qREDS score compared with the REDS and NEWS2 scores to risk-stratify emergency department suspected sepsis patients for in-hospital mortality and 168-hour survival probability: a retrospective cohort study.

内容摘要

The Risk-stratification of Emergency Department suspected Sepsis (REDS) score requires external validation. The six dichotomous variables and lactate can be accurately extracted electronically unlike refractory hypotension (RH), where the recording of the fluid-bolus and blood pressure measurement may be inaccurate. The impact of excluding RH is not known. To develop the quick-REDS (qREDS) score, by removing RH from the REDS score and to validate its prognostic performance in comparison to the original score and the National Early Warning Score (NEWS)2 score, for all-cause in-hospital mortality and 168-hour survival probability (SP). Vital signs, blood results, outcome at 168 hours and at discharge, were extracted from the electronic records of emergency department (ED) adults admitted after intravenous antibiotics for an infection. The REDS, qREDS and NEWS2 scores were calculated, receiver operating characteristic (ROC) curves constructed for in-hospital all-cause mortality, the area under the ROC (AUROC) curves compared and cut-off points noted. Test-characteristics at cut-off points &#x2265;1, &#x2265;3, &#x2265;5 and &#x2265;7 were studied. Kaplan-Meier (KM) curves were constructed for all the scores for SP at 168 hours for score bands 0-2, 3-4 and &#x2265;5. Of 3202 patients, 433 died in hospital and 209 died at 168 hours. AUROC curve: REDS 0.74 (95% CI 0.72 to 0.75) and qREDS 0.73 (95% CI 0.71 to 0.75); both greater than NEWS2 0.66 (95% CI 0.65 to 0.68); p<0.0001. Cut-off points: REDS &#x2265;3, qREDS &#x2265;3 and NEWS2 &#x2265;6. Specificity for in-hospital mortality of score &#x2265;5; REDS 89.2% (95% CI 88.0% to 90.3%), qREDS 90.6% (95% CI 89.4% to 91.6%) and NEWS2 43.9% (95% CI 42.1% to 45.8%). All KM curves were significant, log-rank test p<0.0001. SP at 168 hours: whole population 93.4% (SE 0.4); SP at &#x2265;5points: REDS 78.3% (SE 1.2), qREDS 78.0% (SE 2.0) and NEWS2 90.6% (SE 0.7). SP trends were similar at 24, 48 and 72 hours. qREDS is a valid surrogate for the REDS score and had significantly better prognostic performance than the NEWS2 score for in-hospital mortality and 168-hour survival probability, in ED patients with suspected sepsis.