Intravenous thiamine as an adjuvant therapy for hyperlactatemia in septic shock patients
Abstract
Objective: To assess the effectiveness of intravenous (IV) thiamine in reducing hyperlactatemia in septic shock patients.
Design: Prospective, randomized controlled trial.
Setting: General intensive care unit (GICU), Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur.
Patients and participants: Adult patients with septic shock and hyperlactatemia (lactate ≥2 mmol/l).
Interventions: IV thiamine 200 mg thrice daily for 3 days.
Measurements and results: A total of 72 patients were recruited into the study. Seven patients died within 24 hours of study commencement and were dropped out. Patients were randomized into the thiamine group (TG) who received IV thiamine 200 mg diluted in 50 ml of normal saline, or placebo group (PG) who received 50 ml of normal saline infusion over 30 minutes. Arterial blood lactate samples were collected at time of enrolment, after 6, 12, 18, 24, 48, and 72 hours of study drugs administration. Relative lactate changes over 24 hours, duration of weaning off vasopressors, Sequential Organ Failure Assessment (SOFA) score changes over 72 hours, ICU length of stay (LOS) and mortality rates were compared between groups. There were no significant differences in the relative lactate changes (TG: 37.5% [4.7-59.1] vs PG: 47.8% [29.1-70.7], p=0.091), duration of vasopressors being weaned off (TG: 75.5 [48.0-131.25] vs PG: 88.0 [48.0-147.0]), SOFA score changes (TG: 3.0±3.41 vs PG: 2.7±3.3), ICU LOS (TG: 5.0 [4.0-11.0] vs PG: 6.0 [3.0-12.0]), and ICU mortality rate (TG: 14 [43] vs PG: 12 [37]). Multivariate logistic regression test showed that baseline lactate level was an independent predictor for mortality (p=0.044).
Conclusion: Intravenous thiamine did not show significant improvement in relative lactate changes, time for shock reversal, SOFA scoring, ICU LOS, and mortality rate in septic shock patients with hyperlactatemia. However, baseline lactate level was shown to be an independent predictor for ICU mortality.
Comparison of outcome between percutaneous dilatation tracheostomy and surgical tracheostomy in Intensive Care Unit of Dr. Wahidin Sudirohusodo Hospital Makassar
Abstract
Percutaneous dilatation tracheostomy (PDT) has been widely used in Indonesia, yet no study to evaluate the outcome of PDT compared to surgical tracheostomy (ST) is available.
Objective: This study was aimed to evaluate the use of PDT in Indonesia.
Design: Non-randomized comparative retrospective study.
Setting: Intensive Care Unit of Wahidin Sudirohusodo Hospital Makassar.
Patients: Eighty-four patients aged 15 to 90 years, undergone tracheostomy during 2016 to 2017 were evaluated.
Measurements and results: Samples were evaluated in terms of surgical duration, blood loss volume, mortality, and complication rates such as post-operative bleeding, pneumothorax, subcutaneous emphysema, stomal infection, tracheal stenosis/malacia, and unintended fistula formation. Collected data were analyzed with SPSS version 22. Mean operative duration of PDT (18.3 minutes) were significantly faster than ST (40.2 minutes) (p<0.05), accompanied by significant reduction of mean blood loss 13.6 ml compared to 21.1 ml in ST group (p<0.05). A total of 9 complications (18.8%) found in ST group and 5 (13.9%) in PDT group, with stomal infection was the most common complications. Mortality rate were 52.8% in PDT group and 45.8% in ST group (p>0.05), none associated with the procedure itself.
Conclusion: It is suggested that PDT is a superior technique in placement of tracheostomy canula.
Short-term complications of ultrasound-guided bedside peripherally inserted central catheter in the Intensive Care Unit: 1 year experiences
Abstract
Objectives: Critically ill patients in the intensive care unit (ICU) need central catheter for various reasons, such as long-term intravenous access, nutrition, antibiotic usage, or chemotherapy. Generally, peripherally inserted central catheter (PICC) lines are the most commonly used type of intravenous access meant for long-term use. But, moving critically ill patients from the intensive care unit to the interventional radiology room (IRR), where PICC installation is usually performed, can disrupt ongoing critical care and may be in dangerous situation. Recently, several articles have reported the successful clinical implementation of bedside PICC installation under ultrasound (US) guidance. We aimed to evaluate and report the 1 year experiences of bedside PICC installation under US guidance in ICU by analysis short-term complications.
