Sepsis related medical emergency calls and mortality: correlation with qSOFA score

Sepsis is the leading cause of mortality in critically ill patients, however, despite numerous diagnostic algorithms, there is still a delay in diagnosis. The aim of our study was to characterize the physical, biochemical and health administrative factors which influenced 28-day mortality after medical emergency team (MET) call for sepsis. We analysed MET call data in the 2015 calendar year, applying both the SIRS and qSOFA scores in turn to identify their prognostic utility as well as identifying any independent variables which influenced 28-day mortality. We found that sepsis was the causative aetiology in 970 (22%) MET calls, with a mortality rate of 22%. The mean age was 68.4±17.6 years with a median Charlson comorbidity score (CCS) of 3.0 (IQR 1.25-6.00). Evidence of microbiological growth was seen in 407 (63%) patients, with 35 (9%) being multi-drug resistant. Lactate and bilirubin was significantly higher in those that died compared to those that survived; (2.86 vs 2.22; p-value 0.003) and (34.68 vs 21.03; p=0.004) respectively. Five variables were identified as independent risks for mortality, including; age (p<0.001) and CCS (p<0.001). SIRS and qSOFA positivity doubled (p=0.017) and tripled (p=0.008) the risk of morality respectively. Both the SIRS and qSOFA score had poor sensitivity for mortality (25.7 vs 31.3% respectively) and overall agreement (51%; kappa statistic 0.096). Our results support the use of qSOFA as a prompt to consider the diagnosis of sepsis and as a prognostic tool in the critically-ill patient due to infection, trebling the risk of 28-day mortality, however, both scores were ineffective at ruling out sepsis. Age and Charlson comorbidity score were the most significant independent factors that influenced mortality.