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SOFA and qSOFA usefulness for in-hospital death prediction of elderly patients admitted for suspected infection in internal medicine

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Abstract

Purpose

To reduce intensive care unit overcrowding and optimize resources, elderly patients affected by suspected infection with declining clinical conditions could be managed in internal medicine departments with stepdown beds. However, commonly used prognostic scores, as Sequential Organ Failure Assessment (SOFA) or quick SOFA (qSOFA) have never been studied in this specific setting. The aim of this study was to evaluate the role and the accuracy of SOFA and qSOFA as prognostic scores in a population of elderly patients with suspected infection admitted to stepdown beds of two internal medicine departments.

Methods

Elderly patients admitted from the emergency department in the stepdown beds of two different internal medicine departments for suspected infection were assessed with SOFA and qSOFA scores at the admission. All patients were treated according to current guidelines. Age, sex, comorbidities, Charlson comorbidity index, SOFA and qSOFA were assessed. In-hospital death and length of hospital admission were also recorded.

Results

390 subjects were enrolled. In-hospital death occurred in 144 (36.9%) patients; we observed that both SOFA (HR 1.189; 95% CI 1.128–1.253; p < 0.0001) and qSOFA (HR 1.803; 95% CI 1.503–2.164; p < 0.0001) scores were independently associated with an increased risk of in-hospital death. However, the accuracy of both SOFA (AUC: 0.686; 95% CI 0.637–0.732; p < 0.0001) and qSOFA (AUC: 0.680; 95% CI 0.641–0.735; p < 0.0001) in predicting in-hospital death was low in this population.

Conclusion

Elderly patients admitted to stepdown beds for suspected infection experience a high rate of in-hospital death; both SOFA and qSOFA scores can be useful to identify a group of patients who can benefit from admission to an intermediate care environment, however their accuracy is low.

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Availability of data and material

The datasets analyzed during the current study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Internal and Subintensive Medicine Department, Azienda Ospedaliero-Universitaria “Ospedali Riuniti” di Ancona, Via Conca 10, Ancona, Italy

    Lorenzo Falsetti, Vincenzo Zaccone, Cinzia Nitti & Aldo Salvi

  2. Internal Medicine Department, INRCA-IRCCS Hospital, Osimo (Ancona), Italy

    Marianna Martino, Agnese Fioranelli, Chiara di Pentima, Alessandro Martini, Maurizio Burattini & Nicola Tarquinio

  3. Clinica di Neurologia, Azienda Ospedaliero-Universitaria “Ospedali Riuniti” di Ancona, Ancona, Italy

    Giovanna Viticchi

  4. Emergency Medicine Residency Program, Marche Polytechnic University, Ancona, Italy

    Alessia Raponi

  5. Clinica Medica, Azienda Ospedaliero-Universitaria “Ospedali Riuniti” di Ancona, Ancona, Italy

    Gianluca Moroncini

Authors
  1. Lorenzo Falsetti
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  2. Marianna Martino
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  3. Vincenzo Zaccone
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  4. Giovanna Viticchi
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  6. Gianluca Moroncini
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  7. Agnese Fioranelli
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  8. Chiara di Pentima
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  9. Alessandro Martini
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  11. Aldo Salvi
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  12. Maurizio Burattini
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  13. Nicola Tarquinio
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Contributions

Conceptualization: LF and NT; methodology: LF, NT, MM; formal analysis and investigation: LF, NT, MM; writing—original draft preparation: LF, NT, MM, VZ, GV; writing—review and editing: MM, VZ, AR, GM, AF, CdP, AM, AS, CN, MB; data acquisition: MM, AF, CdP, AM; supervision: LF, NT, AS, MB.

Corresponding author

Correspondence to Lorenzo Falsetti.

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Conflict of interest

None.

Ethics approval

Ethical approval was waived by the Ethics Committees of both participating centres (INRCA Ethics Committee, Prot. N. 23533/19-CE and CERM Ethics Committee, Prot. N. 2019/387). In view of the retrospective nature of the study and all the procedures being performed were part of the routine care.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Falsetti, L., Martino, M., Zaccone, V. et al. SOFA and qSOFA usefulness for in-hospital death prediction of elderly patients admitted for suspected infection in internal medicine. Infection 48, 879–887 (2020). https://doi.org/10.1007/s15010-020-01494-5

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  • DOI: https://doi.org/10.1007/s15010-020-01494-5

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