Usefulness of the mortality in severe sepsis in the Emergency Department score in an Urban Tertiary Care Hospital

Abstract Background The Mortality in Severe Sepsis in the Emergency Department (MISSED) score is a newly proposed scoring system. The goal of this study is to determine if the MISSED score is generalizable to an urban tertiary care hospital. Methods This is a retrospective chart review conducted from July 2012 to June 2014. Inclusion criteria consisted of adult ED patients with severe sepsis, defined as lactate level 4 mmol/L or greater. Demographics, lactate, INR, albumin, ICU admission and ED intubation were analyzed using chi-square, t-test and logistic regression. The MISSED score was calculated using the variables albumin 27 g/L or less, INR 1.3 or greater and age 65 years or older and analyzed using the area under the curve (AUC). The primary outcome was in-hospital mortality. Results 182 patients met inclusion criteria and mortality was 32%. Patients in the mortality group had older age (58.1 ± 17.2 vs 62.7 ± 14.7; P = .07), higher lactate (5.9 ± 2.7 vs 7.3 ± 3.1; P < .01), lower albumin (34.3 ± 8.3 vs 25.6 ± 7.1; P < .0001), higher INR (1.4 ± 0.6 vs 2.4 ± 1.9; P < .0001), ED intubation (21% vs 56%; P < .0001) and ICU admission (41% vs 78%; P < .0001). The regression model found that albumin of 27 g/L or less (OR = 1.8; 95%CI 1.05–3.36), INR 1.3 or greater (OR = 8.3; 95%CI 3.35–20.51) and ED intubation (OR = 5.6; 95%CI 2.56–12.35) predicted mortality. The AUC for the MISSED score was 0.78 [95%CI 0.73–0.85]. Conclusion The MISSED score is useful for predicting mortality in ED patients with severe sepsis.