q-SOFA

1. Efficacy and accuracy of quick sepsis-related organ
failure assessment (qSOFA) and CURB-65 as
prognostic tools for community acquired and
healthcare-associated pneumonia
A PROSPECTIVE COHORT STUDY

2. Introduction
 Pneumonia is defined as an acute infection of the pulmonary
parenchyma, presenting with an acute infiltrate in the chest X-ray [1,
2].
 Even in developed countries, the incidence of pneumonia is still as
high as 9.7 per 1000 persons, with a hospitalization rate of 46.5% and
30-day mortality of 12.9% in patients with community-acquired
pneumonia [3].

3.  The case fatality rate increases to over 50% in patients with
pneumonia-related sepsis/septic shock [3, 4].
 Therefore, early diagnosis of patients with pneumonia-
associated sepsis/septic shock seems paramount.

4.  The CURB-65 score is a pneumonia-specific disease severity score that is
widely used [20].
 The CURB score stratifies patients into five strata, with increasing risk of
mortality between the strata [20].
 Validated in several studies and exhibit high negative predictive value in
patients with pneumonia [20–22].

5.  A CURB-65 score of two or more differentiates patients with a high risk of
mortality (9.1%) from those with a low (1.7%) risk of mortality.
Parameter Value Score
Confusion (GCS <14) 1
Respiratory Rate >30 cpm 1
Blood Pressure SBP < 90mmHg
or
DBP < 60 mmHg
1
Age > 65 years 1

6.  Sepsis, a syndrome of physiologic, pathologic, and
biochemical abnormalities induced by infection, is a major
public health concern, accounting for more than $20 billion
(5.2%) of total US hospital costs in 2011.1
 Sepsis is a leading cause of mortality and critical illness
worldwide.
 Patients who survive sepsis often have long-term physical,
psychological, and cognitive disabilities with significant health
care and social implications.8

7.  Sepsis is defined as life-threatening organ dysfunction caused
by a dysregulated host response to infection.
 Sepsis is a syndrome shaped by pathogen factors and host
factors (eg, sex, race and other genetic determinants, age,
comorbidities, environment) with characteristics that evolve
over time.

8.  Organ dysfunction can be identified as an acute change in
total SOFA score 2 points consequent to the infection.
 A SOFA score 2 reflects an overall mortality risk of
approximately 10% in a general hospital population with
suspected infection.

9.  Patients with suspected infection who are likely to have a
prolonged ICU stay or to die in the hospital can be promptly
identified at the bedside with qSOFA.
Pararmeter Value Score
Altered Mental Status (GCS <14) 1
Respiratory Rate > 22 cpm 1
Blood Pressure SBP < 100mmHg 1

10. General Objective
 Evaluate the predictive performance of qSOFA compared with CURB-65 as
a prognostic tool in patients with pneumonia.

11. Specific Objectives
 Determine the association of the q-SOFA score compared with CURB-65
as to:
1. in-hospital mortality
2. Length of hospitalization
3. Admission to the ICU

12. Specific Objectives
 Obtain demographic data (i.e. age, sex)
 Collect data as follows:
1. Type of pneumonia (CAP/HCAP)
2. Time since start of symptoms
3. History of fever, diarrhea, delirium, myalgia.
4. Risk factors (COPD, cardiac disease, immunosuppression, active neoplasia,
smoking, alcoholism)
5. Vital Signs
6. Laboratory result (BUN)
7. Microbiologic sampling (i.e. blood CS, sputum CS) and result
8. Length of hospitalization
9. ICU admission (primary or secondary)
10. In-hospital mortality

13. Methodology
 A prospective cohort study
 Approval will be obtained from Institutional Review Board/Local Ethics
committee.
 A statistician will be consulted to identify a statistically significant sample size.
 Written and informed consent will be obtained from all participants.
 Data collection will be done by the researcher and/or ER IM Resident On-duty
 A standardized form will be provided that will be filled up by the patient
and/or the folks, and/or the IM Resident on duty.
 Data will be collated
 Statistical Analyses

14. Inclusion Criteria
 All adult patients 18years and above diagnosed with pneumonia who
consulted at the ER will be included in the study.

15.  Patients who refused admission
 Patients who opted for Discharge Against Medical Advise
 Patients who opted transfer to hospital of choice
 Patients who were discharged after 24 hrs of admission
Exclusion Criteria

16. Time Table
Activity
Jul 1 Jul 16 Aug 1 Aug
16
Sep 1 Sep 16 Oct 1 Oct 16 Nov 1 Nov 1 Dec 1 Dec 16 Jan 1 Jan 16
Final Proposal
Ethics Review
Subject Enrollment
Data Gathering
Analysis
Final Report