Efficacy of quick Sequential Organ Failure Assessment with lactate concentration for predicting mortality in patients with community-acquired pneumonia in the emergency department
- Author:
Hwan SONG
1
;
Hyung Gi MOON
;
Soo Hyun KIM
Author Information
- Publication Type:Original Article
- Keywords: Pneumonia; Hospital mortality; Emergency service, hospital; Organ dysfunction scores
- MeSH: Blood Pressure; Critical Illness; Emergencies; Emergency Service, Hospital; Hospital Mortality; Humans; Lactic Acid; Mass Screening; Mortality; Organ Dysfunction Scores; Pneumonia; Respiratory Rate; Retrospective Studies; ROC Curve; Sensitivity and Specificity; Sepsis; Urea
- From: Clinical and Experimental Emergency Medicine 2019;6(1):1-8
- CountryRepublic of Korea
- Language:English
- Abstract: OBJECTIVE: Community-acquired pneumonia (CAP) is a major cause of sepsis, and sepsis-related acute organ dysfunction affects patient mortality. Although the quick Sequential Organ Failure Assessment (qSOFA) is a new screening tool for patients with suspected infection, its predictive value for the mortality of patients with CAP has not been validated. Lactate concentration is a valuable biomarker for critically ill patients. Thus, we investigated the predictive value of qSOFA with lactate concentration for in-hospital mortality in patients with CAP in the emergency department (ED).METHODS: From January 2015 to June 2015, 443 patients, who were diagnosed with CAP in the ED, were retrospectively analyzed. We defined high qSOFA or lactate concentrations as a qSOFA score ≥2 or a lactate concentration >2 mmol/L upon admission at the ED. The primary outcome was all-cause in-hospital mortality.RESULTS: Among the 443 patients, 44 (9.9%) died. Based on the receiver operating characteristic (ROC) analysis, the areas under the curves for the prediction of mortality were 0.720, 0.652, and 0.686 for qSOFA, CURB-65 (confusion, urea, respiratory rate, blood pressure, and age), and Pneumonia Severity Index, respectively. The area under the ROC curve of qSOFA was lower than that of SOFA (0.720 vs. 0.845, P=0.004). However, the area under the ROC curve of qSOFA with lactate concentration was not significantly different from that of SOFA (0.828 vs. 0.845, P=0.509). The sensitivity and specificity of qSOFA with lactate concentration were 71.4% and 83.2%, respectively.CONCLUSION: qSOFA with lactate concentration is a useful and practical tool for the early prediction of in-hospital mortality among patients with CAP in the ED.
