Background: Sepsis continues to impose a major healthcare
burden globally. Early identification and prompt initiation of appropriate
therapy, particularly antibiotics, are critical determinants of survival.
Various bedside scoring systems have been developed for early detection and
prognostication of sepsis.
Objective: This chapter compares the predictive accuracy of
Systemic Inflammatory Response Syndrome (SIRS), quick Sequential Organ Failure
Assessment (qSOFA), National Early Warning Score (NEWS), and Modified Early
Warning Score (MEWS) for in-hospital mortality among patients with suspected
sepsis admitted to the intensive care unit (ICU).
Methods: This prospective comparative study was conducted in
the Department of General Medicine and Critical Care at Dhiraj General
Hospital, affiliated with Sumandeep Vidyapeeth University, Waghodia, Gujarat,
India. A total of 188 adult patients with suspected sepsis admitted to the ICU
were included. Clinical and laboratory parameters required to calculate SIRS,
qSOFA, NEWS, and MEWS were recorded at admission. The Modified EWS (MEWS) score
comprises five physiologic variables: systolic blood pressure (SBP), HR, RR,
temperature, and mental status. The MEWS score considers the relative deviation
from a patient’s normal blood pressure and urine output to identify surgical
patients who would potentially benefit from intensive care. Sensitivity,
specificity, positive predictive value (PPV), negative predictive value (NPV),
and area under the receiver operating characteristic curve (AUROC) were
calculated for each scoring system in predicting ICU mortality. Hierarchical
Summary Receiver Operating Characteristic (HSROC) curve analysis was performed
to compare overall prognostic accuracy.
Results: Among 188 patients, 42 (22.34%) died during
hospitalisation. qSOFA ≥2 demonstrated the highest specificity (73.61%) but the
lowest sensitivity (36.02%). SIRS ≥2 and NEWS ≥5 showed the highest sensitivity
(77.78%), although SIRS had the lowest specificity (23.88%). MEWS ≥5
demonstrated balanced performance with a sensitivity of 76.36% and specificity
of 63.91%. The highest discriminatory ability for ICU mortality was observed
with MEWS ≥5 (AUROC 0.76; 95% CI 0.68–0.84), compared to NEWS ≥5 (AUROC 0.61),
qSOFA ≥2 (AUROC 0.56), and SIRS ≥2 (AUROC 0.49). HSROC analysis confirmed the
superior overall prognostic performance of MEWS. The better predictive accuracy
of NEWS is most likely due to the fact that it incorporates a larger number of
physiological parameters than qSOFA and SIRS, including the majority of their
constituent atoms. Any scoring system for sepsis should favour better sensitivity
over specificity because the consequences of false-negative results (delayed or
missed therapy) are arguably much higher than those of false-positive results
(unnecessary antibiotics). The AUROC for SIRS, however, was so low that it
appears to have very little clinical use.
Conclusion: Among the four scoring systems evaluated, MEWS
demonstrated the highest predictive accuracy for ICU mortality. However, none
of the scoring systems achieved both high sensitivity and high specificity.
These tools should therefore complement, rather than replace, comprehensive
clinical assessment.
Author(s) Details
Hairya Ajaykumar
Lakhani
SBKS Medical Institute and Research Centre, Vadodara, India.
Miloni Mineshbhai
Nada
Surat Municipal Institute of Medical Education and Research (SMIMER),
Affiliated to the Veer Narmad South Gujarat, University, Surat, India.
Aarjuv Majmundar
SBKS Medical Institute and Research Centre, Vadodara, India.
Sucheta Lakhani
SBKS Medical Institute and Research Centre, Vadodara, India.
Jitendra D Lakhani
SBKS Medical Institute and Research Centre, Vadodara, India.
Please see the book here :- https://doi.org/10.9734/bpi/msup/v7/7173
