10.1177/1056789514562152

Vollständiger Abstract

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<h4>Background</h4>Sepsis remains a leading cause of morbidity and mortality in older adults, and early risk stratification in the emergency department (ED) is essential for optimizing patient management. This study compared the prognostic performance of the Sequential Organ Failure Assessment (SOFA), National Early Warning Score (NEWS), National Early Warning Score-Lactate (NEWS-L), and Sepsis Prediction and Evaluation in the Emergency Department (SPEED) score for predicting 28-day mortality in geriatric patients with sepsis.<h4>Methods</h4>This prospective, single-center observational diagnostic accuracy study included consecutive patients aged ≥65 years who met the Sepsis-3 criteria between November 15, 2023, and November 15, 2024. The primary outcome was 28-day all-cause mortality. Discriminatory performance was evaluated using receiver operating characteristic (ROC) curve analysis, and areas under the ROC curves (AUCs) were compared using the DeLong test.<h4>Results</h4>A total of 330 geriatric patients (median age, 79 years) were included, of whom 213 (64.5%) died within 28 days. All four scoring systems demonstrated moderate discriminatory performance. NEWS-L achieved the highest AUC (0.694, 95% CI 0.635-0.753), followed by NEWS (0.679, 95% CI 0.620-0.738), SPEED (0.653, 95% CI 0.593-0.713), and SOFA (0.644, 95% CI 0.584-0.705). Although NEWS-L demonstrated the highest numerical discrimination and SPEED the highest sensitivity, pairwise DeLong comparisons revealed no statistically significant differences among the evaluated scoring systems (all P>0.05).<h4>Conclusions</h4>All evaluated scoring systems demonstrated only moderate prognostic performance for predicting 28-day mortality in geriatric patients with sepsis, and no statistically significant differences were observed among SOFA, NEWS, NEWS-L, and SPEED. These findings suggest that currently available bedside prognostic tools may have limited discriminatory ability in older adults and highlight the need for the development and external validation of geriatric-specific prognostic models.

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