Comparison of the Reverse Shock Index Multiplied by Glasgow Coma Scale Score, MEWS, and qSOFA as Sepsis Screening Tools for Predicting Short-Term Outcomes.

Abstract

Background: A simple screening tool is needed for resource-limited settings because rapid treatment is crucial in sepsis. We investigated whether a simplified score, the reverse shock index multiplied by the Glasgow Coma Scale score (rSIG), could replace the Modified Early Warning Score (MEWS) or the quick Sequential Organ Failure Assessment (qSOFA) for sepsis screening.

Methods: We used data from a Japanese multicenter prospective observational study. This dataset included patients with suspected infection who were admitted from 35 emergency departments (cohort 1) and patients with suspected infection who were admitted to 22 intensive care units (cohort 2). The primary outcome was 28-day mortality. Secondary outcomes were ICU admission or death within 28 days and mechanical ventilation or death within 28 days in cohort 1 and diagnosis of sepsis, need for invasive support (composite of vasopressor use, mechanical ventilation, or death before day 4) in cohort 2.

Results: In cohort 1, the AUROC for rSIG was significantly higher for 28-day mortality than for MEWS but not significantly different from that of qSOFA (0.69 [95% CI 0.64-0.74] vs 0.64 [0.59-0.69] vs 0.68 [0.63-0.72]). In cohort 2, the AUROC of rSIG for 28-day mortality was similar to that of MEWS and qSOFA (0.62 [0.56-0.68] vs 0.58 [0.52-0.64] vs 0.62 [0.56-0.67]). The AUROCs for diagnosis of sepsis, ICU admission or 28-day mortality, and mechanical ventilation or 28-day mortality were similar. The AUROC for need of invasive support was significantly higher for rSIG than for MEWS. For most outcomes, rSIG ≥15 had higher sensitivity than a qSOFA ≥2 or a MEWS total ≥5 or any variable ≥3.

Conclusion: Although there are limitations in the data, rSIG predicted short-term outcomes in patients with suspected infections as well as or better than MEWS and qSOFA.