The role of quick Sepsis-related Organ Failure Assessment score as simple scoring system to predict Fournier gangrene mortality and the correlation with Fournier’s Gangrene Severity Index: Analysis of 69 patients

Objective:Fournier’s gangrene is a rare but life-threatening infection disease with high mortality rate.The quick Sepsis-related Organ Failure Assessment(qSOFA)is a new and simpler scoring system that may identify patients with suspected infection who are at greater risk for a poor outcome.The purpose of this study was to find out role of qSOFA in determining prognosis of Fournier’s gangrene patients.Methods:This study is a case control with retrospective review of Fournier’s gangrene patients treated at Hasan Sadikin Hospital from January 2013 to December 2017 who met inclusion criteria.Participants were divided into two groups according to qSOFA score as high qSOFA(2-3)and low qSOFA(0-1).Results:From 69 patients,the mortality rate was 24.6%.The sensitivity of qSOFA score to predict mortality was 88.2%;the specificity was 94.2%;positive predictive value was 83.3%;negative predictive value was 96.1%;positive likelihood ratio was 15.2;negative likelihood ratio was 0.12;and the area under the receiver operating characteristic curve of qSOFA was 94.2%.There was significant association between qSOFA scale and mortality with p-value of 0.0001.The qSOFA score has strong positive correlation with Fournier’s Gangrene Severity Index(p<0.0001,r=0.704).Conclusion:qSOFA scoring system has a high prognostic value and can be used to determine prognosis of Fournier’s gangrene patients.

Quick assessment of chicken spoilage based on hyperspectral NIR spectra combined with partial least squares regression

Pseudomonas spp.and Enterobacteriaceae are dominant spoilage bacteria in chicken during cold storage(0°C-4°C).In this study,high resolution spectra in the range of 900-1700 nm were acquired and preprocessed using Savitzky-Golay convolution smoothing(SGCS),standard normal variate(SNV)and multiplicative scatter correction(MSC),respectively,and then mined using partial least squares(PLS)algorithm to relate to the total counts of Pseudomonas spp.and Enterobacteriaceae(PEC)of fresh chicken breasts to predict PEC rapidly.The results showed that with full 900-1700 nm range wavelength,MSC-PLS model built with MSC spectra performed better than PLS models with other spectra(RAW-PLS,SGCS-PLS,SNV-PLS),with correlation coefficient(RP)of 0.954,root mean square error of prediction(RMSEP)of 0.396 log10 CFU/g and residual predictive deviation(RPD)of 3.33 in prediction set.Based on the 12 optimal wavelengths(902.2 nm,905.5 nm,923.6 nm,938.4 nm,946.7 nm,1025.7 nm,1124.4 nm,1211.6 nm,1269.2 nm,1653.7 nm,1691.8 nm and 1693.4 nm)selected from MSC spectra by successive projections algorithm(SPA),SPA-MSC-PLS model had RP of 0.954,RMSEP of 0.397 log10 CFU/g and RPD of 3.32,similar to MSC-PLS model.The overall study indicated that NIR spectra combined with PLS algorithm could be used to detect the PEC of chicken flesh in a rapid and non-destructive way.

Comparison of different versions of the quick sequential organ failure assessment for predicting in-hospital mortality of sepsis patients:A retrospective observational study

BACKGROUND:The quick sequential organ failure assessment(qSOFA)is recommended to identify sepsis and predict sepsis mortality.However,some studies have recently shown its poor performance in sepsis mortality prediction.To enhance its effectiveness,researchers have developed various revised versions of the qSOFA by adding other parameters,such as the lactate-enhanced qSOFA(LqSOFA),the procalcitonin-enhanced qSOFA(PqSOFA),and the modified qSOFA(MqSOFA).This study aimed to compare the performance of these versions of the qSOFA in predicting sepsis mortality in the emergency department(ED).METHODS:This retrospective study analyzed data obtained from an electronic register system of adult patients with sepsis between January 1 and December 31,2019.Receiver operating characteristic(ROC)curve analyses were performed to determine the area under the curve(AUC),with sensitivity,specificity,and positive and negative predictive values calculated for the various scores.RESULTS:Among the 936 enrolled cases,there were 835 survivors and 101 deaths.The AUCs of the LqSOFA,MqSOFA,PqSOFA,and qSOFA were 0.740,0.731,0.712,and 0.705,respectively.The sensitivity of the LqSOFA,MqSOFA,PqSOFA,and qSOFA were 64.36%,51.40%,71.29%,and 39.60%,respectively.The specificity of the four scores were 70.78%,80.96%,61.68%,and 91.62%,respectively.The LqSOFA and MqSOFA were superior to the qSOFA in predicting in-hospital mortality.CONCLUSIONS:Among patients with sepsis in the ED,the performance of the PqSOFA was similar to that of the qSOFA and the values of the LqSOFA and MqSOFA in predicting in-hospital mortality were greater compared to qSOFA.As the added parameter of the MqSOFA was more convenient compared to the LqSOFA,the MqSOFA could be used as a candidate for the revised qSOFA to increase the performance of the early prediction of sepsis mortality.