Methods: We performed a retrospective cohort study of 123 PICCs placed in adult ICU at a tertiary care academic medical center between October 2017 and September 2018. The data were analyzed to identify short-term complications, such as malposition of catheter tip, infection, and occlusion.
Results: Among 123 PICCs, 52 cases were performed in the IRR and 71 cases were performed in the ICU. The overall complications were in 18 cases (14.6%). Malposition of catheter tip was found in 12 cases (9.8%), infection was found in 4 cases (3.3%), occlusion was found in 2 cases (1.6%). Complication rate was higher in the ICU group (18.3%) than the IRR group (9.6%). Malposition was found in 11 cases in the ICU group and 1 case in the IRR group. Infection was found in 2 cases in both groups. Occlusion was found in 1 case in both groups.
Conclusions: The incidence of malposition of catheter tip as short-term complication is higher in the case of performing bedside PICC installation under ultrasound in ICU than in IRR.
Do Asian physicians manage hypertensive crisis properly? A Southeast Asia survey analysis
Abstract
Purpose: Hypertension remains a common cause of morbidity and mortality worldwide, and proper management can prevent death. Over the last few decades, several changes in definitions, clinical manifestations, and management have occurred. We aimed to investigate the extent of knowledge about these changes, as the pertain to acute elevations of blood pressure among physicians in Southeast Asia.
Methods: A cross-sectional survey was created and validated. The survey included 25 questions about the definitions of hypertensive urgencies and emergencies, clinical presentations, ideal rate of blood pressure reduction, and other questions. Surveys were distributed at the Asia Pacific Symposium held in Indonesia in August 2017. Descriptive analysis was conducted using IBM SPSS Statistics™ version 25.0 (IBM Corporation, Armonk, NY).
Results: A total of 145 surveys were completed by physicians from India, Indonesia, South Korea, Philippines, Singapore, and Sri Lanka. Of them, only 49.6% (n=72) knew the normal blood pressure cut-off limits, and 19.3% (n=28) did not recognize the differences between hypertensive urgencies and emergencies. Moreover, 53.7% (n=78) of respondents was not aware that hypertensive urgency can be completely asymptomatic. Sixty-four point eight percent (n=94) indicated that acute cerebrovascular accidents were the most common end-organ damage from hypertensive emergencies. In addition, only 44.1% (n=64) were aware of the ideal rate of blood pressure reduction, and 50.3% (n=73) considered sublingual nifedipine as an appropriate choice in hypertensive crisis management.
Conclusions: A significant percentage of physicians in Southeast Asia lack knowledge about hypertensive crisis definitions, clinical presentations, and management.
Corticosteroids and gastrointestinal bleeding in critical care: a systematic review and meta-analysis
Abstract
Background: Current belief suggests that patients receiving corticosteroids have an increased risk of bleeding from stress ulceration and that these patients should receive stress ulcer prophylaxis. This issue is important as many ICU patients receive corticosteroids and the pharmacologic agents used for stress ulcer prophylaxis are associated with adverse events.
Aim: The goal of this systematic review and meta-analysis was to compare the rate of clinically significant (overt) gastrointestinal (GI) bleeding in critically ill patients receiving corticosteroids versus placebo.
Methods: We searched PubMed, Embase, and the Cochrane database from inception through December 2018. In addition, the bibliographies of selected articles were reviewed for relevant studies and included if inclusion criteria were met. Included studies were randomized, placebo-controlled and blinded studies that compared treatment with corticosteroids for any indication in a patient population that included only ICU patients. Primary outcome of interest was rate of clinically significant GI bleeding in patients treated with corticosteroids versus placebo. Results were expressed as risk ratio (RR) with accompanying 95% confidence interval (CI). Heterogeneity, sensitivity analysis, and risk of bias were explored. In addition, we did a subgroup analysis according to the use of “low-dose” (<400 mg hydrocortisone or equivalent/day) versus “high-dose” corticosteroid.
