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, 21 (1), 73

Comparison of qSOFA and SIRS for Predicting Adverse Outcomes of Patients With Suspicion of Sepsis Outside the Intensive Care Unit

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Comparison of qSOFA and SIRS for Predicting Adverse Outcomes of Patients With Suspicion of Sepsis Outside the Intensive Care Unit

Eli J Finkelsztein et al. Crit Care.

Abstract

Background: The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) Task Force recently introduced a new clinical score termed quick Sequential (Sepsis-related) Organ Failure Assessment (qSOFA) for identification of patients at risk of sepsis outside the intensive care unit (ICU). We attempted to compare the discriminatory capacity of the qSOFA versus the Systemic Inflammatory Response Syndrome (SIRS) score for predicting mortality, ICU-free days, and organ dysfunction-free days in patients with suspicion of infection outside the ICU.

Methods: The Weill Cornell Medicine Registry and Biobank of Critically Ill Patients is an ongoing cohort of critically ill patients, for whom biological samples and clinical information (including vital signs before and during ICU hospitalization) are prospectively collected. Using such information, qSOFA and SIRS scores outside the ICU (specifically, within 8 hours before ICU admission) were calculated. This study population was therefore comprised of patients in the emergency department or the hospital wards who had suspected infection, were subsequently admitted to the medical ICU and were included in the Registry and Biobank.

Results: One hundred fifty-two patients (67% from the emergency department) were included in this study. Sixty-seven percent had positive cultures and 19% died in the hospital. Discrimination of in-hospital mortality using qSOFA [area under the receiver operating characteristic curve (AUC), 0.74; 95% confidence intervals (CI), 0.66-0.81] was significantly greater compared with SIRS criteria (AUC, 0.59; 95% CI, 0.51-0.67; p = 0.03). The qSOFA performed better than SIRS regarding discrimination for ICU-free days (p = 0.04), but not for ventilator-free days (p = 0.19), any organ dysfunction-free days (p = 0.13), or renal dysfunction-free days (p = 0.17).

Conclusions: In patients with suspected infection who eventually required admission to the ICU, qSOFA calculated before their ICU admission had greater accuracy than SIRS for predicting mortality and ICU-free days. However, it may be less clear whether qSOFA is also better than SIRS criteria for predicting ventilator free-days and organ dysfunction-free days. These findings may help clinicians gain further insight into the usefulness of qSOFA.

Keywords: Critical care; Infection; Mortality; Organ failure; Severe sepsis.

Figures

Fig. 1
Fig. 1
Association between in-hospital mortality and qSOFA calculated within 8 hours before ICU admission in patients with suspected infection. a Distribution of included patients according to number of qSOFA criteria met and corresponding mortality rates (p < 0.001 using chi-square test). b Comparison of the area under the receiver operating characteristic curves of qSOFA and SIRS criteria for in-hospital mortality (p = 0.03 using the Hanley and McNeil method). Abbreviations: qSOFA quick Sequential (Sepsis-related) Organ Failure Assessment, SIRS Systemic Inflammatory Response Syndrome, ICU intensive care unit
Fig. 2
Fig. 2
Comparison of the area under the receiver operating characteristic curves of qSOFA and SIRS for important clinical outcomes of patients with suspected infection outside the ICU and corresponding p values using the Hanley and McNeil method. Clinical outcomes other than in-hospital mortality (namely, ICU-free days, ventilator-free days, any organ dysfunction-free days, and renal dysfunction-free days) were considered as categorical variables with the median of the entire cohort serving as the threshold. The median of the entire cohort for ICU-free days, ventilator-free days, any organ dysfunction-free days, and renal dysfunction-free days was 22, 28, 5, and 14 days, respectively. Thus, the area under the receiver operating characteristic curve and 95% confidence intervals for ICU-free days <22, ventilator-free days <28, any organ dysfunction-free days <5, and renal dysfunction-free days <14 were calculated and displayed in this figure. Abbreviations: qSOFA quick Sequential (Sepsis-related) Organ Failure Assessment, SIRS Systemic Inflammatory Response Syndrome, ICU intensive care unit

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