Research Article
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Year 2021, Volume: 4 Issue: 5, 741 - 745, 05.09.2021
https://doi.org/10.32322/jhsm.960792

Abstract

References

  • Liu V, Escobar GJ, Greene JD, et al. Hospital deaths in patients with sepsis from 2 independent cohorts. JAMA 2014; 312: 90-2.
  • Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA 2016; 315: 801-10.
  • Perman SM, Goyal M, Gaieski DF. Initial emergency department diagnosis and management of adult patients with severe sepsis and septic shock. Scand J Trauma Resusc Emerg Med 2012; 20: 41.
  • Gauer RL. Early recognition and management of sepsis in adults: the first six hours. Am Fam Physician 2013; 88: 44-53.
  • Esper AM, Moss M, Lewis CA, Nisbet R, Mannino DM, Martin GS. The role of infection and comorbidity: Factors that influence disparities in sepsis. Crit Care Med 2006; 34: 2576-82.
  • Cheng B, Li Z, Wang J, et al. Comparison of the Performance Between Sepsis-1 and Sepsis-3 in ICUs in China: A Retrospective Multicenter Study. Shock 2017; 48: 301-6.
  • Raith EP, Udy AA, Bailey M, et al. Prognostic accuracy of the SOFA score, SIRS criteria, and qSOFA score for in-hospital mortality among adults with suspected infection admitted to the intensive care unit. JAMA 2017; 317: 290-300.
  • Rhee C, Jones TM, Hamad Y, et al. Prevalence, underlying causes, and preventability of sepsis-associated mortality in US Acute Care Hospitals. JAMA Netw Open 2019; 2: e187571.
  • Milbrandt EB, Eldadah B, Nayfield S, Hadley E, Angus DC. Toward an integrated research agenda for critical illness in aging. Am J Respir Crit Care Med 2010; 182: 995-03.
  • Chen QH, Shao J, Liu WL, et al. Predictive accuracy of Sepsis-3 definitions for mortality among adult critically ill patients with suspected infection. Chin Med J (Engl) 2019; 132: 1147-53.
  • Seymour CW, Liu VX, Iwashyna TJ, et al. Assessment of clinical criteria for sepsis: for the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA 2016; 315: 762-74.
  • Acharya SP, Pradhan B, Marhatta MN. Application of "the Sequential Organ Failure Assessment (SOFA) score" in predicting outcome in ICU patients with SIRS. Kathmandu Univ Med J (KUMJ) 2007; 5: 475-83.
  • Khwannimit B, Bhurayanontachai R, Vattanavanit V. Comparison of the performance of SOFA, qSOFA and SIRS for predicting mortality and organ failure among sepsis patients admitted to the intensive care unit in a middle-income country. J Crit Care 2018; 44: 156-60.
  • Wang JY, Chen YX, Guo SB, Mei X, Yang P. Predictive performance of quick Sepsis-related Organ Failure Assessment for mortality and ICU admission in patients with infection at the ED. Am J Emerg Med 2016; 34: 1788-93.
  • Freund Y, Lemachatti N, Krastinova E, et al. Prognostic accuracy of Sepsis-3 criteria for in-hospital mortality among patients with suspected infection presenting to the emergency department. JAMA 2017; 317: 301-08.
  • Shankar-Hari M, Phillips GS, Levy ML, et al. Developing a new definition and assessing new clinical criteria for septic shock: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA 2016; 315: 775-87.
  • Toffaletti JG. Blood lactate: biochemistry, laboratory methods, and clinical interpretation. Crit Rev Clin Lab Sci 1991; 28: 253-68.
  • Garrabou G, Morén C, López S, et al. The effects of sepsis on mitochondria. J Infect Dis 2012; 205: 392-400.
  • Rhodes A, Evans LE, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Med 2017; 43: 304-77.
  • Chertoff J, Chisum M, Simmons L, King B, Walker M, Lascano J. Prognostic utility of plasma lactate measured between 24 and 48 h after initiation of early goal-directed therapy in the management of sepsis, severe sepsis, and septic shock. J Intensive Care 2016; 4: 13.
  • Li Z, Wang H, Liu J, Chen B, Li G. Serum soluble triggering receptor expressed on myeloid cells-1 and procalcitonin can reflect sepsis severity and predict prognosis: a prospective cohort study. Mediators Inflamm 2014; 2014: 641039.
  • Castelli GP, Pognani C, Cita M, Stuani A, Sgarbi L, Paladini R. Procalcitonin, C-reactive protein, white blood cells and SOFA score in ICU: diagnosis and monitoring of sepsis. Minerva Anestesiol 2006; 72: 69-80.
  • Hofer N, Zacharias E, Müller W, Resch B. An update on the use of C-reactive protein in early-onset neonatal sepsis: current insights and new tasks. Neonatology 2012; 102: 25-36.
  • Saeed K, Wilson DC, Bloos F, et al. The early identification of disease progression in patients with suspected infection presenting to the emergency department: a multi-centre derivation and validation study. Crit Care 2019; 23: 40.
  • Yamamoto S, Yamazaki S, Shimizu T, et al. Prognostic utility of serum CRP levels in combination with CURB-65 in patients with clinically suspected sepsis: a decision curve analysis BMJ Open 2015; 5: e007049.