Results: Thirty-five studies, which enrolled 16,659 patients, met inclusion criteria and were analyzed. Significant GI bleeding was recorded for 355 patients (overall rate of 2.1%). Summary data demonstrated no difference in the risk of GI bleeding between those treated with corticosteroids versus placebo (RR 1.08; 95% CI 0.88-1.33; p=0.46) with minimal heterogeneity between studies (Q statistic p=0.86, I2=0%). Similarly, there was no significant difference in the risk of GI bleeding in either the low (RR 1.04; 95% CI 0.78-1.38) or the high dose groups (RR 1.13; 95% CI 0.84-1.53) and in those studies at low risk of bias (RR 1.16; 95% CI 0.91-1.49) and those at a high risk of bias (RR 0.88; 95% CI 0.6-1.28).
Conclusion: This meta-analysis did not identify a clinically significant difference in the rate of overt GI bleeding in critically ill patients receiving corticosteroids as compared to placebo. The role of stress ulcer prophylaxis in these patients remains uncertain.
The effect of N-acetylcysteine on the myeloperxidase and Tei index in patients with acute myocardial infarction
Abstract
Bacground: Myeloperoxidase (MPO) is a strong oxidant and toxic to microorganisms with excess production causing tissue damage. We aimed to determine the effect of N-acetylcysteine (NAC) 600 mg orally 3 times a day for 3 consecutive days on MPO levels and left ventricle myocardial performance index (LVMPI/Tei index) in ST elevation myocardial infarction (STEMI) patients treated with fibrinolytics.
Methods: Pre- and post-design, single blind experimental randomized trial, conducted on 32 patients with STEMI at Intensive Cardiovascular Care Unit (ICVCU). The subjects were divided into 2 groups: 17 patients received 600 mg t.i.d NAC for 72 hours and 15 controls. MPO levels before and after 72 hours and Tei index 72 hours after NAC therapy were measured. Statistical analysis of MPO level and Tei index were analyzed with SPSS 22. Tei index was measured using the pulsed wave Doppler (PWD) and tissue Doppler imaging (TDI).Results: NAC administration showed decrease in the marker of MPO (112.76±57.28 vs 180.40±69.03, p=0.001) and delta MPO (-50.15±46.62 vs 12.06±108.65) 72 hours after NAC therapy compared with control. NAC improved the LVMPI value compared to the control group. Tei index examination using PWD (0.39±0.11 vs 0.49±0.08, p=0.005) and that using TDI (0.41±0.08 vs 0.57±0.08, p=0.001) showed improved values for NAC administration than those with controls.Conclusion: NAC 600 mg orally 3 times a day for 3 consecutive days can reduce MPO levels and improve diastolic function by decreasing LVMPI values.
The effect of oral N-acetylcysteine on galectin-3 and global longitudinal strain in patients with acute myocardial infarction
Abstract
Objective: Galectin-3 (Gal-3) plays a big role in the development of cardiac fibrosis; however, its role in remodeling after acute myocardial infarction (AMI) has not received sufficient attention. Post-AMI measurements of global longitudinal strain (GLS) are beneficial in providing information about infarct area and remodeling. We aimed to determine the effect of N-acetylcysteine (NAC) on Gal-3 and GLS in AMI.
Design: This was a randomized, single-blind study with pre- and post-treatment evaluations performed from May 1 to August 31, 2018.
Setting: Dr. Moewardi Hospital, Indonesia
Patients: ST elevation myocardial infarction (STEMI) patients who received fibrinolytic therapy were randomly allocated to NAC and control groups.
Interventions: A total of 32 STEMI patients were administered fibrinolytic therapy (17 patients were administered standard therapy plus 600 mg NAC orally three times a day for 72 hours and 15 patients were administered standard therapy plus placebo as the control). Gal-3 samples were taken during admission and at 72 hours in both groups, while GLS measurement was only performed 72 hours after admission.
Measurements and results: Gal-3 levels in the NAC and control groups at admission were not significantly different; however, levels were significantly different after 72 hours (p=0.017). After comparing Gal-3 levels during admission and at 72 hours, the NAC group showed significant differences between Gal-3 levels at the time of admission and at 72 hours (p=0.0001); no difference was found in the control group. There were also significant intergroup differences in Gal-3 level changes (p=0.014). In the NAC group, a better and significantly different 72-h GLS value was obtained from that in the control group (p=0.023).
Conclusion: Supplementary therapy with NAC can reduce Gal-3 levels and GLS in AMI patients receiving fibrinolytic therapy.
