Background
Methods
Study definitions
Data analysis
Results
Study population
Characteristics | High qSOFA n = 90 (%) | Low qSOFA n = 312 (%) | p value |
---|---|---|---|
Age, yr. a | 56.5 ± 13.99 | 55.2 ± 15.1 | 0.66 |
Male | 60 (67) | 241 (77) | 0.053 |
Residence Prior to Admission | |||
Home | 66 (73) | 240 (77) | 0.81 |
Skilled Nursing Facility | 5 (6) | 11 (4) | |
Other hospital/rehab center | 9 (10) | 30 (10) | |
Homeless | 10 (11) | 31 (10) | |
Comorbid conditions | |||
None | 2 (2) | 30 (10) | 0.02 |
Diabetes Mellitus | 35 (39) | 142 (46) | 0.28 |
End stage renal disease on dialysis | 16 (18) | 51 (16) | 0.75 |
Cirrhosis | 11 (13) | 32 (11) | 0.52 |
Cardiovascular disease b | 40 (44) | 170 (54) | 0.096 |
Immunosuppressed c | 15 (17) | 37 (12) | 0.28 |
≥ 3 comorbid conditions | 45 (50) | 165 (53) | 0.63 |
Race/Ethnicity | 0.18 | ||
Caucasian | 28 (33) | 92 (30) | |
Asian | 14 (16) | 26 (8) | |
African American | 10 (12) | 34 (11) | |
Hispanic | 32 (37) | 137 (44) | |
Other | 2 (2) | 21 (7) | |
History of Intravenous Drug Use | 13 (15) | 32 (10) | 0.26 |
History of S. aureus infection | 14 (16) | 57 (18) | 0.08 |
History of IV vancomycin therapy | 12 (13%) | 45 (15%) | 0.79 |
Community-onset SAB | 77 (86) | 272 (87) | 0.72 |
Microbial characteristics | 0.03 | ||
MSSA | 52 (58) | 219 (70) | |
MRSA | 38 (42) | 93 (30) | |
Source Risk Category d | 0.0036 | ||
Low risk | 20 (22) | 64 (21) | |
Intermediate risk | 43 (48) | 202 (65) | |
High risk | 26 (29) | 46 (15) | |
Study site | 0.43 | ||
County teaching hospital | 64 (71) | 205 (66) | |
Academic hospital | 11 (12) | 35 (11) | |
Community teaching hospital | 15 (17) | 72 (23) |
Clinical presentation and management
Clinical Presentation | High qSOFA n = 90 (%) | Low qSOFA n = 312 (%) | p value |
---|---|---|---|
Pitt Bacteremia Score a | 2 (0, 3) | 0 (0, 1) | < 0.0001 |
Score ≥ 2 | 57 (69) | 37 (12) | < 0.0001 |
Score ≥ 4 | 19 (23) | 7 (2) | < 0.0001 |
SIRS criteria | |||
Sepsis | 88 (98) | 232 (74) | < 0.0001 |
Severe sepsis | 59 (66) | 86 (28) | < 0.0001 |
Septic shock | 25 (28) | 3 (1) | < 0.0001 |
No sepsis | 2 (2) | 80 (26) | |
Presenting symptoms | |||
Fever | 35 (39%) | 100 (32%) | 0.25 |
Pain | 28 (31%) | 155 (50%) | 0.0018 |
Altered mental status | 21 (23%) | 16 (5%) | < 0.0001 |
Shortness of breath | 10 (11%) | 19 (6%) | 0.11 |
Prognosis and outcome
Clinical Outcomes | High qSOFA n = 90 (%) | Low qSOFA n = 312 (%) | p value |
---|---|---|---|
ICU admission | 58 (64) | 67 (21) | < 0.0001 |
ICU admission within 48 h of first positive culture | 51 (57) | 50 (16) | < 0.0001 |
Need for vasopressors | 31 (35) | 17 (6) | < 0.0001 |
Duration of ICU stay, daysa | 5 (2, 12.3) | 3 (1, 7) | 0.01 |
Duration of ICU stay > 72 h | 43 (48) | 38 (12) | < 0.0001 |
Day 4 Success | 45 (50) | 228 (73) | < 0.0001 |
Died | 2 (4) | 2 (1) | 0.07 |
Day 4 Failure | 44 (49) | 83 (27) | < 0.0001 |
Died | 15 (34) | 7 (8) | 0.0003 |
Microbial Persistence on day 4 | 31 (34) | 62 (20) | 0.0039 |
Died | 10 (32) | 3 (5) | 0.0007 |
Initial GCS < 15 | 54/89 (61) | 31/306 (10) | < 0.0001 |
Died | 13 (24) | 2 (6) | 0.04 |
Initial SBP ≤ 100 mmHg | 57/84 (68) | 52/297 (18) | < 0.0001 |
Died | 12 (21) | 3 (6%) | 0.026 |
Initial RR ≥ 22 breaths per minute | 72/85 (85) | 71/298 (24) | < 0.0001 |
Died | 14 (19) | 4 (6) | 0.021 |
30-day mortality | 17 (19) | 9 (3) | < 0.0001 |
Total Hospital LOS, days a | 16 (8, 32) | 10 (6, 19) | < 0.0001 |
LOS after first positive culture, days a | 14 (7.8, 23) | 9 (6.25, 17) | 0.001 |
Disposition of survivors | N = 73 | N = 303 | 0.92 |
Home | 48 (66) | 198 (65) | |
Skilled nursing facility | 12 (16) | 47 (16) | |
Outside Hospital | 4 (5) | 23 (8) | |
Rehab center | 7 (10) | 23 (8) | |
Homeless/jail | 2 (3) | 12 (4) |
Predictive performance of qSOFA, SIRS, and PBS clinical criteria
ICU admission within 48 h of onset of SAB | Duration of ICU stay longer than 72 h | 30-day mortality | ||||
---|---|---|---|---|---|---|
Variable | OR (95% CI) | p-value | OR (95% CI) | p-value | OR (95% CI) | p-value |
Age | 0.99 (0.97–1.00) | 0.10 | 0.99 (0.97–1.00) | 0.13 | 1.03 (1.00–1.06) | 0.08 |
Gender | 1.14 (0.62–2.11) | 0.68 | 1.04 (0.55–1.97) | 0.90 | 0.90 (0.34–2.42) | 0.84 |
Source Risk Category: High vs. Intermediate & Low | 2.42 (1.27–4.59) | 0.007 | 2.01 (1.05–3.85) | 0.04 | 0.78 (0.26–2.29) | 0.65 |
qSOFA ≥ 2 | 4.40 (2.40–8.09) | < 0.0001 | 4.67 (2.51–8.68) | < 0.0001 | 6.94 (2.49–19.31) | 0.0002 |
PBS ≥ 2 | 4.69 (2.54–8.67) | < 0.0001 | 2.89 (1.53–5.48) | 0.001 | 3.38 (1.25–9.16) | 0.02 |