Comparison of SIRS criteria and qSOFA score for identifying culture-positive sepsis in the emergency department: a prospective cross-sectional multicentre study

Abstract

ObjectiveTo compare the daily practice of two emergency departments (ED) in the Netherlands, where systemic inflammatory response syndrome (SIRS) criteria and quick Sequential Organ Failure Assessment (qSOFA) score are used differently as screening tools for culture-positive sepsis.DesignA prospective cross-sectional multicentre study.SettingTwo EDs at two European clinical teaching hospitals in the Netherlands.Participants760 patients with suspected infection who met SIRS criteria or had a qualifying qSOFA score who were treated at two EDs in the Netherlands from 1 January to 1 March 2018 were included.MethodsSIRS criteria and qSOFA score were calculated for each patient. The first hospital treated the patients who met SIRS criteria following the worldwide Surviving Sepsis Campaign protocol. At the second hospital, only patients who met the qualifying qSOFA score received this treatment. Therefore, patients could be divided into five groups: (1) SIRS+, qSOFA−, not treated according to protocol (reference group); (2) SIRS+, qSOFA−, treated according to protocol; (3) SIRS+, qSOFA+, treated according to protocol; (4) SIRS−, qSOFA+, not treated according to protocol; (5) SIRS−, qSOFA+, treated according to protocol.Primary and secondary outcome measuresTo prove culture-positive sepsis was present, cultures were used as the primary outcome. Secondary outcomes were in-hospital mortality and intensive care unit (ICU) admission.Results98.9% met SIRS criteria and 11.7% met qSOFA score. Positive predictive values of SIRS criteria and qSOFA score were 41.2% (95% CI 37.4% to 45.2%) and 48.1% (95% CI 37.4% to 58.9%), respectively. HRs were 0.79 (95% CI 0.40 to 1.56, p=0.500), 3.42 (95% CI 1.82 to 6.44, p<0.001), 18.94 (95% CI 2.48 to 144.89, p=0.005) and 4.97 (95% CI 1.44 to 17.16, p=0.011) for groups 2–5, respectively.ConclusionqSOFA score performed as well as SIRS criteria for identifying culture-positive sepsis and performed significantly better for predicting in-hospital mortality and ICU admission. This study shows that SIRS criteria are no longer necessary and recommends qSOFA score as the standard for identifying culture-positive sepsis in the ED.Trial registration numberNL8315.

Comparison of QSOFA and sirs scores for the prediction of adverse outcomes of secondary peritonitis among patients admitted on the adult surgical ward in a tertiary teaching hospital in Uganda: a prospective cohort study

“…The above findings however, contrast with those reported by several studies that found qSOFA to be superior to SIRS in predicting in-hospital mortality and ICU admission [ 7 , 8 , 21 , 24 ]. This disparity could be because a few notable differences between the aforementioned studies and this study.…”

“…SIRS was superior to qSOFA in predicting both mortality and prolonged hospital stay, in this study, consistent with the findings of Askim et al [22]. The above findings however, contrast with those reported by several studies that found qSOFA to be superior to SIRS in predicting in-hospital mortality and ICU admission [7,8,21,24]. This disparity could be because a few notable differences between the aforementioned studies and this study.…”

Retrospective Analysis of the Risk Factors and Drug Resistance of Pathogenic Bacteria in Systemic Inflammatory Response Syndrome After Ureteroscopic Holmium Laser Lithotripsy for Impacted Ureteral Calculi

“…SIRS is a common and severe complication of ureteroscopic lithotripsy, with a risk of 5.7–9.7% after HLUL. 20–22 It not only prolongs the patient’s hospital stay but also has the possibility of developing into multiple organ dysfunction, endangering the lives of patients. 20–22 Therefore, it is clinically important to clarify the risk factors for SIRS caused by ureteral lithotripsy.…”

“… 20–22 It not only prolongs the patient’s hospital stay but also has the possibility of developing into multiple organ dysfunction, endangering the lives of patients. 20–22 Therefore, it is clinically important to clarify the risk factors for SIRS caused by ureteral lithotripsy. In this study, we found that the incidence of SIRS after HLULIUC is about 17.75%, significantly higher than that reported in previous studies.…”

“…In this study, we found that the incidence of SIRS after HLULIUC is about 17.75%, significantly higher than that reported in previous studies. 20–22 This may be because patients with IUC often present with pathological changes of hydronephrosis, infection, and ureteral stricture, which increase the difficulty of the operation and the risk of infection.…”