@article {Nishiwakie028856, author = {Hiroki Nishiwaki and Sho Sasaki and Takeshi Hasegawa and Fumihiko Sasai and Hiroo Kawarazaki and Shun Minatoguchi and Daisuke Uchida and Kenichiro Koitabashi and Takaya Ozeki and Fumihiko Koiwa}, editor = {, and , and Nomura, Masahide Furusho;atsushi and Shimizu, Hideaki and Ryuge, Akihiro and Imaizumi, Takahiro and Murasawa, Masaru and Raita, Yoshihiko and Saka, Yosuke and Yazawa, Masahiko and Teranishi, Maho and Suzuki, Yasunori and Fujita, Yoshiro and Murakami, Minoru and Maruta, Yuichi and Fujioka, Megumi and Saito, Hisako and Mizukami, Aya and Shibagaki, Shinya Omiya;yugo and Nomura, Masahide Furusho;atsushi and Shimizu, Hideaki and ;takahiro imaizumi, Akihiro Ryuge and Murasawa, Masaru and Raita, Yoshihiko and ;masahiko yazawa, Yosuke Saka and Teranishi, Maho and Suzuki, Yasunori and Fujita, Yoshiro and Murakami, Minoru and Maruta, Yuichi and Fujioka, Megumi and Saito, Hisako and Mizukami, Aya and Shibagaki, Shinya Omiya;yugo}, title = {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}, volume = {9}, number = {7}, elocation-id = {e028856}, year = {2019}, doi = {10.1136/bmjopen-2018-028856}, publisher = {British Medical Journal Publishing Group}, 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{\textendash}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.}, issn = {2044-6055}, URL = {https://bmjopen.bmj.com/content/9/7/e028856}, eprint = {https://bmjopen.bmj.com/content/9/7/e028856.full.pdf}, journal = {BMJ Open} }