The evaluation of sepsis in the emergency department and its association with mortality

Year 2021, Volume: 4 Issue: 5, 741 - 745, 05.09.2021
https://doi.org/10.32322/jhsm.960792

Abstract

Aim: Sepsis is a life-threatening organ dysfunction accompanied by a dysregulated host response to infection. Patients with sepsis may present with different clinical manifestations, and there is no gold standard diagnostic test. Early diagnosis and rapid treatment result in a decrease in sepsis-related deaths. Quick Sequential Organ Failure Assessment (qSOFA) is a scoring system used in diagnosing sepsis through a rapid evaluation at the time of initial presentation. The purpose of this study was to evaluate the relationship between qSOFA scores and mortality in patients presenting to the emergency department with suspected sepsis.

Material and Method: Seventy patients presenting to the Atatürk University Medical Faculty Emergency Department and commencing treatment with a preliminary diagnosis of sepsis between 01.12.2019 and 01.06.2020 were included in the research. Patients’ qSOFA scores were calculated, and their demographic data, infection parameters and foci, the clinics to which they were admitted, and outcomes were recorded. The data were analyzed, and the relationships between qSOFA classifications and other infection parameters (CRP, procalcitonin, and lactate) and mortality were examined.

Results: Seventy percent (n=49) of the 70 patients in the study were discharged, while 30% (n=21) were exitus. A statistically significant relationship was present between qSOFA scores and mortality (p<0.001). CRP was also significantly related to qSOFA (p=0.003). Significant relationships were determined between CRP, procalcitonin and lactate and mortality (p=0.009, p<0.001, and p=0.009, respectively).

Conclusion: The use of qSOFA scores at initial assessment in the emergency department appears to be a simple and rapid means of diagnosing sepsis. qSOFA levels were significantly associated with mortality. CRP, procalcitonin, and lactate levels were also associated with mortality, and CRP was significantly associated with qSOFA. Early diagnosis and treatment can be expected to reduce mortality

