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1490: COMPARISON OF SIRS, NEWS, SOFA, AND QSOFA FOR PREDICTION OF HOSPITAL MORTALITY IN A SCOTTISH COHORT

Critical Care Medicine • Volume 46 • Number 1 (Supplement) www.ccmjournal.org Learning Objectives: Several scores exist to identify and monitor septic patients, but doubt remains over which is most useful. This study aimed to investigate prediction of hospital mortality by Systemic Inflammatory Response Syndrome criteria (SIRS), National Early Warning Score (NEWS), Sequential Organ Failure Assessment (SOFA) and quick SOFA (qSOFA). Methods: In a single tertiary centre, this retrospective study used data from 2016 for the first day in ICU of patients admitted with sepsis plus administration of epinephrine or norepinephrine within 6hrs of admission, and non-septic patients identified through propensity matching. Statistical analysis was performed in R. Area under the receiver operating characteristic curve (AUC) was used to compare predictive clinical validity (PCV) for mortality of the scores, with a clinically useful predictive threshold set at 0.6. Results: There was no difference in mortality between septic (n = 128) and non-septic (n = 109) patients (p = 0.89), suggesting propensity matching was effective. PCV for hospital mortality was highest for SOFA and NEWS (both AUC 0.71), with odds ratios (OR) for a unit change in score of 1.31 (95% confidence interval [CI] 1.19–1.47; p < 0.001) and 1.33 (95% CI 1.20–1.48; p < 0.001), respectively. These were followed by qSOFA (AUC 0.68; OR 2.58 [95% CI 1.77–3.87; p < 0.001]) and SIRS (AUC 0.59; OR 1.43 [95% CI 1.07–1.93; p = 0.016]). Scores of ≥2 were associated with increased hospital mortality for SIRS (p = 0.016) and qSOFA (p < 0.001). AUC values for mortality of septic patients passed the threshold for SOFA (0.63), NEWS (0.67) and qSOFA (0.69), while AUC reached the threshold for non-septic patients for all scores: SOFA (0.83), NEWS (0.74), qSOFA (0.68) and SIRS (0.63). PCV for qSOFA and NEWS were not significantly different for all or septic patients, but NEWS was superior for non-septic patients (p = 0.036). Conclusions: SOFA, NEWS and qSOFA had clinically useful predictive validity for mortality on the first day in ICU in all patients. As NEWS was overall more predictive than qSOFA, there seems little benefit to introducing qSOFA in the UK where NEWS is already widely used.