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qSOFA as a new community-acquired pneumonia severity score in the emergency setting
  1. Ornella Spagnolello1,2,
  2. Giancarlo Ceccarelli2,
  3. Cristian Borrazzo3,
  4. Angela Macrì1,
  5. Marianna Suppa1,
  6. Enrico Baldini1,
  7. Alessia Garramone1,
  8. Francesco Alessandri4,
  9. Luigi Celani2,
  10. Francesco Vullo5,
  11. Silvia Angeletti6,
  12. Massimo Ciccozzi7,
  13. Claudio Mastroianni2,
  14. Giuliano Bertazzoni1,
  15. Gabriella D'Ettorre2
  1. 1Department of Emergency Medicine, University of Rome La Sapienza, Roma, Lazio, Italy
  2. 2Department of Public Health and Infectious Diseases, University of Rome La Sapienza, Roma, Lazio, Italy
  3. 3Statistical Unit, Department of Public Health and Infectious Diseases, University of Rome La Sapienza, Roma, Lazio, Italy
  4. 4Department of Anesthesia and Intensive Care Medicine, University of Rome La Sapienza, Roma, Lazio, Italy
  5. 5Department of Radiological, Oncological and Anatomo Pathological Sciences, University of Rome La Sapienza, Roma, Lazio, Italy
  6. 6Unit of Clinical Laboratory Science, University Campus Bio-Medico University of Rome Faculty of Medicine and Surgery, Roma, Lazio, Italy
  7. 7Unit of Medical Statistics and Molecular Epidemiology, University Campus Bio-Medico University of Rome Faculty of Medicine and Surgery, Roma, Lazio, Italy
  1. Correspondence to Dr Ornella Spagnolello, Department of Emergency Medicine, University of Rome La Sapienza, Roma, Lazio, Italy; spagnolello.ornella{at}gmail.com

Abstract

Background Quick Sequential Organ Failure Assessment (qSOFA) score is a bedside prognostic tool for patients with suspected infection outside the intensive care unit (ICU), which is particularly useful when laboratory analyses are not readily available. However, its performance in potentially septic patients with community-acquired pneumonia (CAP) needs to be examined further, especially in relation to early outcomes affecting acute management.

Objective First, to compare the performance of qSOFA and CURB-65 in the prediction of mortality in the emergency department in patients presenting with CAP. Second, to study patients who required critical care support (CCS) and ICU admission.

Methods Between January and December 2017, a 1-year retrospective observational study was carried out of adult (≥18 years old) patients presenting to the emergency department (ED) of our hospital (Rome, Italy) with CAP. The accuracy of qSOFA, qSOFA-65 and CURB-65 was compared in predicting mortality in the ED, CCS requirement and ICU admission. The concordance among scores ≥2 was then assessed for 30-day estimated mortality prediction.

Results 505 patients with CAP were enrolled. Median age was 71.0 years and mortality rate in the ED was 4.7%. The areas under the curve (AUCs) of qSOFA-65, CURB-65 and qSOFA in predicting mortality rate in the ED were 0.949 (95% CI 0.873 to 0.976), 0.923 (0.867 to 0.980) and 0.909 (0.847 to 0.971), respectively. The likelihood ratio of a patient having a qSOFA score ≥2 points was higher than for qSOFA-65 or CURB-65 (11 vs 7 vs 6.7). The AUCs of qSOFA, qSOFA-65 and CURB-65 in predicting CCS requirement were 0.862 (95% CI 0.802 to 0.923), 0.824 (0.758 to 0.890) and 0.821 (0.754 to 0.888), respectively. The AUCs of qSOFA-65, qSOFA and CURB-65 in predicting ICU admission were 0.593 (95% CI 0.511 to 0.676), 0.585 (0.503 to 0.667) and 0.570 (0.488 to 0.653), respectively. The concordance between qSOFA-65 and CURB-65 in 30-day estimated mortality prediction was 93%.

Conclusion qSOFA is a valuable score for predicting mortality in the ED and for the prompt identification of patients with CAP requiring CCS. qSOFA-65 may further improve the performance of this useful score, showing also good concordance with CURB-65 in 30-day estimated mortality prediction.

  • pneumonia/infections
  • death/mortality
  • emergency department
  • clinical assessment
  • intensive care
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Footnotes

  • Handling editor Roland Merchant

  • OS and GC contributed equally.

  • Contributors OS, AM, EB, AG and MS conceived and designed the study and equally contributed to data acquisition. OS, GC, CB and MC conducted the data analysis and equally contributed to manuscript preparation. GD, GB, FV, CM and supervised manuscript preparation and following revisions. FA, LC and SA contributed to manuscript implementation.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request addressed to the corresponding author.

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