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Sepsis Surveillance Using Adult Sepsis Events Simplified eSOFA Criteria versus Sepsis-3 SOFA Criteria
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3 2019
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Source: Crit Care Med. 47(3):307-314
Details:
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Alternative Title:Crit Care Med
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Description:Objectives:
Sepsis-3 defines organ dysfunction as an increase in the Sequential Organ Failure Assessment (SOFA) score by ≥2 points. However, some SOFA score components are not routinely recorded in all hospitals’ electronic health record (EHR) systems, limiting its utility for wide-scale sepsis surveillance. The Centers for Disease Control and Prevention (CDC) recently released the Adult Sepsis Event surveillance definition that includes simplified organ dysfunction criteria optimized for EHRs (eSOFA). We compared eSOFA versus SOFA with regard to sepsis prevalence, overlap, and outcomes.
Design, Setting, and Patients:
Retrospective cohort study of adults hospitalized during 2013–2015 at 111 U.S. hospitals in the Cerner HealthFacts dataset.
Interventions:
None.
Measurements and Main Results:
We identified clinical indicators of presumed infection (blood cultures and antibiotics) concurrent with either (a) an increase in SOFA score by ≥2 points (Sepsis-3) or (b) ≥1 eSOFA criteria: vasopressor initiation, mechanical ventilation initiation, lactate ≥2.0 mmol/L, doubling in creatinine, doubling in bilirubin to ≥2.0 mg/dL, or ≥50% decrease in platelet count to <100 cells/μL (CDC Adult Sepsis Event). We compared receiver operating characteristic curves (AUROC) for discriminating in-hospital mortality, adjusting for baseline characteristics. Of 942,360 patients in the cohort, 57,242 (6.1%) had sepsis by SOFA versus 41,618 (4.4%) by eSOFA. Agreement between sepsis by SOFA and eSOFA was good (Cronbach’s alpha 0.81). Baseline characteristics and infectious diagnoses were similar, but mortality was higher with eSOFA (17.1%) versus SOFA (14.4%, p<0.001) as was discrimination for mortality (AUROC 0.774 versus 0.759, p<0.001). Comparisons were consistent across subgroups of age, infectious diagnoses, and comorbidities.
Conclusions:
The Adult Sepsis Event’s eSOFA organ dysfunction criteria identify a smaller, more severely ill sepsis cohort compared to the SOFA score, but with good overlap and similar clinical characteristics. Adult Sepsis Events may facilitate wide-scale automated sepsis surveillance that tracks closely with the more complex Sepsis-3 criteria.
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Pubmed ID:30768498
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Pubmed Central ID:PMC6383796
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