Diagnostic and prognostic comparison of sepsis scoring systems used in the emergency department

Objective: In our study, we aimed to compare SIRS, qSOFA and NEWS the frequently used sepsis assessment scales in terms of diagnostic accuracy predicting clinical prognosis and mortality in patients admitted to the emergency department and prediagnosed with sepsis. At the same time, it is one of our aims in this study to investigate the role of acute phase reactants such as procalcitonin, lactate, CRP(c-reactive protein) and ferritin in understanding the severity of the disease. Material and Method: Our study is a prospective and cross-sectional study. Patients who applied to Çukurova University Medical Faculty Hospital Emergency Department and were prediagnosed with sepsis were evaluated. The SIRS, qSOFA, and NEWS sepsis assessment scales were applied to these patients. Demographic data, medical histories, vital signs, 30-day mortality data and laboratory findings of the patients were recorded and analyzed. The patients were called after 30 days, and their mortality and causes of mortality were learned and noted. ROC analysis was applied to determine the cut-off values. Results: The mean age of the 87 patients included in the study was 61.2±16.3 years. It was observed that 52.9% (n=46) of the patients were female. The mean pulse rate was 111.9±22.9 and the mean respiratory rate was 25.9±6.6. Other vital signs were within the normal ranges. We found that all three scales performed similarly in terms of diagnosing sepsis and assessing the severity of the disease, but the NEWS scale was superior in terms of predicting mortality. A qSOFA scale score above two indicates severe sepsis with 39.7% sensitivity and 86.2% specificity, septic shock with 54.8% sensitivity and 82.1% specificity, and mortality with 45.2% sensitivity and 76.8% specificity. A SIRS scale score above two indicates severe sepsis with 100% sensitivity and 55.2% specificity, and septic shock with 100% sensitivity and 28.6% specificity, while 30-day mortality with 93.5% sensitivity and 25% specificity. If the cut-off value is accepted as 6, NEWS has a high sensitivity like SIRS (87.9% for severe sepsis, 96.8% for septic shock and 93.5% for mortality) and high specificity like qSOFA. If the cut-off value is accepted as 10 (82.8% for sepsis, 73.2% for septic shock and 78.6% for mortality). In the regression analysis serum ferritin level was found to be the most effective laboratory test to predict mortality was serum ferritin level. It was observed that a serum ferritin level above 428.5 mg/dL could detect 30-day mortality with a 87% sensitivity and 85% specificity. Conclusion: As a result of our study, it was observed that the NEWS score can be easily used in the rapid evaluation and diagnosing sepsis of the patients admitted to the emergency department with sepsis, and it is quite successful in predicting mortality. In addition, high serum ferritin levels could predict mortality with high sensitivity and specificity. Key Words: Emergency Department, NEWS, Prognosis, qSOFA, Sepsis, SIRS