References

  • Liu V, Escobar GJ, Greene JD, et al. Hospital deaths in patients with sepsis from 2 independent cohorts. JAMA 2014; 312: 90-2.
  • Singer M, Deutschman CS, Seymour CW, et al. The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA 2016; 315: 801-10.
  • Perman SM, Goyal M, Gaieski DF. Initial emergency department diagnosis and management of adult patients with severe sepsis and septic shock. Scand J Trauma Resusc Emerg Med 2012; 20: 41.
  • Gauer RL. Early recognition and management of sepsis in adults: the first six hours. Am Fam Physician 2013; 88: 44-53.
  • Esper AM, Moss M, Lewis CA, Nisbet R, Mannino DM, Martin GS. The role of infection and comorbidity: Factors that influence disparities in sepsis. Crit Care Med 2006; 34: 2576-82.
  • Cheng B, Li Z, Wang J, et al. Comparison of the Performance Between Sepsis-1 and Sepsis-3 in ICUs in China: A Retrospective Multicenter Study. Shock 2017; 48: 301-6.
  • Raith EP, Udy AA, Bailey M, et al. Prognostic accuracy of the SOFA score, SIRS criteria, and qSOFA score for in-hospital mortality among adults with suspected infection admitted to the intensive care unit. JAMA 2017; 317: 290-300.
  • Rhee C, Jones TM, Hamad Y, et al. Prevalence, underlying causes, and preventability of sepsis-associated mortality in US Acute Care Hospitals. JAMA Netw Open 2019; 2: e187571.
  • Milbrandt EB, Eldadah B, Nayfield S, Hadley E, Angus DC. Toward an integrated research agenda for critical illness in aging. Am J Respir Crit Care Med 2010; 182: 995-03.
  • Chen QH, Shao J, Liu WL, et al. Predictive accuracy of Sepsis-3 definitions for mortality among adult critically ill patients with suspected infection. Chin Med J (Engl) 2019; 132: 1147-53.
  • Seymour CW, Liu VX, Iwashyna TJ, et al. Assessment of clinical criteria for sepsis: for the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA 2016; 315: 762-74.
  • Acharya SP, Pradhan B, Marhatta MN. Application of "the Sequential Organ Failure Assessment (SOFA) score" in predicting outcome in ICU patients with SIRS. Kathmandu Univ Med J (KUMJ) 2007; 5: 475-83.
  • Khwannimit B, Bhurayanontachai R, Vattanavanit V. Comparison of the performance of SOFA, qSOFA and SIRS for predicting mortality and organ failure among sepsis patients admitted to the intensive care unit in a middle-income country. J Crit Care 2018; 44: 156-60.
  • Wang JY, Chen YX, Guo SB, Mei X, Yang P. Predictive performance of quick Sepsis-related Organ Failure Assessment for mortality and ICU admission in patients with infection at the ED. Am J Emerg Med 2016; 34: 1788-93.
  • Freund Y, Lemachatti N, Krastinova E, et al. Prognostic accuracy of Sepsis-3 criteria for in-hospital mortality among patients with suspected infection presenting to the emergency department. JAMA 2017; 317: 301-08.
  • Shankar-Hari M, Phillips GS, Levy ML, et al. Developing a new definition and assessing new clinical criteria for septic shock: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA 2016; 315: 775-87.
  • Toffaletti JG. Blood lactate: biochemistry, laboratory methods, and clinical interpretation. Crit Rev Clin Lab Sci 1991; 28: 253-68.
  • Garrabou G, Morén C, López S, et al. The effects of sepsis on mitochondria. J Infect Dis 2012; 205: 392-400.
  • Rhodes A, Evans LE, Alhazzani W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Med 2017; 43: 304-77.
  • Chertoff J, Chisum M, Simmons L, King B, Walker M, Lascano J. Prognostic utility of plasma lactate measured between 24 and 48 h after initiation of early goal-directed therapy in the management of sepsis, severe sepsis, and septic shock. J Intensive Care 2016; 4: 13.
  • Li Z, Wang H, Liu J, Chen B, Li G. Serum soluble triggering receptor expressed on myeloid cells-1 and procalcitonin can reflect sepsis severity and predict prognosis: a prospective cohort study. Mediators Inflamm 2014; 2014: 641039.
  • Castelli GP, Pognani C, Cita M, Stuani A, Sgarbi L, Paladini R. Procalcitonin, C-reactive protein, white blood cells and SOFA score in ICU: diagnosis and monitoring of sepsis. Minerva Anestesiol 2006; 72: 69-80.
  • Hofer N, Zacharias E, Müller W, Resch B. An update on the use of C-reactive protein in early-onset neonatal sepsis: current insights and new tasks. Neonatology 2012; 102: 25-36.
  • Saeed K, Wilson DC, Bloos F, et al. The early identification of disease progression in patients with suspected infection presenting to the emergency department: a multi-centre derivation and validation study. Crit Care 2019; 23: 40.
  • Yamamoto S, Yamazaki S, Shimizu T, et al. Prognostic utility of serum CRP levels in combination with CURB-65 in patients with clinically suspected sepsis: a decision curve analysis BMJ Open 2015; 5: e007049.
There are 25 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Original Article
Authors

Fatma Kesmez Can 0000-0001-8085-7589

Erdal Tekin 0000-0002-6158-0286

Abdullah Can 0000-0001-9751-0696

Handan Alay 0000-0002-4406-014X

Aysun Aras 0000-0003-3361-7042

Publication Date September 5, 2021
Published in Issue Year 2021 Volume: 4 Issue: 5

Cite

AMA Kesmez Can F, Tekin E, Can A, Alay H, Aras A. The evaluation of sepsis in the emergency department and its association with mortality. J Health Sci Med / JHSM. September 2021;4(5):741-745. doi:10.32322/jhsm.960792

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