Performance of quick sequential organ failure assessment and modified age disease adjusted qadSOFA for the prediction of outcomes in emergency general surgery patients

This is the first study investigating qSOFA as a predictor for clinical outcomes in EGS. A new modified qSOFA (qadSOFA) was developed. The AUROC of qSOFA and qadSOFA for mortality was 0.715 and 0.859, respectively with an optimal cut-off value identified as qadSOFA≥3. BACKGROUND Sepsis is a highly prevalent condition and is associated with a reported in-hospital mortality rate up to 40% in patients with abdominal sepsis requiring emergency general surgery (EGS). The quick sequential organ failure assessment score (qSOFA) has not been studied for EGS patients. METHODS Retrospective cohort study in adult patients undergoing abdominal EGS at a university tertiary care center from 2016 to 2018. The primary outcome was mortality. The effect of clinical variables on outcomes was assessed in univariable and multivariable logistic regression analyses. Based on these results, the qSOFA score was modified. The performance of scores was assessed using receiver operating characteristics. RESULTS Five hundred seventy-eight patients undergoing abdominal EGS were included. In-hospital mortality was 4.8% (28/578). Independent predictors for mortality were mesenteric ischemia (odds ratio [OR] 15.9; 95% confidence interval [CI] 5.2–48.6; p < 0.001), gastrointestinal tract perforation (OR 4.9; 95% CI 1.7–14.0; p = 0.003), 65 years or older (OR 4.1; 95% CI 1.5–11.4; p = 0.008), and increasing qSOFA (OR 1.8; 95% CI 1.2–2.8; p = 0.007). The modified qSOFA (qadSOFA) was developed. The area under the receiver operating characteristic curve of the qSOFA and qadSOFA for mortality was 0.715 and 0.859, respectively. Optimal cutoff value was identified as qadSOFA ≥ 3 (Youden Index 64.1%). CONCLUSION This is the first study investigating the qSOFA as a predictor for clinical outcomes in EGS. Compared with the qSOFA, the new qadSOFA revealed an excellent predictive power for clinical outcomes. Further validation of qadSOFA is warranted. LEVEL OF EVIDENCE Diagnostic test/criteria; Level II.

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