Predicting 30-day mortality in older patients with suspected infections by adding performance status to quick sequential organ failure assessment

Background

Quick Sequential Organ Failure Assessment (qSOFA) is a simple and easy tool for identifying patients with suspected infection, who are at a high risk of poor outcome. However, its predictive performance is still insufficient. The Eastern Cooperative Oncology Group Performance Status (ECOG-PS) score, a tool to evaluate physical function, has been recently reported to be useful in predicting the prognosis of patients with pneumonia. We aimed to evaluate the added value of ECOG-PS to qSOFA in predicting 30-day mortality in older patients admitted with suspected infections.

Methods

Between 2018 and 2019, we prospectively collected data from adults aged 65 years or older, admitted with suspected infection at two acute care hospitals. Predictive performance was compared between two logistic regression models: one using qSOFA score alone (qSOFA model) and the other in which ECOG-PS was added to qSOFA (extended model).

Results

Of the 1536 enrolled patients, 135 (8.8%) died within 30 days. The area under the curve of the extended model was significantly higher than that of the qSOFA model (0.67 vs. 0.64, p = 0.008). When the risk groups were categorized as follows: low (<5%), intermediate (5%–10%), and high (≥10%), 5.0% of those who died and 2.1% of those who survived were correctly reclassified by the extended model with an overall categorized net reclassification improvement of 0.03 (95% confidence interval: −0.06 to 0.30).

Conclusions

Adding the ECOG-PS score could improve the performance of qSOFA in predicting mortality in older patients admitted with suspected infection.