Sepsis Surveillance Using Adult Sepsis Events Simplified eSOFA Criteria Versus Sepsis-3 Sequential Organ Failure Assessment Criteria*

• Type of Material: Article
• Authors: Chanu Rhee, Harvard Medical School; Zilu Zhang, Harvard Medical School; Sameer S. Kadri, National Institutes of Health; David Murphy, Emory University; Gregory Martin, Emory University; Elizabeth Overton, Emory University; Christopher W. Seymour, University of Pittsburgh; Derek C. Angus, University of Pittsburgh; Raymund Dantes, Emory University; Lauren Epstein, Emory University; David Fram, Commonwealth Informat; Richard Schaaf, Commonwealth Informat; Rui Wang, Harvard Medical School; Michael Klompas, Harvard Medical School
• Language: English
• Date: 2019-03-01
• Publisher: Lippincott, Williams and Wilkins
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: Copyright © 2019 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1097/CCM.0000000000003521
• Title of Journal or Parent Work: Critical Care Medicine
• Volume: 47
• Issue: 3
• Start Page: 307
• End Page: 314
• Grant/Funding Information: Financial Support: This work was funded by the Centers for Disease Control and Prevention (U54CK000484), the Agency for Healthcare Research and Quality (K08HS025008 to C.R.), the National Institutes of Health (R35GM119519 to C.W.S. and D.C.A.), and National Institutes of Health Intramural funds (S.S.K).
• Keywords: SOFA; General & Internal Medicine; DETERIORATION; Life Sciences & Biomedicine; Adult Sepsis Event; electronic health records; MORTALITY; CARE; sepsis; Sequential Organ Failure Assessment score; organ dysfunction; ASSOCIATION; Science & Technology; Critical Care Medicine; ASSESSMENT SCORE; TRENDS; INTERNATIONAL CONSENSUS DEFINITIONS; FRAMEWORK; surveillance; RELIABILITY
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

Objectives: Sepsis-3 defines organ dysfunction as an increase in the Sequential Organ Failure Assessment score by greater than or equal to 2 points. However, some Sequential Organ Failure Assessment score components are not routinely recorded in all hospitals' electronic health record systems, limiting its utility for wide-scale sepsis surveillance. The Centers for Disease Control and Prevention recently released the Adult Sepsis Event surveillance definition that includes simplified organ dysfunction criteria optimized for electronic health records (eSOFA). We compared eSOFA versus Sequential Organ Failure Assessment with regard to sepsis prevalence, overlap, and outcomes. Design: Retrospective cohort study. Setting: One hundred eleven U.S. hospitals in the Cerner HealthFacts dataset. Patients: Adults hospitalized in 2013-2015. Interventions: None. Measurements and Main Results: We identified clinical indicators of presumed infection (blood cultures and antibiotics) concurrent with either: 1) an increase in Sequential Organ Failure Assessment score by 2 or more points (Sepsis-3) or 2) 1 or more eSOFA criteria: vasopressor initiation, mechanical ventilation initiation, lactate greater than or equal to 2.0 mmol/L, doubling in creatinine, doubling in bilirubin to greater than or equal to 2.0 mg/dL, or greater than or equal to 50% decrease in platelet count to less than 100 cells/μL (Centers for Disease Control and Prevention Adult Sepsis Event). We compared area under the receiver operating characteristic curves for discriminating in-hospital mortality, adjusting for baseline characteristics. Of 942,360 patients in the cohort, 57,242 (6.1%) had sepsis by Sequential Organ Failure Assessment versus 41,618 (4.4%) by eSOFA. Agreement between sepsis by Sequential Organ Failure Assessment and eSOFA was good (Cronbach's alpha 0.81). Baseline characteristics and infectious diagnoses were similar, but mortality was higher with eSOFA (17.1%) versus Sequential Organ Failure Assessment (14.4%; p < 0.001) as was discrimination for mortality (area under the receiver operating characteristic curve, 0.774 vs 0.759; p < 0.001). Comparisons were consistent across subgroups of age, infectious diagnoses, and comorbidities. Conclusions: The Adult Sepsis Event's eSOFA organ dysfunction criteria identify a smaller, more severely ill sepsis cohort compared with the Sequential Organ Failure Assessment score, but with good overlap and similar clinical characteristics. Adult Sepsis Events may facilitate wide-scale automated sepsis surveillance that tracks closely with the more complex Sepsis-3 criteria.