Abstract

Systemic inflammatory response syndrome (SIRS) reportedly has a low performance for distinguishing infection from non-infection. We explored the distribution of the patients diagnosed by SIRS (SIRS patients) or a quick sequential organ failure assessment (qSOFA) (qSOFA patients) and confirmed the performance of the both for predicting ultimate infection after hospital admission. We retrospectively analyzed the data from a multicenter prospective study. When emergency physicians suspected infection, SIRS or the qSOFA were applied. The area under the receiver operating characteristic curves (AUC) was used to assess the performance of the SIRS and qSOFA for predicting established infection. A total of 1,045 patients were eligible for this study. The SIRS patients accounted for 91.6% of qSOFA patients and they showed a higher rate of final infection than that of non-SIRS patients irrespective of the qSOFA diagnosis. The AUCs for predicting infection with SIRS and a qSOFA were 0.647 and 0.582, respectively. The SIRS significantly predicted an ultimate infection (AUC, 0.675; p = 0.018) in patients who met the SIRS and qSOFA simultaneously. In conclusion, the SIRS patients included almost all qSOFA patients. SIRS showed a better performance for predicting infection for qSOFA in those who met both definitions.

Details

Title
The SIRS criteria have better performance for predicting infection than qSOFA scores in the emergency department
Author
Gando Satoshi 1 ; Shiraishi Atsushi 2 ; Abe, Toshikazu 3 ; Kushimoto Shigeki 4 ; Toshihiko, Mayumi 5 ; Fujishima Seitaro 6 ; Hagiwara Akiyoshi 7 ; Shiino Yasukazu 8 ; Shiraishi Shin-ichiro 9 ; Hifumi Toru 10 ; Otomo Yasuhiro 11 ; Okamoto Kohji 12 ; Sasaki Junichi 13 ; Kiyotsugu, Takuma 14 ; Yamakawa Kazuma 15 ; Hoshino Atsumi 16 ; Abe, Toshiaki 17 ; Sugita Manabu 18 ; Hanaki Yoshihiro 19 ; Harada Masahiro 20 ; Yoshihara Hideaki 21 ; Morino Kazuma 22 ; Shimizu Yoshihiro 23 ; Ishikura Hiroyasu 24 ; Deguchi Yoshizumi 25 ; Nachi Sho 26 ; Kawakami Masato 27 ; Maehara Junichi 28 ; Okada Kunihiko 29 ; Kiyota Kazuya 30 ; Miki Yasuo 31 ; Koike Kaoru 32 ; Muroya Takashi 33 ; Yamashita Hisashi 34 ; Anan Hideaki 35 ; Kaneko Tadashi 36 ; Kittaka Hirotada 37 ; Yamaguchi, Hiroyuki 38 

