Clin Exp Emerg Med.  2019 Mar;6(1):1-8. 10.15441/ceem.17.262.

Efficacy of quick Sequential Organ Failure Assessment with lactate concentration for predicting mortality in patients with community-acquired pneumonia in the emergency department

• Song H
• Moon HG
• Kim SH

• KMID: 2447302
• DOI: http://doi.org/10.15441/ceem.17.262

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.

Keyword

Pneumonia; Hospital mortality; Emergency service, hospital; Organ dysfunction scores

MeSH Terms

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
Lactic Acid
Urea