Correlation between zinc plasma level to inflammation response of patient with ventilator in pediatrics intensive care unit
Abstract
Objective: Critical conditions arise when there is a threat or ongoing organ failure that disrupts the balance of the body's oxygen and physiological needs. Patients often require help, such as endotracheal intubation procedures, mechanical ventilation, and renal or liver replacement therapy, in place of impaired organ function. Usually, complications are more common in children than in adults. Zinc is one of the micronutrients that plays a vital role as an antioxidant and the role of defense immune modulators against systemic inflammatory response syndrome (SIRS). Outcome patient with ventilator depends on SIRS response to the disease. Meanwhile the study about zinc supplementation in Pediatric Intensive Care Unit (PICU) is limited. The main objective of this study was to look at the correlation of plasma zinc levels with inflammatory responses in children of 1-12 years old with ventilator in pediatric intensive care unit.
Design and setting: This study was prospective study in Sanglah General Hospital, Denpasar and was calculated by Pearson analysis to determine the correlation of variables plasma zinc with levels of pro-inflammatory cytokines interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-α) and continued by general linier model analysis.
Results: More than 70% sample was insufficiency zinc for the first 24 hours and after 72 hours, respectively. Correlation between plasma zinc and pro-inflammatory cytokines were TNF-α; p<0.001 r: -0.91, and IL-6; p=0.013, r: -0.48 in 24 hours, and IL-6; p>0.05 r: 0.011, and TNF-α; p<0.01 r: 0.659 in 72 hours.
Conclusions: There were significant correlation in TNF-α and IL-6 measurement between zinc plasma insufficiency with pro-inflammatory cytokines in the first 24 hours and significant correlation in TNF-α in 72 hours. Therefore, zinc supplementation in 72 hours from patient admission to PICU may have important role to reduce morbidity in PICU.
Lactic acid’s role in sodium hypertonic lactic solution as a neuroprotector measured from the level of ATP, MCT-1 and necrosis area in intracerebral hematoma rats model
Abstract
Objective: To discover the role of hypertonic sodium lactate (HSL) as the energy source, which in turn will act as a neuroprotector, by measuring adenosine triphosphate (ATP) level, monocarboxylate transporter 1 (MCT-1) and the extent of the necrotic areas.
Design: This was an experimental study that used randomized post-test only control group design.
Setting: Experimental Animal Care Unit Universitas Gadjah Mada.
Patient and participant: 32 white mice of Rattus norvegicus.
Intervention: After the protocol of this study was approved by the research ethic committee, 32 rats were randomly divided into two groups: HSL group (n=16) and NaCl 3% group (n=16) as the control group. Both groups were anesthetized using conversion-dose pentothal.
Results: ATP level in HSL group was higher compared to the control group (p=0.031). MCT-1 in HSL group was also higher than the control group (p=0.010). Necrotic areas were less extensive in the HSL group than the control group (p=0.000). Lactate levels at minute 30 (T30) and minute 360 (T360) increased in the HSL group, while increasing in the control group up to T30, then decreased gradually until T360.
Conclusion: Exogenous lactate in solution has effect as a neuroprotective of brain in the intracerebral hemorrhage (ICH).
End-of-life care (EOLC) in Jordanian critical care units: Barriers and strategies for improving
Abstract
Background: End-of-life care (EOLC) is a pivotal element of work in ICUs and for critical care nurses, thus, it is considered one of the top research priorities recently as number of admission ICUs increasing and high percentage of deaths also.
Objective: This study was conducted to explore the obstacles of EOLC and strategies for improvement from nurses' perception.
Methods: The questionnaire, that was developed by Beckstrand and Kirchhoff (2005), was used to collect data from 163 critical care nurses from different hospitals.
Results: Two hundred questionnaires were distributed. One hundred and sixty-three questionnaires were completed and returned with response rate 81.5%. The majority of the participants were male nurse 104 (63.8%), with bachelor degree 153 (93.9%), working in adult ICU 105 (64.4%), as bedside nurse 141 (86.5 %). The highest obstacles from the nurses’ perception were family and friends who continually call the nurse wanting an update on the patient’s condition rather than calling the designated family member for information (mean=4.07). Furthermore, the highest three supportive behaviors from the nurses’ perception were physicians agreeing about direction of patient care (mean=3.96), family members accept that patient is dying (mean=3.94), and family designating one family member as contact person for the rest of the family (mean=3.89).