1  Division of Acute and Critical Care Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan (GRID:grid.39158.36) (ISNI:0000 0001 2173 7691) 
2  Department of Acute and Critical Care Medicine, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan (GRID:grid.490419.1) (ISNI:0000 0004 1763 9791) 
3  Emergency and Trauma Center, Kameda Medical Center, Kameda, Japan (GRID:grid.414927.d) (ISNI:0000 0004 0378 2140) 
4  Department of General Medicine, Juntendo University, Tokyo Japan; Health Services Research and Development Center, University of Tsukuba, Tsukuba, Japan (GRID:grid.20515.33) (ISNI:0000 0001 2369 4728) 
5  Division of Emergency and Critical Care Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (GRID:grid.69566.3a) (ISNI:0000 0001 2248 6943) 
6  Department of Emergency Medicine, School of Medicine, University of Occupational and Environmental Health, Fukuoka, Japan (GRID:grid.271052.3) (ISNI:0000 0004 0374 5913) 
7  Center for General Medicine Education, Keio University School of Medicine, Tokyo, Japan (GRID:grid.26091.3c) (ISNI:0000 0004 1936 9959) 
8  Center Hospital of the National Center for Global Health and Medicine, Tokyo Japan; Department of Emergency Medicine, Niizashiki Chuo General Hospital, Tokyo, Japan (GRID:grid.26091.3c) 
9  Department of Acute Medicine, Kawasaki Medical School, Kawasaki, Japan (GRID:grid.415086.e) (ISNI:0000 0001 1014 2000) 
10  Department of Emergency and Critical Care Medicine, Aizu Chuo Hospital, Aizu, Japan (GRID:grid.415086.e) 
11  Department of Emergency and Critical Care Medicine, St. Luke’s International Hospital, Tokyo, Japan (GRID:grid.430395.8) 
12  Trauma and Acute Critical Care Center, Medical Hospital, Tokyo Medical and Dental University, Tokyo, Japan (GRID:grid.265073.5) (ISNI:0000 0001 1014 9130) 
13  Department of Surgery, Center for Gastroenterology and Liver Disease, Kitakyushu City Yahata Hospital, Yahata, Japan (GRID:grid.440098.1) 
14  Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Tokyo, Japan (GRID:grid.26091.3c) (ISNI:0000 0004 1936 9959) 
15  Emergency & Critical Care Center, Kawasaki Municipal Kawasaki Hospital, Kawasaki, Japan (GRID:grid.415107.6) (ISNI:0000 0004 1772 6908) 
16  Division of Trauma and Surgical Care, Osaka General Medical Center, Osaka, Japan (GRID:grid.415107.6) 
17  Kameda Medical Center, Kamogawa, Japan (GRID:grid.414927.d) (ISNI:0000 0004 0378 2140) 
18  Juntendo University Urayasu Hospital, Urayasu, Japan (GRID:grid.482669.7) (ISNI:0000 0004 0569 1541) 
19  Juntendo University Nerima Hospital, Urayasu, Japan (GRID:grid.482668.6) (ISNI:0000 0004 1769 1784) 
20  Kawasaki Medical School Hospital, Kurashiki, Japan (GRID:grid.415106.7) (ISNI:0000 0004 0641 4861) 
21  National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan (GRID:grid.415538.e) 
22  Tokyo Medical and Dental University Hospital, Tokyo, Japan (GRID:grid.474906.8) 
23  Yamagata Prefectural Central Hospital, Yamagata, Japan (GRID:grid.417323.0) (ISNI:0000 0004 1773 9434) 
24  Kyoto Okamoto Memorial Hospital, Kyoto, Japan (GRID:grid.417323.0) 
25  Kagawa University Hospital, Kagawa, Japan (GRID:grid.471800.a) 
26  Tokyo Women’s Medical University Medical Center East, Tokyo, Japan (GRID:grid.413376.4) (ISNI:0000 0004 1761 1035) 
27  Kitakyushu City Yahata Hospital, Kitakyushu, Japan (GRID:grid.440098.1) 
28  Saiseikai Kumamoto Hospital, Kumamoto, Japan (GRID:grid.416612.6) 
29  Saku Central Hospital, Saku, Japan (GRID:grid.416751.0) (ISNI:0000 0000 8962 7491) 
30  Saitama Red Cross Hospital, Saitama, Japan (GRID:grid.416704.0) (ISNI:0000 0000 8733 7415) 
31  Fujieda Municipal General Hospital, Fujieda, Japan (GRID:grid.415119.9) (ISNI:0000 0004 1772 6270) 
32  Kyoto University Hospital, Kyoto, Japan (GRID:grid.411217.0) (ISNI:0000 0004 0531 2775) 
33  Kansai Medical University Hospital, Kansai, Japan (GRID:grid.410783.9) (ISNI:0000 0001 2172 5041) 
34  St. Mary’s Hospital, Kurume, Japan (GRID:grid.416532.7) (ISNI:0000 0004 0569 9156) 
35  Fujisawa City Hospital, Fujisawa, Japan (GRID:grid.415120.3) (ISNI:0000 0004 1772 3686) 
36  Kumamoto University Hospital, Kumamoto, Japan (GRID:grid.411152.2) (ISNI:0000 0004 0407 1295) 
37  Osaka Mishima Emergency Critical Care Center, Osaka, Japan (GRID:grid.452656.6) (ISNI:0000 0004 0623 203X) 
38  Seirei Yokohama Hospital, Yokohama, Japan (GRID:grid.452656.6) 
Publication year
2020
Publication date
2020
Publisher
Nature Publishing Group
e-ISSN
20452322
Source type
Scholarly Journal
Language of publication
English
DOI
https://doi.org/10.1038/s41598-020-64314-8
ProQuest document ID
2403301572
Copyright
© The Author(s) 2020. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.