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Prognostic accuracy of SIRS criteria, qSOFA score and GYM score for 30-day-mortality in older non-severely dependent infected patients attended in the emergency department

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Abstract

The aim of this study was to determine the accuracy of systemic inflammatory response syndrome (SIRS), quick Sepsis-related Organ Failure Assessment (qSOFA) score and GYM score to predict 30-day mortality in older non-severely dependent patients attended for an episode of infection in the emergency department (ED). We performed an analytical, observational, prospective cohort study including patients 75 years of age or older, without severe functional dependence, attended for an infectious process in 69 Spanish EDs for 2-day three-seasonal periods. Demographic, clinical and analytical data were collected. The primary outcome was 30-day mortality after the index event. We included 1071 patients, with a mean age of 83.6 [standard deviation (SD) 5.6] years; 544 (50.8%) were men. Seventy-two patients (6.5%) died within 30 days. SIRS criteria ≥ 2 had a sensitivity of 65% [95% confidence interval (CI) 53.1–75.9] and a specificity of 49% (95% CI 46.0–52.3), a qSOFA score ≥ 2 had a sensitivity of 28% (95% CI 18.2–39.8) and a specificity of 94% (95% CI 91.9–95.1), and a GYM score ≥ 1 had a sensitivity of 81% (95% CI 69.2–88.6) and a specificity of 45% (95% CI 41.6–47.9). A GYM score ≥ 1 and a qSOFA score ≥ 2 were the cut-offs with the highest sensitivity (p < 0.001) and specificity (p < 0.001), respectively. The area under the curve (AUC) was 0.73 (95% CI 0.66–0.79; p < 0.001) for the GYM score, 0.69 (95% CI 0.61–0.76; p < 0.001) for the qSOFA score and 0.65 (95% CI 0.59–0.72; p < 0.001) for SIRS. A GYM score ≥ 1 may be the most sensitive score and a qSOFA score ≥ 2 the most specific score to predict 30-day mortality in non-severely dependent older patients attended for acute infection in EDs.

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Authors and Affiliations

  1. Emergency Department, Hospital Universitario Clínico San Carlos, Calle Profesor Martín-Lagos s/n, 28040, Madrid, Spain

    J. González del Castillo, E. J. García-Lamberechts & F. J. Martín-Sánchez

  2. Health Research Institute, Hospital Universitario San Carlos, Madrid, Spain

    J. González del Castillo, E. J. García-Lamberechts & F. J. Martín-Sánchez

  3. Emergency Department, Complejo Hospitalario Universitario de Toledo, Universidad Castilla-La Mancha, Toledo, Spain

    A. Julian-Jiménez

  4. Emergency Department, Hospital Virgen de la Luz, Cuenca, Spain

    F. González-Martínez

  5. Emergency Department, Hospital Rio Hortega, Valladolid, Spain

    J. Álvarez-Manzanares

  6. Emergency Department, Hospital Universitario Reina Sofía, Murcia, Spain

    P. Piñera

  7. Emergency Department, Hospital Universitario Virgen de la Macarena, Sevilla, Spain

    C. Navarro-Bustos

  8. Emergency Department, Hospital Universitario de Basurto, Bilbao, Spain

    M. Martinez-Ortiz de Zarate

  9. Emergency Department, Hospital Universitario de Bellvitge, Barcelona, Spain

    F. Llopis-Roca

  10. Emergency Department, Hospital Universitario Central de Asturias, Oviedo, Spain

    M. Debán Fernández

  11. Emergency Department, Hospital Universitario de Galdakao, Galdakao, Spain

    J. Gamazo-Del Rio

Authors
  1. J. González del Castillo
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  2. A. Julian-Jiménez
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  3. F. González-Martínez
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  4. J. Álvarez-Manzanares
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  6. C. Navarro-Bustos
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  7. M. Martinez-Ortiz de Zarate
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  8. F. Llopis-Roca
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  9. M. Debán Fernández
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  10. J. Gamazo-Del Rio
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  11. E. J. García-Lamberechts
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  12. F. J. Martín-Sánchez
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representing the Infectious Disease Group of the Spanish Emergency Medicine Society (see addendum)

Contributions

All authors contributed to the development of the study protocol. JGdC and FJMS planned the study concept and design. JGdC obtained ethics committee approval and performed the study supervision. The other authors and members of the Infectious Disease Group of the Spanish Emergency Medicine Society collected all data. FJMS and JGdC analysed and interpreted the data. FJMS and JGdC prepared the first manuscript draft. All authors contributed to manuscript revision and all approved of the final document.

Corresponding author

Correspondence to J. González del Castillo.

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Funding

No financial support was used. The promoter of this study has been the Infectious Disease Group of the Spanish Emergency Medicine Society. This group has received financial support from Merck, Tedec-Meiji, Pfizer, Thermo Fisher, Laboratorios Rubio and Novartis in the last year to organise conferences and group meetings. None of the authors has received any financial compensation.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The Ethical Committee of the Clínico San Carlos Hospital approved the study.

Informed consent

All the patients or tutors provided informed consent to participate in the study.

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González del Castillo, J., Julian-Jiménez, A., González-Martínez, F. et al. Prognostic accuracy of SIRS criteria, qSOFA score and GYM score for 30-day-mortality in older non-severely dependent infected patients attended in the emergency department. Eur J Clin Microbiol Infect Dis 36, 2361–2369 (2017). https://doi.org/10.1007/s10096-017-3068-7

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  • DOI: https://doi.org/10.1007/s10096-017-3068-7

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