0,509 – 0,756] | 0,029 |
NEWS2-amp ≥ 5 | 0,565 ± 0,057 | [0,453 – 0,678] | 0,280 |
NEWS2-amp ≥ 6 | 0,640 ± 0,053 | [0,536 – 0,744] | 0,021 |
NEWS2-amp ≥ 7 | 0,637 ± 0,054 | [0,530 – 0,743] | 0,024 |
NEWS2-amp ≥ 8 | 0,623 ± 0,057 | [0,512 – 0,734] | 0,043 |