Oral Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2019

Prognostic performance of qSOFA in cancer patients admitted to the emergency department with suspected infection (#25)

Tze TL Koh 1 , Emmanuel EC Canet 2 , Sobia SA Amjad 3 , Rinaldo RB Bellomo 4 , David DT Taylor 5 , Hui HG Gan 6 , Nada NM Marhoon 6 , Andrew AL Lim 6 , Vivek VK Krishnan 7 , Richard RK Khor 1
  1. Radiation Oncology, Olivia Newton John Cancer Research and Wellness Centre, Heidelberg, VIC, Australia
  2. Medical ICU, Hôtel-Dieu, University Hospital, Nantes, Loire-Atlantique, France
  3. University of Melbourne, Parkville , VIC, Australia
  4. ICU, Austin Health, He, VIC, Australia
  5. Emergency Department, Austin Health, Heidelberg, VIC, Australia
  6. Medical oncology, Olivia Newton John Cancer Research and Wellness Centre, Heidelberg, VIC, Australia
  7. MKM Health, South Yarra, VIC, AUSTRALIA

Aims: We aimed to test the performance of the quick Sequential Organ Failure Assessment (qSOFA) score for predicting adverse outcomes in cancer patients admitted to the emergency department (ED) with suspected infection.

Methods: Retrospective cohort analysis of all ED patients with suspected infection admitted between 01 December 2014 and 01 June 2017 at a tertiary hospital. Cancer patients were identified by cross-linking the electronic health records of the ED and oncology department. The primary outcome was in-hospital mortality and/or ICU stay ≥ 3 days.

Results: Among 165,912 patients admitted to the ED, 11,205 (6.8%) had suspected infection, of whom 1,655 (14.8%) had cancer. Solid tumors accounted for 1,267 (76.5%) patients and 388 (23.5%) had hematological malignancies. Chemotherapy or radiotherapy were administered within 6 months before ED admission in 560 (33.8%) patients and 167 (10.1%) had neutropenia at ED admission. 371 (22.4%) patients were qSOFA positive (+). qSOFA+ patients were older, more prone to respiratory infections, and more likely to be admitted to ICU or require mechanical ventilation. In-hospital mortality, and in-hospital mortality or ICU stay ≥ 3 days were 17.3% and 21% respectively for qSOFA+ patients vs 4.7% and 6.9% for qSOFA negative patients (p<0.0001). For prediction of in-hospital mortality, a positive qSOFA had a positive predictive value (PPV) of 17% and a negative predictive value (NPV) of 95%. For prediction of in-hospital mortality or ICU stay ≥ 3 days, the PPV and NPV of a positive qSOFA were 21% and 93%, respectively.

Conclusions: Among cancer patients admitted to the ED with suspected infection, a positive qSOFA was associated with a much greater risk of ICU admission and hospital mortality. Its absence helped identify patients with low risk of such adverse outcomes.