Predictive validity of the qSOFA criteria for sepsis in non-ICU inpatients

Forward, Emily; Konecny, Pamela; Burston, J.; Adhikari, Suman; Doolan, Heather; Jensen, Tomas

doi:10.1007/s00134-017-4776-2

Cited by 20 publications

(17 citation statements)

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“…We could retrieve ten data from nine studies regarding the prognostic performance of positive qSOFA scores in predicting acute organ dysfunction [ 19 , 23 , 25 , 30 , 31 , 33 – 35 , 39 ]. Researchers in four studies reported the performance of positive SIRS criteria in predicting acute organ dysfunction [ 19 , 25 , 33 , 39 ]. In the pooled estimates, patients with positive qSOFA scores and SIRS criteria were associated with acute organ dysfunction in 82.8% (2433 of 2936 patients) and 36.2% (1830 of 5047 patients), respectively.…”

Section: Resultsmentioning

confidence: 99%

Performance of the quick Sequential (sepsis-related) Organ Failure Assessment score as a prognostic tool in infected patients outside the intensive care unit: a systematic review and meta-analysis

et al. 2018

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BackgroundThe usefulness of the quick Sequential (Sepsis-related) Organ Failure Assessment (qSOFA) score in providing bedside criteria for early prediction of poor outcomes in patients with suspected infection remains controversial. We investigated the prognostic performance of a positive qSOFA score outside the intensive care unit (ICU) compared with positive systemic inflammatory response syndrome (SIRS) criteria.MethodsA systematic literature search was performed using MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials. Data were pooled on the basis of sensitivity, specificity, and diagnostic OR. Overall test performance was summarized using a hierarchical summary ROC and the AUC. Meta-regression analysis was used to identify potential sources of bias.ResultsWe identified 23 studies with a total of 146,551 patients. When predicting in-hospital mortality in our meta-analysis, we identified pooled sensitivities of 0.51 for a positive qSOFA score and 0.86 for positive SIRS criteria, as well as pooled specificities of 0.83 for a positive qSOFA score and 0.29 for positive SIRS criteria. Discrimination for in-hospital mortality had similar AUCs between the two tools (0.74 vs. 0.71; P = 0.816). Using meta-regression analysis, an overall mortality rate ≥ 10% and timing of qSOFA score measurement could be significant sources of heterogeneity. For predicting acute organ dysfunction, although the AUC for a positive qSOFA score was higher than that for positive SIRS criteria (0.87 vs. 0.76; P < 0.001), the pooled sensitivity of positive qSOFA score was very low (0.47). In addition, a positive qSOFA score tended to be inferior to positive SIRS criteria in predicting ICU admission (0.63 vs. 0.78; P = 0.121).ConclusionsA positive qSOFA score had high specificity outside the ICU in early detection of in-hospital mortality, acute organ dysfunction, and ICU admission, but low sensitivity may have limitations as a predictive tool for adverse outcomes. Because between-study heterogeneity was highly represented among the studies, our results should be interpreted with caution.Electronic supplementary materialThe online version of this article (10.1186/s13054-018-1952-x) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Performance of the quick Sequential (sepsis-related) Organ Failure Assessment score as a prognostic tool in infected patients outside the intensive care unit: a systematic review and meta-analysis

et al. 2018

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“…Several recently published trials investigated the predictive performance of qSOFA in patients in the general emergency department population with suspected infection [ 7 , 16 , 17 , 27 – 30 ]; some of these studies also investigated patients with pneumonia [ 17 , 28 , 30 ]. Other authors have shown that qSOFA has significant predictive ability in respect to in-hospital mortality in patients with pneumonia [ 17 , 28 , 30 ].…”

Section: Discussionmentioning

confidence: 99%

“…Despite the good predictive ability of qSOFA in general ED patients [ 7 , 16 , 27 ], the prognostic accuracy of the qSOFA score was much smaller for in-hospital mortality among adults admitted to the ICU with suspected infection [ 29 ]. In the ICU setting, the SOFA score shows the best predictive ability [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Utility of quick sepsis-related organ failure assessment (qSOFA) to predict outcome in patients with pneumonia

