Performance of Sepsis Scoring Systems in a developing country ­ a prospective cohort study

Background: Sepsis and its sequelae poses a significant socio-economic burden on health care systems globally. Risk stratification plays a fundamental role in emergency department management, since early and aggressive management in high-risk cohorts leads to improved outcomes. Several risk stratification tools exist but in the local setting (developing country with high chronic disease burden) there is no standardised recommendation for beside utilisation. Objectives: We aimed to compare the ability of the quick Sepsis-related Organ Failure Assessment (qSOFA) score with the Systemic Inflammatory Response Syndrome (SIRS) criteria and National Early Warning Score (NEWS) to detect and risk stratify patients with presumed sepsis outside of the intensive care unit (ICU). Methods: A prospective observational cohort study was conducted at a public tertiary hospital during the period May to June 2017. Ethical and institutional approval was secured and informed consent was sought from study participants aged eighteen (18) years and older. Demographic and clinical data were collected via a data collection instrument and statistical analysis was undertaken using IBM SPSS v23. Results: 304 patients were treated for presumed sepsis. The primary outcomes of in-hospital death or intensive care unit admission were seen in 14.8%. Discrimination for the primary outcome was highest for NEWS (AUROC 0.88 [95% CI 0.83-0.94]) followed by qSOFA (AUROC 0.82 [95% CI 0.74-0.89]) and SIRS (AUROC 0.69 [95% CI 0.61-0.77]). A NEWS value of ≥4 resulted in a sensitivity of 93.3%, and negative predictive value of 98.3% (p<0.001). A qSOFA score ≥2 demonstrated a specificity of 94.6 % and a negative predictive value of 91.4% (p<0.001). A SIRS criteria score ≥2 resulted in a sensitivity of 88.9%, and a negative predictive value of 95.0% (p=0.001). Univariate analysis showed that: need for supplemental oxygen, an oxygen saturation less than 91%, a Glasgow Coma Scale <15 and non-selfpresentation were associated with the highest odds ratios for death in-hospital or ICU admission. Conclusions: Urgent identification of high-risk patients with presumed infection is critical in achieving a positive outcome. NEWS was superior to both qSOFA AND SIRS in predicting in-hospital mortality and need for ICU admission A qSOFA score ≥2 demonstrated a high specificity but poor sensitivity, thus limiting its use as a bedside tool. The findings of this study are consistent with the Sepsis-3 guidelines, which recommend qSOFA as being superior to SIRS criteria. However, we found that NEWS had a superior predictive value to both. Its role in the identification of high-risk subjects should be further evaluated.

Severity of acute Zika virus infection: A prospective emergency room surveillance study during the 2015­2016 outbreak in Suriname

Acute Zika virus (ZIKV) infection is usually mild and self-limiting. Earlier, we reported three cases of fatal acute ZIKV infection in patients without typical signs of ZIKV, but rather with criteria of systemic inflammation response syndrome (SIRS). To follow up these observations, we prospectively included patients at the emergency room with temperature instability and suspected to have acute ZIKV infection, SIRS, or both. A total of 102 patients were included of whom N =21 (21%) were suspected of acute ZIKV infection, N =56 (55%) of acute ZIKV infection with SIRS criteria, and N =25 (24%) of SIRS alone. ZIKV-PCR was positive in N =21 (20%) patients. Eight (38%) ZIKV-positive patients needed admission to the hospital of whom four (50%) presented with SIRS alone. One ZIKV-positive patient had vascular co-morbidity and died following shock and severe coagulopathy. We confirm the hypothesis that acute ZIKV infection can present atypical and severely with systemic inflammation and have lethal course particularly amongst patients with significant prior disease...(AU)