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Research
Identifying adults with sepsis, bedside tools versus administrative data: a cohort study
Meghan Bateson
University of the West of Scotland
Corresponding Author
ORCiD: https://orcid.org/0000-0001-5873-8030
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
Our objective was to calculate how well the bedside severity scores qSOFA, NEWS, and SIRS predict 30-day mortality from onset of infection compared to the Sepsis-3 recommended diagnostic criteria of an increase in SOFA score of ≥2 as a consequence of infection. We then assessed the ability of routinely collected administrative data (ICD-10 codes and blood culture sampling) to identify patients with clinical sepsis. The overall purpose is to inform development of a robust proxy measure for sepsis surveillance at scale.
Methods
This single centre retrospective case note review was set in a district general hospital in Scotland. Adult admissions between 1 st October 2015 and 31 st March 2016 with a blood culture were matched to admissions without a blood culture. The performance characteristics of SOFA, qSOFA, NEWS and SIRS were calculated to predict 30 day mortality. The ability of routinely collected administrative data to identify people with sepsis was assessed using receiver operating characteristic curves.
Results
This cohort of 958 admissions comprised 479 patients with a blood culture sampled and 479 without. There were 269 (28%) patients with sepsis as per the Sepsis-3 definition, and 361 (37.7%) with infection. 30-day mortality from onset of infection was 19.0% and 7.2% in the sepsis and infection groups respectively (p<0.001). NEWS ≥7 (AUROC 0.71) was a more accurate predictor of 30-day mortality from onset of infection compared to SOFA ≥2 (or Δ2) (AUROC 0.63), qSOFA ≥ 2 (AUROC 0.64) and SIRS≥2 (AUROC 0.65). ICD-10 sepsis codes (A40, A41 & R57.2) were recorded in only 26 (9.4%) sepsis admissions. Blood culture sampling performed better at identifying patients with sepsis (AUROC 0.63) compared to ICD-10 sepsis codes (AURO 0.54) or positive blood cultures (AUROC 0.53).
Conclusions
NEWS ≥7 was a better predictor of 30-day mortality in patients with infection than SIRS, qSOFA or SOFA. ICD-10 sepsis codes lack sensitivity for reliable sepsis surveillance. Blood culture sampling showed potential for inclusion as part of a clinically relevant proxy marker for sepsis surveillance.
Keywords
Sepsis, qSOFA, SOFA, NEWS, SIRS, ICD-10, blood culture
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This is a preprint. It has not completed peer review.
Research
Identifying adults with sepsis, bedside tools versus administrative data: a cohort study
Meghan Bateson
University of the West of Scotland
Corresponding Author
ORCiD: https://orcid.org/0000-0001-5873-8030
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
History
CURRENT STATUS: Posted
Version 1
Posted 14 Jan, 2020
No community comments so far
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Critical Care & Emergency Medicine
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
Our objective was to calculate how well the bedside severity scores qSOFA, NEWS, and SIRS predict 30-day mortality from onset of infection compared to the Sepsis-3 recommended diagnostic criteria of an increase in SOFA score of ≥2 as a consequence of infection. We then assessed the ability of routinely collected administrative data (ICD-10 codes and blood culture sampling) to identify patients with clinical sepsis. The overall purpose is to inform development of a robust proxy measure for sepsis surveillance at scale.
Methods
This single centre retrospective case note review was set in a district general hospital in Scotland. Adult admissions between 1 st October 2015 and 31 st March 2016 with a blood culture were matched to admissions without a blood culture. The performance characteristics of SOFA, qSOFA, NEWS and SIRS were calculated to predict 30 day mortality. The ability of routinely collected administrative data to identify people with sepsis was assessed using receiver operating characteristic curves.
Results
This cohort of 958 admissions comprised 479 patients with a blood culture sampled and 479 without. There were 269 (28%) patients with sepsis as per the Sepsis-3 definition, and 361 (37.7%) with infection. 30-day mortality from onset of infection was 19.0% and 7.2% in the sepsis and infection groups respectively (p<0.001). NEWS ≥7 (AUROC 0.71) was a more accurate predictor of 30-day mortality from onset of infection compared to SOFA ≥2 (or Δ2) (AUROC 0.63), qSOFA ≥ 2 (AUROC 0.64) and SIRS≥2 (AUROC 0.65). ICD-10 sepsis codes (A40, A41 & R57.2) were recorded in only 26 (9.4%) sepsis admissions. Blood culture sampling performed better at identifying patients with sepsis (AUROC 0.63) compared to ICD-10 sepsis codes (AURO 0.54) or positive blood cultures (AUROC 0.53).
Conclusions
NEWS ≥7 was a better predictor of 30-day mortality in patients with infection than SIRS, qSOFA or SOFA. ICD-10 sepsis codes lack sensitivity for reliable sepsis surveillance. Blood culture sampling showed potential for inclusion as part of a clinically relevant proxy marker for sepsis surveillance.
Figure 1
Figure 2