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External validation of the quick Sequential Organ Failure Assessment score for mortality and bacteraemia risk evaluation in Japanese patients undergoing haemodialysis: a retrospective multicentre cohort study
  1. Hiroki Nishiwaki1,2,3,
  2. Sho Sasaki2,4,
  3. Takeshi Hasegawa1,2,3,
  4. Fumihiko Sasai1,
  5. Hiroo Kawarazaki5,
  6. Shun Minatoguchi6,7,
  7. Daisuke Uchida8,
  8. Kenichiro Koitabashi9,
  9. Takaya Ozeki7,10,
  10. Fumihiko Koiwa1
  11. the JOINT-KD collaborators
    1. 1 Division of Nephrology, Department of Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
    2. 2 Center for Innovative Research for Communities and Clinical Excellence, Fukushima Medical University, Fukushima, Japan
    3. 3 Research Administration Center (SURAC), Showa University, Tokyo, Japan
    4. 4 Department of Nephrology/Clinical Research Support Office, Iizuka Hospital, Iizuka, Japan
    5. 5 Department of Nephrology, Inagi Municipal Hospital, Inagi, Japan
    6. 6 Department of Nephrology, Chubu Rosai Hospital, Nagoya, Japan
    7. 7 Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan
    8. 8 Department of Nephrology and Hypertension, Kawasaki Municipal Tama Hospital, Kawasaki, Japan
    9. 9 Division of Nephrology and Hypertension, Saint Marianna University School of Medicine, Kawasaki, Japan
    10. 10 Department of Nephrology, Toyohashi Municipal Hospital, Toyohashi, Japan
    1. Correspondence to Dr Takeshi Hasegawa; tahasegawa-npr{at}umin.net

    Abstract

    Objectives We aimed to examine the validity of the quick Sequential Organ Failure Assessment (qSOFA) score for mortality and bacteraemia risk assessment in Japanese haemodialysis patients.

    Design This is a retrospective multicentre cohort study.

    Setting The six participating hospitals are tertiary-care institutions that receive patients on an emergency basis and provide primary, secondary and tertiary care. The other participating hospital is a secondary-care institution that receives patients on an emergency basis and provides both primary and secondary care.

    Participants This study included haemodialysis outpatients admitted for bacteraemia suspicion, who had blood drawn for cultures within 48 hours of their initial admission.

    Primary and secondary outcome measures The primary outcome measure was overall in-hospital mortality. Secondary outcomes included 28-day in-hospital mortality and the incidence of bacteraemia diagnosed based on blood culture findings. The discrimination, calibration and test performance of the qSOFA score were assessed. Missing data were handled using multiple imputation.

    Results Among the 507 haemodialysis patients admitted with bacteraemia suspicion between August 2011 and July 2013, the overall in-hospital mortality was 14.6% (74/507), the 28-day in-hospital mortality was 11.1% (56/507) and the incidence of bacteraemia, defined as a positive blood culture, was 13.4% (68/507). For predicting in-hospital mortality among haemodialysis patients, the area under the receiver operating characteristic curve was 0.61 (95% CI 0.56–0.67) for a qSOFA score ≥2. The Hosmer-Lemeshow χ2 statistics for the qSOFA score as a predictor of overall and 28-day in-hospital mortality were 5.72 (p=0.02) and 7.40 (p<0.01), respectively.

    Conclusion On external validation, the qSOFA score exhibited low diagnostic accuracy and miscalibration for in-hospital mortality and bacteraemia among haemodialysis patients.

    • dialysis
    • infectious diseases
    • nephrology

    This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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    Footnotes

    • Contributors All authors have seen and approved the final version of the manuscript for publication. HN was responsible for the research idea and study design. HN, SS, FS, HK, SM, DU, KK, TO and JOINT-KD collaborators were responsible for data acquisition. HN, SS and TH were responsible for data analysis/interpretation. HN and SS were responsible for statistical analysis. TH and FK provided supervision or mentorship. Each author contributed important intellectual content during manuscript drafting or revision and accepts accountability for the overall work by ensuring that questions pertaining to the accuracy or integrity of any portion of the work are appropriately investigated and resolved.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Ethics approval The present study was approved by the ethics committees of St. Marianna Medical University (No. 2713) and Showa University Fujigaoka Hospital (No. 2014072) and was conducted in accordance with the ethical standards set out in the Declaration of Helsinki and its later amendments.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement You can use the anonymous data set used in this study, only if the reason for reusing the data is clear and it is determined that the reason is appropriate. We will keep the data for the data retention period applied for our Institutional Review Boards.

    • Collaborators The JOINT-KD collaborators included Masahide Furusho (Department of Nephrology, Kagoshima Medical Center, Kagoshima, Japan), Atsushi Nomura (Department of Immunology, Juntendo University School of Medicine, Tokyo, Japan), Hideaki Shimizu (Department of Nephrology, Daido Hospital, Nagoya, Japan), Akihiro Ryuge (Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan), Takahiro Imaizumi (Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan), Masaru Murasawa (Department of Nephrology, St. Marianna University School of Medicine Yokohama City Seibu Hospital, Yokohama, Japan), Yoshihiko Raita (Department of Nephrology, Okinawa Chubu Hospital, Okinawa, Japan), Yosuke Saka (Department of Nephrology, Kasugai Municipal Hospital, Kasugai, Japan), Masahiko Yazawa (Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan), Maho Terashita (Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan), Yasunori Suzuki (Division of Nephrology and Rheumatology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan), Yoshiro Fujita (Department of Nephrology, Chubu Rosai Hospital, Nagoya, Japan), Minoru Murakami (Department of Nephrology, Saku Central Hospital , Saku, Japan), Yuichi Maruta (Division of Nephrology, Department of Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan), Megumi Oikawa (Division of Nephrology, Department of Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan), Hisako Saito (Division of Nephrology and Endocrinology, The University of Tokyo, Tokyo, Japan), Aya Mizukami(Division of Nephrology, Department of Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan), Shinya Omiya (Division of Nephrology, Department of Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan) and Yugo Shibagaki (Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki).

    • Patient consent for publication Not required.

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