Contribution of Quick Sequential Organ Failure Assessment Score Combined with Electrocardiography in Risk Stratification of Patients with Acute Pulmonary Embolism

Background： The quick Sequential Organ Failure Assessment （qSOFA） score emerged recently. We investigated its contribution to risk stratification in acute pulmonary embolism （PE） by combining with electrocardiography （ECG）. Methods： Acute PE patients diagnosed in Beijing Chao-Yang Hospital, Capital Medical University, from 2008 to 2018 were retrospectively studied and divided into high- and low-risk groups by imaging and biomarkers. The ECG scores consisted oftachycardia, McGinn-White sign （S1Q3T3）, right bundle branch block, and T-wave inversion of leads V1-V3. A new combination of qSOFA scores and ECG scores by logistic regression for predicting high-risk stratification patients with acute PE was evaluated by a receiver operating characteristic curve. Results： Totally 1318 patients were enrolled, including 271 in the high-risk group and 1047 in the low-risk group. A combination predictive scoring system named qSOFA-ECG = qSOFA score ＋ ECG score was created. The optimal cutoffvalue for qSOFA-ECG was 2, and the sensitivity, specificity, positive predictive value, and negative predictive value were 81.5%, 72.3%, 43.2%, and 93.8%, respectively. For predicting high-risk stratification and reperfusion therapy, the qSOFA-ECG is superior to PE Severity Index （PESI） and simplified PESI. Conclusions： The qSOFA score contributes to identify acute PE patients with potentially hemodynamic decompensation that need monitoring and possible reperfusion therapy at the emergency department arrival when used in combination with ECG score.

Role of international normalized ratio in nonpulmonary sepsis screening:An observational study

Currently,there is a lack of sepsis screening tools that can be widely used worldwide.Pulmonary sepsis can be of sufficient concern to physicians due to their noticeable symptoms,which usually rely less on screening tools.AIM To investigate the efficiency of the international normalized ratio(INR)for the early rapid recognition of adult nonpulmonary infectious sepsis.METHODS This is a prospective observational study.A total of 108 sepsis patients and 106 nonsepsis patients were enrolled according to relevant inclusion and exclusion criteria.Commonly used clinical indicators,such as white blood cell,neutrophil count,lymphocyte count,neutrophil-lymphocyte count ratio(NLCR),platelets(PLT),prothrombin time,INR,activated partial thromboplastin time,and quick Sequential“Sepsis-related”Organ Failure Assessment(qSOFA)scores were recorded within 24 h after admission.The diagnostic performances of these clinical indicators were analyzed and compared through multivariate logistic regression analysis,Spearman correlation,and receiver operating characteristic curve analysis.The INR value of the sepsis group was significantly higher than that of the nonsepsis group.INR has superior diagnostic efficacy for sepsis,with an area under the curve value of 0.918,when those preexisting diseases which significantly affect coagulation function were excluded.The diagnostic efficacy of the INR was more significant than that of NLCR,PLT,and qSOFA(P<0.05).Moreover,INR levels of 1.17,1.20,and 1.22 could be used to categorize the relative risk of nonpulmonary infections sepsis into three categories:low,medium and high risk,respectively.CONCLUSION The INR is a promising and easily available biomarker for diagnosis,and it can be used as one of the indicators for early screening of adult nonpulmonary infectious sepsis.When its value is higher than the optimal cutoff value(1.22),high vigilance is required for adult nonpulmonary infectious sepsis.

Performance and comparison of assessment models to predict 30-day mortality in patients with hospital-acquired pneumonia

Background:Hospital-acquired pneumonia(HAP)is the most common hospital-acquired infection in China with substantial morbidity and mortality.But no specific risk assessment model has been well validated in patients with HAP.The aim of this study was to investigate the published risk assessment models that could potentially be used to predict 30-day mortality in HAP patients in non-surgical departments.Methods:This study was a single-center,retrospective study.In total,223 patients diagnosed with HAP from 2012 to 2017 were included in this study.Clinical and laboratory data during the initial 24 hours after HAP diagnosis were collected to calculate the pneumonia severity index(PSI);consciousness,urea nitrogen,respiratory rate,blood pressure,and age≥65 years(CURB-65);Acute Physiology and Chronic Health Evaluation II(APACHE II);Sequential Organ Failure Assessment(SOFA);and Quick Sequential Organ Failure Assessment(qSOFA)scores.The discriminatory power was tested by constructing receiver operating characteristic(ROC)curves,and the areas under the curve(AUCs)were calculated.Results:The all-cause 30-day mortality rate was 18.4%(41/223).The PSI,CURB-65,SOFA,APACHE II,and qSOFA scores were significantly higher in non-survivors than in survivors(all P<0.001).The discriminatory abilities of the APACHE II and SOFA scores were better than those of the CURB-65 and qSOFA scores(ROC AUC:APACHE II vs.CURB-65,0.863 vs.0.744,Z=3.055,P=0.002;APACHE II vs.qSOFA,0.863 vs.0.767,Z=3.017,P=0.003;SOFA vs.CURB-65,0.856 vs.0.744,Z=2.589,P=0.010;SOFA vs.qSOFA,0.856 vs.0.767,Z=2.170,P=0.030).The cut-off values we defined for the SOFA,APACHE II,and qSOFA scores were 4,14,and 1.Conclusions:These results suggest that the APACHE II and SOFA scores determined during the initial 24 h after HAP diagnosis may be useful for the prediction of 30-day mortality in HAP patients in non-surgical departments.The qSOFA score may be a simple tool that can be used to quickly identify severe infections.