Outcome prediction using the Mortality in Emergency Department Sepsis score combined with procalcitonin for influenza patients.

BACKGROUND: Severe influenza is often associated with bacterial coinfection and can trigger sepsis, which increases the severity, complexity and mortality of the disease. To determine an effective method for predicting 28-day mortality of emergency department (ED) patients with influenza, we investigated the Mortality in Emergency Department Sepsis (MEDS) score, procalcitonin (PCT) and other relevant biomarkers. METHODS: We conducted a retrospective, observational, monocentric study, and the endpoint was 28-day mortality. Independent predictors were identified and a new combination predictive model was created both by logistic regression, and the model was evaluated by a receiver operating characteristic (ROC) curve. RESULTS: A total of 364 consecutive ED admitted patients with influenza were enrolled and 45 patients died within 28 days. For predicting 28-day mortality, the MEDS score and PCT were independent predictors with adjusted odds ratio of 1.318 (95% CI 1.206-1.439) and 1.038 (95% CI 1.010-1.065), and with AUCs of 0.817 (95% CI 0.756-0.878) and 0.793 (95% CI 0.725-0.861), respectively. The new combination of the MEDS score with PCT significantly improved the efficacy for predicting 28-day mortality with an AUC of 0.857 (95% CI 0.809-0.905), and was superior to the SOFA score with an AUC of 0.837 (95% CI 0.779-0.894). CONCLUSION: The MEDS score and PCT, especially when combined, perform well for predicting mortality of ED admitted patients with influenza.

Outcome prediction using the Mortality in Emergency Department Sepsis score combined with procalcitonin for influenza patients / Predicción del resultado utilizando la puntuación de mortalidad por sepsis en la unidad de urgencias combinada con procalcitonina en los pacientes con gripe

Background: Severe influenza is often associated with bacterial coinfection and can trigger sepsis, which increases the severity, complexity and mortality of the disease. To determine an effective method for predicting 28-day mortality of emergency department (ED) patients with influenza, we investigated the Mortality in Emergency Department Sepsis (MEDS) score, procalcitonin (PCT) and other relevant biomarkers. Methods: We conducted a retrospective, observational, monocentric study, and the endpoint was 28-day mortality. Independent predictors were identified and a new combination predictive model was created both by logistic regression, and the model was evaluated by a receiver operating characteristic (ROC) curve. Results: A total of 364 consecutive ED admitted patients with influenza were enrolled and 45 patients died within 28 days. For predicting 28-day mortality, the MEDS score and PCT were independent predictors with adjusted odds ratio of 1.318 (95% CI 1.206-1.439) and 1.038 (95% CI 1.010-1.065), and with AUCs of 0.817 (95% CI 0.756-0.878) and 0.793 (95% CI 0.725-0.861), respectively. The new combination of the MEDS score with PCT significantly improved the efficacy for predicting 28-day mortality with an AUC of 0.857 (95% CI 0.809-0.905), and was superior to the SOFA score with an AUC of 0.837 (95% CI 0.779-0.894). Conclusion: The MEDS score and PCT, especially when combined, perform well for predicting mortality of ED admitted patients with influenza

Antecedentes: La gripe severa se asocia a menudo a la coinfección bacteriana, pudiendo desencadenar sepsis, lo cual incrementa la gravedad, la complejidad y la mortalidad de la enfermedad. Para determinar un método efectivo de predecir la mortalidad a 28 días de los pacientes con gripe en la unidad de urgencias (ED), investigamos la puntuación de mortalidad por sepsis en la unidad de urgencias (MEDS), procalcitonina (PCT) y otros biomarcadores relevantes. Métodos: Realizamos un estudio retrospectivo, observacional y unicéntrico, cuya evaluación clínica fue la mortalidad a 28 días. Identificamos factores predictivos independientes, creamos un nuevo modelo predictivo combinado por regresión logística, y evaluamos el modelo mediante una curva ROC. Resultados: Incluimos a un total de 364 pacientes consecutivos ingresados en la ED, de los cuales 45 fallecieron en el plazo de 28 días. Para predecir la mortalidad a 28 días, la puntuación MEDS y PCT fueron factores predictivos independientes con odds ratio ajustados de 1,318 (IC 95%: 1,206-1,439) y 1,038 (IC 95%: 1,010-1;065), y ABC de 0,817 (IC 95%: 0,756-0,878) y 0,793 (IC 95%: 0,725-0,861), respectivamente. La nueva combinación de la puntuación MEDS y PCT mejoró significativamente la eficacia para predecir la mortalidad a 28 días con ABC de 0,857 (IC 95%: 0,809-0,905), siendo superior a la puntuación SOFA con ABC de 0,837 (IC 95%: 0,779-0,894). Conclusión: La puntuación MEDS y PCT, especialmente cuanto se combinan, constituyen una buena predicción de la mortalidad de los pacientes ingresados en la ED con gripe