et al. 2017

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BackgroundDespite on-going advances in medical treatment, the burden of disease of pneumonia remains high. We aimed to determine the association of the qSOFA score with in-hospital mortality, length of hospitalisation, and admission to the intensive care unit (ICU) in patients with pneumonia. Further, in a subgroup analysis, the outcomes were compared for qSOFA in comparison to other risk scores, including the CURB-65 and SIRS scores.MethodsIn a retrospective analysis, admission data from the ED of the Bern University Hospital, Switzerland, were screened to identify patients admitted for pneumonia. In addition to clinical characteristics, qSOFA and CURB-65 scores and SIRS criteria were assessed and evaluated with respect to the defined study outcomes.Results527 patients (median age 66 IQR 50–76) were included in this study. The overall in-hospital mortality was 13.3% (n = 70); 22.0% (n = 116) were transferred to the ICU. The median length of hospitalisation was 7 days (IQR 4–12). In comparison to qSOFA-negative patients, qSOFA-positive patients had increased odds ratios for in-hospital mortality (OR 2.6, 95%:1.4, 4.7, p<0.001) and ICU admission (3.5, 95% CI: 2.0. 5.8, p<0.001) and an increased length of stay (p<0.001). For ICU admission, the specificity of qSOPA-positivity (≥2) was 82.1% and sensitivity 43.0%. For in-hospital mortality, the specificity of qSOPA-positivity (≤2) was 88.9% and sensitivity 24.4%.In the subgroup analysis (n = 366). The area under the receiver operating curve for ICU admission was higher for qSOFA than for the CURB-65 score (p = 0.013). The evaluated scores did not differ significantly in their prognostication of in-hospital mortality (p>0.05).ConclusionsThe qSOFA score is associated with in-hospital mortality, ICU admission and length of hospitalisation in ED patients with pneumonia. Subgroup analysis revealed that qSOFA is superior to CURB-65 in respect to prognostication of ICU admission.

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“…SOFA is an older tool that predicts mortality in patient populations, although some elements of the SOFA score are outdated (such as "renal dose" dopamine). In addition, qSOFA has fairly robust validity in predicting mortality and prolonged stay in patients prior to ICU admission (although its accuracy is lower in the ICU) [112,[115][116][117]. However, both mortality and increased length of ICU stay are themselves influenced by clinical decision making.…”

Section: What In-hospital Clinical Information Is Associated With Impmentioning

confidence: 99%

Surviving sepsis campaign: research priorities for sepsis and septic shock

et al. 2018

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Objective: To identify research priorities in the management, epidemiology, outcome and underlying causes of sepsis and septic shock.Design: A consensus committee of 16 international experts representing the European Society of Intensive Care Medicine and Society of Critical Care Medicine was convened at the annual meetings of both societies. Subgroups had teleconference and electronic-based discussion. The entire committee iteratively developed the entire document and recommendations.Methods: Each committee member independently gave their top five priorities for sepsis research. A total of 88 suggestions (ESM 1 -supplemental table 1) were grouped into categories by the committee co-chairs, leading to the formation of seven subgroups: infection, fluids and vasoactive agents, adjunctive therapy, administration/epidemiology, scoring/identification, post-intensive care unit, and basic/translational science. Each subgroup had teleconferences to go over each priority followed by formal voting within each subgroup. The entire committee also voted on top priorities across all subgroups except for basic/translational science. Results:The Surviving Sepsis Research Committee provides 26 priorities for sepsis and septic shock. Of these, the top six clinical priorities were identified and include the following questions: (1) can targeted/personalized/precision medicine approaches determine which therapies will work for which patients at which times?; (2) what are ideal endpoints for volume resuscitation and how should volume resuscitation be titrated?; (3) should rapid diagnostic tests be implemented in clinical practice?; (4) should empiric antibiotic combination therapy be used in sepsis or septic shock?; (5) what are the predictors of sepsis long-term morbidity and mortality?; and (6) what information identifies organ dysfunction?Conclusions: While the Surviving Sepsis Campaign guidelines give multiple recommendations on the treatment of sepsis, significant knowledge gaps remain, both in bedside issues directly applicable to clinicians, as well as understanding the fundamental mechanisms underlying the development and progression of sepsis. The priorities identified represent a roadmap for research in sepsis and septic shock.

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Predictive validity of the qSOFA criteria for sepsis in non-ICU inpatients

Cited by 20 publications

References 4 publications

Performance of the quick Sequential (sepsis-related) Organ Failure Assessment score as a prognostic tool in infected patients outside the intensive care unit: a systematic review and meta-analysis

Performance of the quick Sequential (sepsis-related) Organ Failure Assessment score as a prognostic tool in infected patients outside the intensive care unit: a systematic review and meta-analysis

Utility of quick sepsis-related organ failure assessment (qSOFA) to predict outcome in patients with pneumonia

Surviving sepsis campaign: research priorities for sepsis and septic shock

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