J Korean Soc Emerg Med.  2016 Aug;27(4):301-312. 10.0000/jksem.2016.27.4.301.

Comparing the Usefulness of the Initial Predisposition Infection Response Organ Failure Score and the Mortality in Emergency Department Sepsis Score for Predicting the Prognosis of Septic Patients Admitted to the Intensive Care Unit

• Jang SM
• Kim JW
• Kim SY
• Lee KR
• Park SO
• Baek KJ
• Hong DY

• KMID: 2350882
• DOI: http://doi.org/10.0000/jksem.2016.27.4.301

Abstract

PURPOSE
The predisposition infection response organ failure (PIRO) score has been developed to be used in the emergency department (ED) to risk stratify sepsis case but has not been well studied domestically. The aim of this study was to compare the usefulness between the PIRO score and the mortality in emergency department sepsis (MEDS) score in predicting the mortality of septic patients admitted to the intensive care unit (ICU).
METHODS
We conducted a retrospective study of patients who were suspected to have sepsis and were admitted to the ICU via the ED during a period between January 2013 and June 2015. PIRO and MEDS scores were calculated from the ED data. A comparative analysis was performed the evaluate the areas under the receiver operator characteristic (ROC) curves for 28-day mortality.
RESULTS
During the 30-month period, a total of 199 patients diagnosed with sepsis were enrolled. Fifty-seven patients (28.6%) died within 28 days of presentation. The PIRO score showed increasing mortality with higher scores. The area under the ROC curve (AUC) for mortality was 0.890 (95% confidence interval [CI]=0.830 to 0.950) for PIRO and 0.705 (95% CI=0.609 to 0.801) for MEDS score.
CONCLUSION
The MEDS score in the ED did not predict mortality better than PIRO score. The PIRO score was a good predictor of the outcome for patients with suspected sepsis. We believe that the PIRO score may be the most useful and appropriate clinical prediction tool for patients with suspected sepsis in the ED.

Keyword

Emergency service; Hospital; Hospital mortality; Intensive care unit; Prognosis; Sepsis

MeSH Terms

Critical Care*
Emergencies*
Emergency Service, Hospital*
Hospital Mortality
Humans
Intensive Care Units*
Mortality*
Organ Dysfunction Scores*
Prognosis*
Retrospective Studies
ROC Curve
Sepsis*