Conclusion: As the number of deaths is increasing in critical care units, the needs to understand how the EOLC is provided in these units. Identifying obstacles and supportive behaviours will assist the stakeholders and policymakers to set the action plans for improving the quality of EOLC.
Electrical cardiometry for non-invasive cardiac output monitoring in children with dengue hemorrhagic fever and shock in comparison between referral and non-referral
Abstract
Objective: Shock in dengue hemorrhagic fever (DHF) is mostly caused by plasma leakage. Hemodynamic monitoring is essential for improving the quality of management and the outcome. We sought to find the hemodynamic profile of dengue hemorrhagic fever children with shock.
Design: a cohort prospective study.
Setting: Pediatric Intensive Care Unit (PICU) at tertiary general hospital in Surabaya, Indonesia.
Patients and participants: Children <18-year-old admitted to the PICU with diagnosis DHF with shock.
Intervention: All patients underwent measurement of hemodynamic profile with electrical cardiometry ICON OsypkaTM after the first fluid resuscitation.
Measurements and results: There were 37 patients with DHF grade 3. All patients had normal blood pressure on first examination, with the mean of systolic and diastolic blood pressure were 82.5±9.21 mmHg and 51.8±16.32 mmHg, respectively. They had low stroke volume (66.7%), high heart rate (60.6%), low cardiac output (49%), and high systemic vascular resistance (55%). Mean resuscitation fluid volume was 35.30±31.99 ml/kg, where referral patient had significantly higher resuscitation fluid volume (49.45±39.46 ml/kg) than non-referral (19.75±0.60 ml/kg), p=0.002. Thoracic fluid content were significantly higher in referral (75%) than those in non-referral patients (16.7%), p=0.001.
Conclusion: After first fluid resuscitation, children with DHF grade 3 obtained normal blood pressure but still in hypovolemic state. Referral patients had higher fluid volume resuscitation and thoracic fluid content than those in non-referral.
The effectiveness of a short training course for emergency medicine residents to confirm tracheal tube placement by ultrasound
Abstract
Objective: The present study aimed to evaluate the performance of tracheal ultrasound by novice emergency medicine residents after participating in a short training course.
Methods: This was an observational prospective study conducted between July 2016 and September 2017 at three university-affiliated emergency departments in Tehran, Iran. Adult patients (over 18 years of age) who needed emergency intubation were included. Investigators were emergency medicine residents who did not have prior experience in tracheal ultrasound. Training course consisted of 40 minutes of theoretical education and three days of hands-on training. Immediately after intubation by treating physicians, two investigators evaluated the placement of the tracheal tube simultaneously. One investigator used tracheal ultrasound and the second investigator used quantitative waveform capnography. The registrant was a nurse who was asked to record the results of each investigator in the following format: 1. Correct tracheal intubation, 2. Esophageal intubation, and 3. Time spent to complete the evaluation. Finally, the ultrasound results were compared with those of capnography.
Results: Ninety patients were included in the study. Based on the capnography results, there were three (3.3%) esophageal intubations and 87 (96.6%) tracheal intubations. Investigators reported the same results by tracheal ultrasound. The mean±SD time spent to complete the evaluation was 32±10 seconds for capnography and 48±15 seconds for tracheal ultrasound (p value of 0.0001).Conclusion: Emergency medicine residents with basic knowledge of ultrasound can learn tracheal ultrasound techniques through a short training course.
Delirium in critically ill patients: incidence, risk factors and outcomes
Abstract
Objective: To determine the incidence, and evaluate the risk factors and outcomes of delirium in general Intensive Care Unit (ICU).
Design: Prospective cross-sectional observational study.
Setting: Teaching hospital in Kuala Lumpur, Malaysia.
Patients and participants: Patients ages of 18 and above admitted for more than 24 hours in general ICU were recruited into the study.
Measurements and results:The demographic data, predisposing and precipitating factors, and environmental factors were collected. Confusional Assessment Method (CAM-ICU) was done daily to assess delirium, when the patient had a sedation score of above Richmond Agitation and Sedation Scale (RASS) -3. Patients were followed up till discharged from ICU. Length of mechanical ventilation and length of ICU stay were recorded.
