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Title: New sepsis definition (Sepsis-3) and community-acquired pneumonia mortality: A validation and clinical decision-making study
Author: Ranzani, Otavio T.
Prina, Elena
Menéndez, Rosario
Ceccato, Adrian
Cillóniz, Catia
Méndez, Raúl
Gabarrús, Albert
Barbeta, Enric
Bassi, Gianluigi Li
Ferrer, Miquel
Torres Martí, Antoni
Keywords: Pneumònia adquirida a la comunitat
Community-acquired pneumonia
Issue Date: 15-Nov-2017
Publisher: American Thoracic Society
Abstract: RATIONALE: The Sepsis-3 Task Force updated the clinical criteria for sepsis, excluding the need for systemic inflammatory response syndrome (SIRS) criteria. The clinical implications of the proposed flowchart including the quick Sequential (Sepsis-related) Organ Failure Assessment (qSOFA) and SOFA scores are unknown. OBJECTIVES: To perform a clinical decision-making analysis of Sepsis-3 in patients with community-acquired pneumonia. METHODS: This was a cohort study including adult patients with community-acquired pneumonia from two Spanish university hospitals. SIRS, qSOFA, the Confusion, Respiratory Rate and Blood Pressure (CRB) score, modified SOFA (mSOFA), the Confusion, Urea, Respiratory Rate, Blood Pressure and Age (CURB-65) score, and Pneumonia Severity Index (PSI) were calculated with data from the emergency department. We used decision-curve analysis to evaluate the clinical usefulness of each score and the primary outcome was in-hospital mortality. MEASUREMENTS AND MAIN RESULTS: Of 6,874 patients, 442 (6.4%) died in-hospital. SIRS presented the worst discrimination, followed by qSOFA, CRB, mSOFA, CURB-65, and PSI. Overall, overestimation of in-hospital mortality and miscalibration was more evident for qSOFA and mSOFA. SIRS had lower net benefit than qSOFA and CRB, significantly increasing the risk of over-treatment and being comparable with the 'treat-all' strategy. PSI had higher net benefit than mSOFA and CURB-65 for mortality, whereas mSOFA seemed more applicable when considering mortality/intensive care unit admission. Sepsis-3 flowchart resulted in better identification of patients at high risk of mortality. CONCLUSIONS: qSOFA and CRB outperformed SIRS and presented better clinical usefulness as prompt tools for patients with community-acquired pneumonia in the emergency department. Among the tools for a comprehensive patient assessment, PSI had the best decision-aid tool profile.
Note: Versió postprint del document publicat a:
It is part of: American Journal of Respiratory and Critical Care Medicine, 2017, vol. 196, num. 10, p. 1287-1297
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ISSN: 1073-449X
Appears in Collections:Articles publicats en revistes (Medicina)
Articles publicats en revistes (IDIBAPS: Institut d'investigacions Biomèdiques August Pi i Sunyer)

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