NICE guidance on sepsis is of limited value in postoperative colorectal patients: the scores that cry ‘wolf!’

Herrod, P.J.J.; Cox, M.; Keevil, H.; Smith, KJE; Lund, J. N.

Abstract

Background and aims
Late recognition of sepsis and consequent death remains a problem. To address this, the National Institute for Health and Care Excellence has published updated guidance recommending the use of the Quick Sequential Organ Failure Assessment (Q-SOFA) score when assessing patients at risk of sepsis following the publication of the Third International Consensus Definitions for Sepsis and Septic Shock. The trauma from major surgery produces a systemic inflammatory response syndrome (SIRS) postoperatively as part of its natural history, which may falsely trigger scoring systems. We aimed to assess the accuracy of Q-SOFA and SIRS criteria as recommended scores for early detection of sepsis and septic complications in the first 48hrs after colorectal cancer surgery.

Methods
We reviewed all elective major colorectal operations in a single centre during a 12-month period from prospectively maintained electronic records.

Results
One hundred and thirty nine patients were included in this study. In all, 29 patients developed postoperative infective complications in hospital. Nineteen patients triggered on SIRS without developing infective complications, while 42 patients triggered on Q-SOFA with no infective complications. The area under the ROC curve was 0.52 for Q-SOFA and 0.67 for SIRS.

Discussion
Q-SOFA appears to perform little better than a coin toss at identifying postoperative sepsis after colorectal cancer resection and is inferior to the SIRS criteria. More work is required to assess whether a combination of scoring criteria, biochemical markers and automated tools could increase accurate detection of postoperative infection and trigger early intervention.

Citation

Herrod, P., Cox, M., Keevil, H., Smith, K., & Lund, J. N. (2018). NICE guidance on sepsis is of limited value in postoperative colorectal patients: the scores that cry ‘wolf!’. Annals of The Royal College of Surgeons of England, 100(4), 275-278. https://doi.org/10.1308/rcsann.2017.0227

• Journal Article Type: Article
• Acceptance Date: Jan 24, 2018
• Online Publication Date: Jan 24, 2018
• Publication Date: Apr 1, 2018
• Deposit Date: Jun 10, 2019
• Publicly Available Date: Jun 17, 2019
• Journal: The Annals of The Royal College of Surgeons of England
• Print ISSN: 0035-8843
• Electronic ISSN: 1478-7083
• Publisher: Royal College of Surgeons of England
• Peer Reviewed: Peer Reviewed
• Volume: 100
• Issue: 4
• Pages: 275-278
• DOI: https://doi.org/10.1308/rcsann.2017.0227
• Keywords: Sepsis – Systemic inflammatory response syndrome – Postoperative complications – Colorectal neoplasms
• Public URL: https://nottingham-repository.worktribe.com/output/1379348
• Publisher URL: https://publishing.rcseng.ac.uk/doi/10.1308/rcsann.2017.0227
• Contract Date: Jun 10, 2019