dc.description.abstract |
Background: Sepsis is common in surgical patients, and its presence influences the outcomes in
those to undergo surgery. Factors such as advanced age, presence of comorbidities and many
other conditions increase mortality in surgical patients with sepsis. There is no single test to
diagnose sepsis, but a set of criteria that have kept evolving from 1991 onwards. The current
definition of sepsis generated in 2016 introduced the Sequential (Sepsis-related) Organ Failure
Assessment (SOFA) score simplified into quick Sequential (Sepsis-related) Organ Failure
Assessment score qSOFA score that not only helps to define sepsis but also to identify patients
who are likely to die from it. The qSOFA score has been validated in high income countries but
some authors advocated for its recalibration.
Objectives: The aim of this study was to develop a prognostic tool accurate in predicting
outcomes in surgical patients with sepsis who presented at University Teaching Hospital of
Kigali (CHUK), University Teaching Hospital of Butare (CHUB) and in other centers with limited
resources
Methods: This was a prospective cohort study conducted over a period of one year from
February 2018 to January 2019. The patients recruited in the first 6 months at CHUK served as
the derivation cohort and those recruited in the next 6 months from both CHUK and CHUB
served as the validation cohort. We used a pre-established questionnaire for data collection,
the data were entered in excel, and analyzed in STATA version 14. Appropriate statistical tests
were used for the derivation of the Kigali Surgical Sepsis (KiSS) score and its prognostic accuracy
was tested by comparing it with qSOFA score in terms of sensitivity, specificity and their area
under receiver operator characteristic (AUROC) curves.
Results: A total of 288 patients were recruited with 144 in each cohort. The mean age was 36.5
and median age was 32.6. Males were 117/288 (40.6%) and females were 171/288 (59.4%). The
mean LOHS was 22.9 days. The overall intensive care unit (ICU) admission rate was 51.4% and
in-hospital mortality rate was 21.7%.
Factors associated with hospital mortality were age above 55 years (p = 0.034), presence of
comorbidities (p = 0.069), hypotension (p = 0.014), tachycardia (p = 0.061), tachypnea (p =
0.028), decreased level of consciousness (p = 0.021), presence of GIT perforation (p = 0.026)
and number of impaired organ function (p = 0.035). A predictive score (KiSS score) consisting of
six parameters was derived from these factors and compared to qSOFA score.
The sensitivity of KiSS score in predicting mortality was 73% (vs 52% for qSOFA), and the
specificity was 97% (vs 87% for qSOFA). The predictive validity for hospital mortality was
assessed by Area under Receiver Operator Characteristic (AUROC) curve and it was 0.939 (95%
CI, p<0.001) for KiSS and 0.684 (95% CI, p<0.001) for qSOFA.
Conclusion: The Kigali Surgical Sepsis (KiSS) score developed from this study was found to be
superior to the qSOFA score in predicting hospital mortality. The KiSS score showed an added
advantage of stratifying surgical patients to be operated on into those with good prognosis,
those with variable prognosis and those with poor prognosis |
en_US |
dc.subject |
Outcomes, sepsis in surgery, qSOFA score, limited resources, KiSS score, sensitivity, specificity, mortality, morbidity |
en_US |