Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/16610
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dc.contributor.authorRaith, Eamon P-
dc.contributor.authorUdy, Andrew A-
dc.contributor.authorBailey, Michael-
dc.contributor.authorMcGloughlin, Steven-
dc.contributor.authorMacIsaac, Christopher-
dc.contributor.authorBellomo, Rinaldo-
dc.contributor.authorPilcher, David V-
dc.contributor.authorAustralian and New Zealand Intensive Care Society (ANZICS) Centre for Outcomes and Resource Evaluation (CORE)-
dc.date2017-01-17-
dc.date.accessioned2017-03-19T23:12:46Z-
dc.date.available2017-03-19T23:12:46Z-
dc.date.issued2017-01-17-
dc.identifier.citationJAMA 2017; 317(3): 290-300en_US
dc.identifier.urihttps://ahro.austin.org.au/austinjspui/handle/1/16610-
dc.description.abstractIMPORTANCE: The Sepsis-3 Criteria emphasized the value of a change of 2 or more points in the Sequential [Sepsis-related] Organ Failure Assessment (SOFA) score, introduced quick SOFA (qSOFA), and removed the systemic inflammatory response syndrome (SIRS) criteria from the sepsis definition. OBJECTIVE: Externally validate and assess the discriminatory capacities of an increase in SOFA score by 2 or more points, 2 or more SIRS criteria, or a qSOFA score of 2 or more points for outcomes among patients who are critically ill with suspected infection. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort analysis of 184 875 patients with an infection-related primary admission diagnosis in 182 Australian and New Zealand intensive care units (ICUs) from 2000 through 2015. EXPOSURES: SOFA, qSOFA, and SIRS criteria applied to data collected within 24 hours of ICU admission. MAIN OUTCOMES AND MEASURES: The primary outcome was in-hospital mortality. In-hospital mortality or ICU length of stay (LOS) of 3 days or more was a composite secondary outcome. Discrimination was assessed using the area under the receiver operating characteristic curve (AUROC). Adjusted analyses were performed using a model of baseline risk determined using variables independent of the scoring systems. RESULTS: Among 184 875 patients (mean age, 62.9 years [SD, 17.4]; women, 82 540 [44.6%]; most common diagnosis bacterial pneumonia, 32 634 [17.7%]), a total of 34 578 patients (18.7%) died in the hospital, and 102 976 patients (55.7%) died or experienced an ICU LOS of 3 days or more. SOFA score increased by 2 or more points in 90.1%; 86.7% manifested 2 or more SIRS criteria, and 54.4% had a qSOFA score of 2 or more points. SOFA demonstrated significantly greater discrimination for in-hospital mortality (crude AUROC, 0.753 [99% CI, 0.750-0.757]) than SIRS criteria (crude AUROC, 0.589 [99% CI, 0.585-0.593]) or qSOFA (crude AUROC, 0.607 [99% CI, 0.603-0.611]). Incremental improvements were 0.164 (99% CI, 0.159-0.169) for SOFA vs SIRS criteria and 0.146 (99% CI, 0.142-0.151) for SOFA vs qSOFA (P <.001). SOFA (AUROC, 0.736 [99% CI, 0.733-0.739]) outperformed the other scores for the secondary end point (SIRS criteria: AUROC, 0.609 [99% CI, 0.606-0.612]; qSOFA: AUROC, 0.606 [99% CI, 0.602-0.609]). Incremental improvements were 0.127 (99% CI, 0.123-0.131) for SOFA vs SIRS criteria and 0.131 (99% CI, 0.127-0.134) for SOFA vs qSOFA (P <.001). Findings were consistent for both outcomes in multiple sensitivity analyses. CONCLUSIONS AND RELEVANCE: Among adults with suspected infection admitted to an ICU, an increase in SOFA score of 2 or more had greater prognostic accuracy for in-hospital mortality than SIRS criteria or the qSOFA score. These findings suggest that SIRS criteria and qSOFA may have limited utility for predicting mortality in an ICU setting.en_US
dc.subjectHospital Mortalityen_US
dc.subjectIntensive Care Unitsen_US
dc.subjectOrgan Dysfunction Scoresen_US
dc.subjectSepsisen_US
dc.subjectSystemic Inflammatory Response Syndromeen_US
dc.titlePrognostic accuracy of the SOFA score, SIRS criteria, and qSOFA score for in-hospital mortality among adults with suspected infection admitted to the intensive care uniten_US
dc.typeJournal Articleen_US
dc.identifier.journaltitleJAMAen_US
dc.identifier.affiliationDepartment of Intensive Care and Hyperbaric Medicine, Alfred Hospital, Prahran, Victoria, Australiaen_US
dc.identifier.affiliationDiscipline of Surgery, School of Medicine, University of Adelaide, Adelaide, South Australia, Australiaen_US
dc.identifier.affiliationAustralian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Prahran, Victoria, Australiaen_US
dc.identifier.affiliationDepartment of Infectious Diseases, Alfred Hospital, Prahran, Victoria, Australiaen_US
dc.identifier.affiliationDepartment of Intensive Care, Royal Melbourne Hospital, Parkville, Victoria, Australiaen_US
dc.identifier.affiliationUniversity of Melbourne, Parkville, Victoria, Australiaen_US
dc.identifier.affiliationIntensive Care Unit, Austin Hospital, Heidelberg, Victoria, Australiaen_US
dc.identifier.affiliationCentre for Outcome and Resource Evaluation, Australian and New Zealand Intensive Care Society, Melbourne, Victoria, Australiaen_US
dc.identifier.pubmedurihttps://pubmed.ncbi.nlm.nih.gov/28114553en_US
dc.identifier.doi10.1001/jama.2016.20328en_US
dc.type.contentTexten_US
dc.type.austinJournal Articleen_US
local.name.researcherBellomo, Rinaldo
item.openairecristypehttp://purl.org/coar/resource_type/c_18cf-
item.cerifentitytypePublications-
item.fulltextNo Fulltext-
item.grantfulltextnone-
item.openairetypeJournal Article-
crisitem.author.deptIntensive Care-
crisitem.author.deptData Analytics Research and Evaluation (DARE) Centre-
Appears in Collections:Journal articles
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