Relation of early warning and sepsis scores with mortality among patients with suspected infection admitted to medical intensive care units

In medical intensive care units (ICU), important part of admissions consists of patients with suspected infection. Modified Early Warning Score (MEWS), Systemic Inflammatory Response Syndrome (SIRS), Sepsis Related Organ Failure Assessment (SOFA) and Quick Sepsis Related Organ Failure Assessment (qSOFA) scores are used to recognize such patients early and evaluate their prognosis. There are various results for efficacy of these scores in predicting patient's prognosis. However, number of studies evaluating efficacy of scores in different time periods before ICU need is limited. In our study, we aimed to evaluate the efficacy of these scores, which was calculated 48, 24 and 8 hours earlier than ICU admission and first 2 hours of ICU stay and compare one another in terms of mortality prediction. A total of 120 patients who were admitted to medical ICUs from wards or emergency department in Hacettepe University Hospitals and met the suspicion of infection criteria in last 48 hours period before ICU admission were included the present study between 01.01.2018-31.05.2018. Mean (SD) age of the study population was 66,3 (17,1) and %44,2 of patients was male. Statistical comparison between survivors and non-survivors was made according to three primary end points: In-hospital mortality, ICU mortality and 28-days mortality. Multivariate logistic regression analysis with cut off values of SIRS and SOFA scores calculated 48 hours before ICU admission showed increased risk of in-hospital mortality (OR: 7,6 and 13,2 resp.), ICU mortality (OR: 37,0 and 18,2 resp.) and 28-days mortality (OR: 11,9 and 16,2 resp.). For -24th hour period, SOFA and qSOFA associated with increased in-hospital mortality risk (OR: 14,2 and 2,9 resp.) while SIRS and SOFA scores associated with increased ICU mortality (OR: 5,6 and 8,3 resp.) and 28-days mortality (OR: 6,8 and 5,5 resp.). At -8th hour period, SOFA and qSOFA associated with increased risk of in-hospital mortality (OR: 18,3 and 3,9 resp.), ICU mortality (OR: 13,5 and 4,6 resp.) and 28-days mortality (OR: 9,0 and 3,5 resp.). Receiver operating characteristics analysis done with highest scores before ICU admission according to in-hospital mortality showed AUROC values (%95 CI) of 0,80 (0,72-0,89) for SOFA, 0,66 (0,54-0,76) for MEWS, 0,63 (0,51-0,74) for qSOFA and 0,61 (0,49-0,73) for SIRS. In conclusion, SOFA score is the most sensitive scoring system to predict mortality of patients admitted to medical ICU with suspected infection from emergency department or wards.