Additional value of geriatric parameters to Quick Sepsis Related Organ Failure Assessment score for predicting clinical deterioration in older emergency department patients with a suspected infection: post-hoc analysis of a prospective observational study

Agneta H Calf; Hjalmar R Bouma; Liann Weil; Emma M de Jong; Marije de Haan; Barbara C van Munster; Jan C Ter Maaten

doi:10.52964/AMJA.0989

Additional value of geriatric parameters to Quick Sepsis Related Organ Failure Assessment score for predicting clinical deterioration in older emergency department patients with a suspected infection: post-hoc analysis of a prospective observational study

Acute Med. 2024;23(3):140-151. doi: 10.52964/AMJA.0989.

Authors

Agneta H Calf¹, Hjalmar R Bouma², Liann Weil³, Emma M de Jong⁴, Marije de Haan⁴, Barbara C van Munster³, Jan C Ter Maaten⁵

Affiliations

¹ MD, University of Groningen, University Medical Center Groningen, Department of Geriatrics, P.O. Box 30 001, HPC AA41, 9700 RB Groningen, The Netherlands.
² University of Groningen, University Medical Center Groningen, Department of Internal Medicine, P.O. Box 30 001, HPC TA10, 9700 RB Groningen, The Netherlands, University of Groningen, University Medical Center Groningen, Department of Acute Care, P.O. Box 30 001, HPC TA10, 9700 RB Groningen, The Netherlands, University of Groningen, University Medical Center Groningen, Department of Clinical Pharmacy and Pharmacology, P.O. Box 30 001, HPC AP50, 9700 RB Groningen, the Netherlands.
³ University of Groningen, University Medical Center Groningen, Department of Geriatrics, P.O. Box 30 001, HPC AA41, 9700 RB Groningen, The Netherlands.
⁴ University of Groningen, University Medical Center Groningen, Department of Internal Medicine, P.O. Box 30 001, HPC TA10, 9700 RB Groningen, The Netherlands.
⁵ University of Groningen, University Medical Center Groningen, Department of Internal Medicine, P.O. Box 30 001, HPC TA10, 9700 RB Groningen, The Netherlands, University of Groningen, University Medical Center Groningen, Department of Acute Care, P.O. Box 30 001, HPC TA10, 9700 RB Groningen, The Netherlands.

PMID: 39513263
DOI: 10.52964/AMJA.0989

Abstract

Aim: To investigate the additional value of geriatric parameters such as physical impairment to the quick Sequential Organ Failure Assessment (qSOFA) tool for predicting clinical deterioration in older ED patients with a suspected infection and to validate the final prediction model.

Methods: Post-hoc multivariable regression analysis from a prospective observational cohort study of adult patients visiting the ED of a university hospital to develop a prediction model. External validation of the prediction model was performed using the prospective data-biobank Acutelines.

Results: In older patients, qSOFA (OR 1.47 (95% CI 1.12-1.95)) and physical impairment (OR 1.84 (95% CI 1.20-2.82)) were independently associated with clinical deterioration within 72 hours. This resulted in a prediction model with an area under the curve of 0.62 (95% CI 0.56-0.68) in the derivation cohort, and of 0.62 (95% CI 0.56-0.68) in the validation cohort. Calibration of the model was poor.

Conclusion: In older ED patients with a suspected infection, not only disease severity scores, but also presence of physical impairment is independently associated with clinical deterioration.

Publication types

Observational Study

MeSH terms

Aged
Aged, 80 and over
Clinical Deterioration
Emergency Service, Hospital*
Female
Geriatric Assessment* / methods
Humans
Male
Organ Dysfunction Scores*
Predictive Value of Tests
Prospective Studies
Sepsis* / diagnosis
Severity of Illness Index