• Yasemin Cag, Oguz Karabay, Oguz Resat Sipahi, Firdevs Aksoy, Gul Durmus, Ayse Batirel, Oznur Ak, Zeliha Kocak-Tufan, Aynur Atilla, Nihal Piskin, Turkay Akbas, Serpil Erol, Derya Ozturk-Engin, Hulya Caskurlu, Ugur Onal, Haluk Erdogan, Aslıhan Demirel, Arzu Dogru, Rezan Harman, Aziz Ahmad Hamidi, Derya Karasu, Fatime Korkmaz, Pınar Korkmaz, Civelek Eser Fatma F Ankara Diskapı Yildirim Beyazit Egitim ve Arastirma Hastanesi, Enfeksiyon Hastaliklari ve Klinik Mikrobiyoloji Department, Ankara, Turkey., Yalcin Onem, Sinem Cesur, Musa Salmanoglu, İlknur Erdem, Hüsrev Diktas, and Haluk Vahaboglu.
• Istanbul Medeniyet Universitesi Tip Fakultesi, Enfeksiyon Hastaliklari ve Klinik Mikrobiyoloji Department, Istanbul, Turkey.
• Plos One. 2018 Jan 1; 13 (9): e0204608.

AbstractSepsis is a severe clinical syndrome owing to its high mortality. Quick Sequential Organ Failure Assessment (qSOFA) score has been proposed for the prediction of fatal outcomes in sepsis syndrome in emergency departments. Due to the low predictive performance of the qSOFA score, we propose a modification to the score by adding age. We conducted a multicenter, retrospective cohort study among regional referral centers from various regions of the country. Participants recruited data of patients admitted to emergency departments and obtained a diagnosis of sepsis syndrome. Crude in-hospital mortality was the primary endpoint. A generalized mixed-effects model with random intercepts produced estimates for adverse outcomes. Model-based recursive partitioning demonstrated the effects and thresholds of significant covariates. Scores were internally validated. The H measure compared performances of scores. A total of 580 patients from 22 centers were included for further analysis. Stages of sepsis, age, time to antibiotics, and administration of carbapenem for empirical treatment were entered the final model. Among these, severe sepsis (OR, 4.40; CIs, 2.35-8.21), septic shock (OR, 8.78; CIs, 4.37-17.66), age (OR, 1.03; CIs, 1.02-1.05) and time to antibiotics (OR, 1.05; CIs, 1.01-1.10) were significantly associated with fatal outcomes. A decision tree demonstrated the thresholds for age. We modified the quick Sequential Organ Failure Assessment (mod-qSOFA) score by adding age (> 50 years old = one point) and compared this to the conventional score. H-measures for qSOFA and mod-qSOFA were found to be 0.11 and 0.14, respectively, whereas AUCs of both scores were 0.64. We propose the use of the modified qSOFA score for early risk assessment among sepsis patients for improved triage and management of this fatal syndrome.

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