Comparison efficiency of Systemic Inflammatory Response Syndrome (SIRS), quick Sequential Organ Failure Assessment (qSOFA), Rapid Emergency Medicine Score (REMS) and Modified Shock Index (MSI) to predict in-hospital mortality among patients with sepsis in the Emergency Department
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Abstract
BACKGROUND:Several early warning scores (EWSs) have been validated for screening and monitoring patients with sepsis in the Emergency Department (ED). These EWSs include Systemic Inflammatory Response Syndrome (SIRS), quick Sequential Organ Failure Assessment (qSOFA), Rapid Emergency Medicine Score (REMS), and Modified Shock Index (MSI). Studies comparing the effectiveness in predicting in-hospital mortality are limited.
OBJECTIVE:To compare the effectiveness of SIRS, qSOFA, REMS, and MSI in predicting 28-day in-hospital mortality after the diagnosis of sepsis and to assess their suitability for use in the emergency department.
METHODS:A retrospective cohort study enrolled patients who visited the ED from January 1, 2022, to December 31, 2022. Data on sepsis patients were collected from electronic medical records and medical records. The effectiveness of SIRS, qSOFA, REMS, and MSI in predicting 28-day mortality was evaluated.
RESULTS:259 patients were enrolled, with a 28-day mortality rate of 37%. REMS exhibited the highest area under the Receiver Operating Characteristic curve (AUROC) at 0.64 (95% CI, 0.57-0.70), qSOFA (AUROC 0.62; 95% CI, 0.55-0.68), SIRS (AUROC 0.61; 95% CI, 0.53-0.68), and MSI (AUROC 0.56; 95% CI, 0.49-0.63). SIRS and qSOFA demonstrated similar sensitivity and specificity. SIRS had a sensitivity of 59.37% and a specificity of 57.66%, qSOFA had a sensitivity of 60.41% and a specificity of 59.50%. REMS and MSI showed low sensitivity and high specificity. REMS had a sensitivity of 40.62% and a specificity of 80.36%, and MSI had a sensitivity of 33.33% and a specificity of 77.91%.
CONCLUSIONS AND RECOMMENDATIONS:SIRS and qSOFA are EWSs that correlate with the 28-day in-hospital mortality of patients with sepsis and are suitable for use in the ED. While, REMS and MSI are more precise and should be reassessed after patients are admitted to the ward.
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