Background Definitions and clinical criteria for sepsis have been revised in 2016. A simple bedside score ('qSOFA' , for quick Sequential [Sepsis-Related] Organ Failure Assessment) has been proposed, which incorporates hypotension (systolic blood pressure ≤100 mmHg), altered mental status and respiratory rate ≥ 22/min: the presence of at least two of these criteria has been associated with poor outcomes typical of sepsis. The aim of this study was to evaluate qSOFA as a predictor of 30-day mortality in a model with other predictors of death among patients admitted to a single-centre emergency department (ED). Methods A historical cohort study among prospectively registered patients with suspected or documented infection. The admission period was from 1 st of November 2013 to 31 th of October 2014. Baseline clinical data and data for survival were obtained from a standard sepsis admission form, the patient records and The Danish Civil Registration System. Logistic regression analysis was used to adjust for potential confounders and to determine whether the predictive factors for death in the crude analyses were independently associated with 30-day mortality. Results A total of 434 patients were included in the study. Fifty-seven (13.1%; 95% confidence interval [CI] 9.9-16.3%) patients died during the first 30 days. Among several potential confounders tested in the model we found that age (odds ratio [OR] 1.29; 95% CI 1.03-1.61), Charlson Comorbidity Score ≥ 3 (OR 3.83; 95% CI 1.41-10.37), qSOFA score ≥2 (OR 4.78; 95% CI 2.09-10.91) and lactate values (lactate values < 2.0 as reference) within the interval 2.00-3.99 (OR 2.21; 95% CI 1.06-4.62) and lactate values ≥ 4.0 (OR 3.97; 95% CI 1.44-2,92) were associated with 30-day mortality. Conclusion qSOFA can be helpful to identify infectious patients in an ED with increased risk of 30-day mortality.

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Background: Only few prospective studies have evaluated the new quick Sequential (Sepsis-Related) Organ Failure Assessment (qSOFA) score in emergency department (ED) settings. The aim of this study was to determine the prognostic value of qSOFA compared to systemic inflammatory response syndrome (SIRS) in predicting 28-day mortality of infected patients admitted to an ED.   Methods: A prospective observational cohort study of all adult (≥18 years) infected patients admitted to the ED of Slagelse Hospital during 01.10.2017 to 31.03.2018. All patients with suspected or documented infection on arrival to the ED, and treated with antibiotics, were included. Admission variables included in the SIRS- and qSOFA criteria were prospectively obtained from triage forms. Information regarding 28-day mortality was obtained from the Danish Civil Registration System. The diagnostic performance of qSOFA and SIRS score for predicting 28-day mortality was assessed by analyses of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the receiver operating curve (AUC) with 95% confidence intervals (CI). Results: A total of 2,168 patients (47.42% male) were included. A total of 181 (8.35%) met at least two qSOFA criteria, and 1,046 (48.25%) met at least two SIRS criteria on admission. The overall 28-day mortality was 7.47% (95% CI 6.40-8.66%). Unadjusted odds ratio of qSOFA and SIRS for 28-day mortality was 2.93 (95% CI 1.92-4.47) vs 1.27 (95% CI 0.92-1.74), respectively. A qSOFA score of at least two for predicting 28-day mortality had a sensitivity of 19.10% (95% CI 13.40-26.00%), a specificity of 92.50% (95% CI 91.30-93.60%), a PPV and NPV of 17.10% (95% CI 11.90-23.40%) and 93.40% (95% CI 92.20-94.50%), respectively. A SIRS score of at least two for predicting 28-day mortality had a sensitivity of 53.70 (95% CI 45.70-61.60%), a specificity of 52.20% (95% CI 50.00-54.40%), a PPV and NPV of 8.32% (95% CI 6.72-10.20%) and 93.30% (95% CI 91.70-94.70%), respectively. The AUC for qSOFA and SIRS was 0.56 (95% CI 0.53-0.59) vs 0.53 (95% CI 0.49-0.57).   Conclusion: Use of qSOFA had improved specificity, but with poor sensitivity, in predicting in 28-day mortality. qSOFA and SIRS showed similar discrimination potential for mortality.