PIRO, SOFA and MEDS Scores in Predicting One-Month Mortality of Sepsis Patients; a Diagnostic Accuracy Study
Archives of Academic Emergency Medicine,
Vol. 7 No. 1 (2019),
1 January 2019
,
Page e59
https://doi.org/10.22037/aaem.v7i1.399
Abstract
Introduction: Different scoring systems based on clinical and laboratory findings are designed for prediction of short-term mortality of patients with severe sepsis and septic shock. This study aimed to compare the screening performance characteristics of PIRO, SOFA and MEDS Scores in predicting one-month mortality of sepsis patients.
Methods: This diagnostic accuracy study was performed on septic shock and severe sepsis patients referring to emergency department of Loghmane Hakim Hospital, Tehran, Iran, from 2017 to 2018. The performance of MEDS, SOFA, and PIRO models in predicting 30-day mortality of patients was evaluated using discrimination and calibration indices.
Results: 200 patients with the mean age of 71.03±15.59 years were studied (61% male). During the 30 days, 66 patients died (mortality rate=33%). The area under the ROC curve of PIRO, MEDS, and SOFA scores were 0.83 (95% CI=0.78-0.89), 0.94 (95% CI=0.91-0.97) and 0.87 (95% CI=0.81-0.92), respectively. Based on Brier, BrierScaled and Nagelkerke’s R2 ofthe models, the best performance in predicting one-month mortality belonged to MEDS score. C-statistic showed that MEDS score had the highest value in the differentiation between the survived and non-survived cases.
Conclusion: This study showed that MEDS score performs better than PIRO and SOFA scores in predicting one-month mortality of patients with severe sepsis and septic shock.
- Decision support systems
- clinical
- patient outcome assessment
- mortality
- sepsis
- shock
- septic
How to Cite
References
Martin GS, Mannino DM, Eaton S, Moss M. The epidemiology of sepsis in the United States from 1979 through 2000. N Engl J Med. 2003;348(16):1546-54.
Rivara FP. Introduction: the scientific basis for injury control. Epidemiologic reviews. 2003;25:20-3.
Mehrdad R, Seifmanesh S, Chavoshi F, Aminian O, Izadi N. Epidemiology of occupational accidents in iran based on social security organization database. Iranian Red Crescent medical journal. 2014;16(1):e10359.
Brun-Buisson C. The epidemiology of the systemic inflammatory response. Intensive Care Med. 2000;26 Suppl 1:S64-74.
Fine MJ, Auble TE, Yealy DM, Hanusa BH, Weissfeld LA, Singer DE, et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med. 1997;336(4):243-50.
Lim WS, van der Eerden MM, Laing R, Boersma WG, Karalus N, Town GI, et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax. 2003;58(5):377-82.
Vincent JL, de Mendonca A, Cantraine F, Moreno R, Takala J, Suter PM, et al. Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Working group on "sepsis-related problems" of the European Society of Intensive Care Medicine. Critical care medicine. 1998;26(11):1793-800.
Shapiro NI, Wolfe RE, Moore RB, Smith E, Burdick E, Bates DW. Mortality in Emergency Department Sepsis (MEDS) score: a prospectively derived and validated clinical prediction rule. Critical care medicine. 2003;31(3):670-5.
Marshall JC. The PIRO (predisposition, insult, response, organ dysfunction) model: toward a staging system for acute illness. Virulence. 2014;5(1):27-35.
Rathour S, Kumar S, Hadda V, Bhalla A, Sharma N, Varma S. PIRO concept: staging of sepsis. Journal of postgraduate medicine. 2015;61(4):235-42.
Nguyen HB, Van Ginkel C, Batech M, Banta J, Corbett SW. Comparison of Predisposition, Insult/Infection, Response, and Organ dysfunction, Acute Physiology And Chronic Health Evaluation II, and Mortality in Emergency Department Sepsis in patients meeting criteria for early goal-directed therapy and the severe sepsis resuscitation bundle. Journal of critical care. 2012;27(4):362-9.
Safari S, Shojaee M, Rahmati F, Barartloo A, Hahshemi B, Forouzanfar MM, et al. Accuracy of SOFA score in prediction of 30-day outcome of critically ill patients. Turkish journal of emergency medicine. 2016;16(4):146-50.
de Groot B, Lameijer J, de Deckere ER, Vis A. The prognostic performance of the predisposition, infection, response and organ failure (PIRO) classification in high-risk and low-risk emergency department sepsis populations: comparison with clinical judgement and sepsis category. Emergency medicine journal : EMJ. 2014;31(4):292-300.
Macdonald SP, Arendts G, Fatovich DM, Brown SG. Comparison of PIRO, SOFA, and MEDS scores for predicting mortality in emergency department patients with severe sepsis and septic shock. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine. 2014;21(11):1257-63.
Bone RC, Sibbald WJ, Sprung CL. The ACCP-SCCM consensus conference on sepsis and organ failure. Chest. 1992;101(6):1481-3.
Jones AE, Trzeciak S, Kline JA. The Sequential Organ Failure Assessment score for predicting outcome in patients with severe sepsis and evidence of hypoperfusion at the time of emergency department presentation. Critical care medicine. 2009;37(5):1649-54.
Sankoff JD, Goyal M, Gaieski DF, Deitch K, Davis CB, Sabel AL, et al. Validation of the Mortality in Emergency Department Sepsis (MEDS) score in patients with the systemic inflammatory response syndrome (SIRS). Critical care medicine. 2008;36(2):421-6.
Rubulotta F, Marshall JC, Ramsay G, Nelson D, Levy M, Williams M. Predisposition, insult/infection, response, and organ dysfunction: A new model for staging severe sepsis. Critical care medicine. 2009;37(4):1329-35.
Shojaee M, Safari S, Sabzghabaei A, Alavi-Moghaddam M, Arhami Dolatabadi A, Kariman H, et al. Pro-BNP versus MEDS Score in Determining the Prognosis of Sepsis Patients; a Diagnostic Accuracy Study. Emergency (Tehran, Iran). 2018;6(1):e4-e.
Jones AE, Saak K, Kline JA. Performance of the Mortality in Emergency Department Sepsis score for predicting hospital mortality among patients with severe sepsis and septic shock. Am J Emerg Med. 2008;26(6):689-92.
Calle P, Cerro L, Valencia J, Jaimes F. Usefulness of severity scores in patients with suspected infection in the emergency department: a systematic review. The Journal of emergency medicine. 2012;42(4):379-91.
Geier F, Popp S, Greve Y, Achterberg A, Glockner E, Ziegler R, et al. Severity illness scoring systems for early identification and prediction of in-hospital mortality in patients with suspected sepsis presenting to the emergency department. Wiener klinische Wochenschrift. 2013;125(17-18):508-15.
Chen YX, Li CS. Risk stratification and prognostic performance of the predisposition, infection, response, and organ dysfunction (PIRO) scoring system in septic patients in the emergency department: a cohort study. Critical care (London, England). 2014;18(2):R74.
de Groot B, de Deckere ER, Flameling R, Sandel MH, Vis A. Performance of illness severity scores to guide disposition of emergency department patients with severe sepsis or septic shock. European journal of emergency medicine : official journal of the European Society for Emergency Medicine. 2012;19(5):316-22.
Howell MD, Talmor D, Schuetz P, Hunziker S, Jones AE, Shapiro NI. Proof of principle: the predisposition, infection, response, organ failure sepsis staging system. Critical care medicine. 2011;39(2):322-7.
- Abstract Viewed: 354 times
- PDF Downloaded: 196 times
- HTML Downloaded: 29 times