A total of 139 patients were recruited with overall incidence of delirium was 42%. Among patients who had delirium, 68% were of hypoactive delirium, 25% of mixed delirium and 7% were hyperactive delirium. The significant predisposing risk factors for developing delirium were age, higher Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, visual or hearing impairment, smoking, renal impairment, diabetes, and hypertension. The factors detected precipitating delirium were sepsis, use of vasopressors, renal replacement therapies, and acute respiratory distress syndrome (ARDS). The presence of catheters, higher Sequential Organ Failure Assessment (SOFA) scores, and abnormal urea and bilirubin levels further significantly increased risk of delirium. Environmental conditions increasing the risk of delirium included absence of daylight exposure and visible clocks, and use of physical restraints. As a result of delirium, patients had longer length of mechanical ventilation and ICU stay.Conclusions: Recognizing predisposing factors and optimizing the modifiable risk factors will improve the length of mechanical ventilation and ICU stay.
Dispatcher-assisted cardiopulmonary resuscitation improves the neurological outcomes of out-of-hospital cardiac arrest victims: a retrospective analysis of prehospitalisation records in Kumamoto City
Abstract
Background: Dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) is an effective tool for improving the outcome of out-of-hospital cardiac arrest (OHCA) by providing dispatcher assistance (DA) to bystander cardiopulmonary resuscitation (BCPR) and public access defibrillators (PAD). However, it is unclear whether DA-CPR improves the neurological outcomes of OHCA. In this study, we assessed the effectiveness of DA-CPR using prehospitalisation records in Kumamoto City (Japan), which has a population of 730,000, an area of 390 km2, and 25 ambulances. The DA-CPR protocol in Kumamoto City commenced in 2014.
Methods: We retrospectively analysed the prehospitalisation records in Kumamoto City between 2014 and 2016. The cases were divided into two groups according to whether they received DA: DA group and non-DA group. The BCPR and PAD rates were compared between the two groups. The neurological outcomes (Glasgow–Pittsburgh cerebral performance category 1–2) were compared between the two groups by propensity score analysis with inverse probability of treatment weighting.
Results: A total of 1607 prehospitalisation records were identified and divided into the DA (n=1132) and non-DA (n=474) groups. BCPR (72% vs 17%, p<0.001) and PAD (11% vs 5%, p<0.001) rates were greater in the DA group. Propensity score analysis showed that the neurological outcome was significantly better in the DA group (odds ratio 1.718; 95% confidence interval: 1.017-2.902; p=0.0431).Conclusions: DA-CPR was associated with improved BCPR, PAD, and neurological outcomes of OHCA in this analysis of prehospitalisation cases in Kumamoto City.
The accuracy of SIRS criteria, qSOFA and SOFA for mortality suspected sepsis patient admitted to the Intensive Care Unit Dr. Hasan Sadikin General Hospital Bandung, January-December 2017
Abstract
Objective: The high mortality rate found on infectious patients in the intensive care unit (ICU) calls for sepsis identification tools. Sepsis consensus introduced Systemic Inflammatory Response Syndrome (SIRS) criteria, quick Sequential Organ Failure Assessment (qSOFA) score, and Sequential Organ Failure Assessment (SOFA) score. This study aimed at comparing the accuracy and quality to discriminate among the SIRS, qSOFA score, and SOFA score for predicting mortality among patients at risk of sepsis admitted to the ICU.
Design: This study used the analytic observational method with retrospective cohort approach to a sample of 73 qualified medical record data. The data regarding the SIRS, qSOFA, and SOFA criteria were applied after 24 hours of ICU admission.
Setting: ICU of Dr. Hasan Sadikin General Hospital, Bandung from January to December 2017.
Measurements and results: The results of this study showed the SOFA score as being the most accurate and having a good quality to discriminate, with the value of area under the receiver operating characteristic (AUROC) 0.866 (95% CI 0.782-0.95; p=0.00); the qSOFA score had AUROC of 0.707 (95% CI 0.588-0.826; p=0.002) while SIRS criteria were not significant.Conclusions: The conclusion of this study is that in patients with suspected sepsis admitted to an ICU, the SOFA score is the most accurate to predict mortality, whereas qSOFA could be considered and the SIRS criteria is not recommended.