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Validation of Sepsis-3 using survival analysis and clinical evaluation of quick SOFA, SIRS, and burn-specific SIRS for sepsis in burn patients with suspected infection

Citation

Hur, Jun et al. (2022), Validation of Sepsis-3 using survival analysis and clinical evaluation of quick SOFA, SIRS, and burn-specific SIRS for sepsis in burn patients with suspected infection, Dryad, Dataset, https://doi.org/10.5061/dryad.dbrv15f4d

Abstract

Purpose: Sepsis-3 is a life-threatening organ dysfunction caused by dysregulated host responses to infection; and defined using the Sepsis-3 criteria, introduced in 2016, however, the criteria need to be validated in specific clinical fields. We investigated mortality prediction and compared the diagnostic performance of quick Sequential Organ Failure Assessment (qSOFA), systemic inflammatory response syndrome (SIRS), and burn-specific SIRS (bSIRS) in burn patients.

Methods: This single-center retrospective cohort study examined burn patients in Seoul, Korea during January 2010–December 2020. Overall, 1,391 patients with suspected infection were divided into four sepsis groups using SOFA, qSOFA, SIRS, and burn-specific SIRS.

Results: Hazard ratios (HRs) of all unadjusted models were statistically significant; however, the HR (0.726, p = 0.0080.001) in the SIRS ≥2 group is below 1. In the adjusted model, HRs of the SOFA ≥2 (2.426, p < 0.001), qSOFA ≥2 (7.198, p < 0.001), and SIRS ≥2 (0.575, p < 0.001) groups were significant. The diagnostic performance of dichotomized qSOFA, SIRS, and bSIRS for sepsis was defined by the Sepsis-3 criteria. The mean onset day was 4.13±2.97 according to Sepsis-3. The sensitivity of SIRS (0.989, 95% confidence interval [CI]: 0.982–0.994) was higher than that of qSOFA (0.841, 95% CI: 0.819–0.861) and bSIRS (0.803, 95% CI: 0.779–0.825). Specificities of qSOFA (0.929, 95% CI: 0.876–0.964) and bSIRS (0.922, 95% CI: 0.868–0.959) were higher than those of SIRS (0.461, 95% CI: 0.381–0.543).

Conclusion: Sepsis-3 is a good alternative diagnostic tool because it reflects sepsis severity without delaying diagnosis. SIRS showed higher sensitivity than qSOFA and bSIRS and may therefore more adequately diagnose sepsis.

Methods

The electrical medical records were anonymized and retrieved from the clinical database warehouse in Hangang Sacred Heart Hospital, Hallym University, Seoul, Korea. The database consists of structured data collected prospectively for all patients admitted to the BICU. 1,391 burn patients with a suspected infection between January 2010 and December 2021 were included.

The electrical medical records were anonymized and retrieved from the clinical database warehouse in Hangang Sacred Heart Hospital, Hallym University, Seoul, Korea. The database consists of structured data collected prospectively for all patients admitted to the BICU. Patient demographics such as age, sex, comorbidities, and variables for burn-specific scoring systems such as the Abbreviated Burn Severity Index (ABSI), Hangang, and revised Baux (rBaux) scores were calculated for each patient upon admission.

Usage Notes

Data management and statistical analysis were performed using R (A language and environment for statistical computing, Vienna, Austria, Version 4.1.0).

Funding

National Research Foundation of Korea, Award: 2021R1A2C20060331222182102840102

Ministry of Science and ICT, South Korea