The comparison of quick sepsis related organ failure assessment, systemic inflammatory response syndrome and national early warning score in determination of sepsis diagnosis, mortality and morbidity in emergency department

Purpose In this study, it was aimed to compare the qSOFA, SIRS and NEWS scores of the patients, who were admitted to the emergency department with suspicion of infection and / or were given antibiotherapy or taken culture for suspicion of infection during the emergency service follow-up, in terms of sepsis / septic shock diagnosis, early and late period mortality, morbidity according to the gold standard SOFA score. Method The patients, who were admitted to the Emergency Department of Ege University with the suspicion of infection and / or who were given antibiotherapy or taken culture with the suspicion of infection during the emergency service follow-up, were diagnosed with sepsis according to the SOFA score as the gold standard. The arrival qSOFA, SIRS and NEWS scores of the patients were calculated. Septic shock were diagnosed if there is an inotropic need or lactate elevation in patients with the diagnosis of sepsis. The incidence of sepsis and sepsis shock was calculated and these scoring systems were compared in terms of diagnosis, early and late mortality, morbidity and safe discharge. VI In our study, Chi-Square, T-Test, Man-Whitney tests were performed in the diagnosis of sepsis / septic shock. Kaplan-Meier and Cox Regression Analyzes were performed for mortality. Results n = 525 patients were included in our study and 11.8% (n = 62) of these patients were excluded from the study for a variety of reasons and a total of n = 463 patients were included in the study. 59.2% (n = 274) of the patients were male and the mean age was 63.27 ± 18.06. 62% (n = 287) of the patients were diagnosed with sepsis and 13,8% (n = 64) with septic shock. It was determined that the 2-day rate was 2.5% (n = 12), the 7-day mortality rate was 8.4% (n = 39) and the 30-day mortality rate was 18.1% (n = 84). It was observed that 16.6% of the patients included in the study(n = 77), needed intubation, 14.25% (n = 66) needed inotropic requirement and 0.6% (n = 3) developed fatal arrhythmia . 17.27% (n = 80) of the patients in the study were admitted to the intensive care unit. It was determined that the most common disease was pneumonia [36.5% (n = 182)], respectively followed by urinary tract infection [23.1% (n = 115)], intraabdominal infection [16.3% (n = 81)] soft tissue infection [34% (n = 6.8)]. It was observed that 47.5% (n = 220) of the patients were monitored in the emergency service and 3.2% (n = 14) of them developed mortality in the emergency department. 52.48% (n = 243) of the patients were hospitalized. 17,27% (n = 80) of these patients were admitted to the intensive care unit, 35,20% (n = 163) were hospitalized in service. It was determined that the mortality rate of intensive care was 8,7% (n = 41) and the mortality rate of service was 4% (n = 119). 72.6% of the patients (n = 336) were positive for SIRS and 14.50% (n = 67) were positive for qSOFA. When evaluated according to the NEWS score, 24.62% (n = 114) had a high risk, and 24.40% (n = 113) had a moderate risk and 50.97% (n = 236) had a low risk. In terms of the diagnosis of sepsis, the sensitivity of NEWS-1 was 35,54%, specificity 93,18%, PPD 89,47%, NPD 46,99; the sensivity of NEWS-2 was 65,85%, VII specificity 78,41%, PPD 83,26% , NPD 58.47%; the sensivity of qSOFA was 23.00%, specificity 99.43%, PPD 98.5%, NPD 44.19%; the sensivity of SIRS was 77.35%, specificity 35.23%, PPD 66.0% , NPD 48,82%. AUROC values of qSOFA, SIRS and NEWS in the diagnosis of sepsis were determined as NEWS = 0.731, qSOFa = 0.728 and SIRS = 0.570, respectively. AUROC values in the diagnosis of septic shock were determined as NEWS = 0,801, qSOFA = 0,795 SIRS = 0,573, respectively. AUROC values in mortality were found as NEWS = 0.772, qSOFA = 0.775, SIRS = 0.542. Relative risks (RR) were calculated in terms of the diagnosis of sepsis and septic shock. Accordingly, the risk of sepsis was found to be increased by 5.19 (95% CI; RR = 3.01-8.97) in patients with high-moderate risk compared to the low-risk group according to NEWS-2. The risk of sepsis was found to be increased by 1.76 (95% CI; RR = 1.60-1.93) in patients with qSOFA-positive patients compared to qSOFA negatives. .The risk of sepsis was found to be increased by 1.68 (95% CI; RR = 1.50-1.89) in the high-risk group compared to the middle and low-risk group according to NEWS-1. The risk of sepsis was found to be increased by 1,29 (95% CI; RR = 1,07-1,55) in patients with SIRS positive compared to the negative group. The risk of septic shock was found to be increased by 6.69 (95% CI; RR = 1.60-1.93) in patients with qSOFA positive compared to the negatives. The risk of septic shock was found to be increased by 6.35 (95% CI; RR = 3.21-12.55) in patients in high-moderate risk group compared to the low-risk group according to NEWS-2. The risk of sepsis was found to be increased by 5,10 (95% CI; RR = 3,22-8,08) in the patients in high risk group compared to the moderate-low risk group according to NEWS-1. The risk of sepsis was found to be increased by 2.31 (95% CI; RR = 1.17-4.53) in patients with SIRS positive compared to the negative group. Mortality odds ratios (OR) of the scores were calculated and accordingly the rate of mortality possibility in patients in the high-moderate risk group was 6.08 (95% CI; OR = 3.42-10.79) compared to the patients in the low-risk group.The rate of mortality possibility was found to be 5.26 (95% CI; OR = 3.39-8.17) in patients with qSOFA positive compared to the negative group. The rate of mortality possibility VIII was 4.83 (95% CI; RR = 3.14-7.44) in the high-risk group compared to moderate-low risk group according to NEWS-1. The rate of mortality possibility was found to be 1.86 (95% CI; RR = 1.06-3.25) in patients with SIRS positive compared to negatives. It was determined that elderly patients, patients with diabetes mellitus, chronic renal failure, and malignancy were found to be diagnosed with a significantly higher incidence of sepsis than those without. (p <0.005) The ratio of mortality possibility in the patients with CRF and Malignancy was 1.98 (95% CI OR = 1.07-3.66) and 3.67 (95% CI OR = 2.38-5.65) respectively compared to those without diagnosis. In our study, hypothermia and hypotension were found to be significantly higher in both sepsis and mortality (p <0.001). In terms of determining the hospitalization of intensive care unit; it was determined that qSOFA score was statistically and significantly more positive, patients in the high-risk group according to NEWS-1 were found to be statistically significiantly higher, and those with high-moderate risk according to NEWS-2 were found to be statistically significantly higher (p <0.005). SIRS did not have any significant features in determining intensive care unit stay (p = 0.076) Conclusions In the emergency service patient population, the NEWS scoring system is superior in the diagnosis of sepsis / septic shock, mortality (early and late period) and morbidity compared to qSOFA and SIRS scoring systems. The SIRS scoring system has higher sensitivity than the NEWS and QSOFA scoring systems, thus, it can be used in emergency services. Since qSOFA, recommended for use in the emergency department, is not good at diagnosis of sepsis, mortality and morbidity results and it is worthless about safe discharge, it is not suitable for use in emergency departments. NEWS scoring system should be used in emergency services in risk classification and diagnosis.