Prognostic accuracy of SOFA, MEWS, and SIRS criteria in predicting the mortality rate of patients with sepsis: A meta‐analysis

Abstract

BackgroundIn recent years, some studies classified patients with sepsis and predicted their mortality by using some evaluation scales. Several studies reported significant differences in the predictive values of several tools, and the non‐uniformity of the cut‐off value.ObjectiveTo determine and compare the prognostic accuracy of Sequential Organ Failure Assessment (SOFA) score, Modified Early Warning Score (MEWS), and Systemic Inflammatory Response Syndrome (SIRS) criteria in predicting the mortality of patients with sepsis.MethodsThis study comprised of systematic literature review and meta‐analysis according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses. We searched PubMed, Embase, Web of Science and Cochrane Library databases from their establishment to July 31, 2022. The research articles published in the index journals provide sufficient data (true positive, false positive, true negative, and false negative results) for patients with sepsis. The combined sensitivity and specificity of the 95% confidence interval (CI) were calculated using the bivariate random effect model (BRM). The hierarchical overall subject working characteristics (HSROC) curve was drawn to evaluate the accuracy of the overall prognosis.ResultsData of 55 088 patients from 32 studies were included in this meta‐analysis. SOFA had an intermediate sensitivity of 0.73 (95% CI: 0.67–0.78) and a specificity of 0.70 (0.63–0.76). SIRS criteria had the highest sensitivity of 0.75 (0.66–0.82) and the lowest specificity of 0.40 (0.29–0.52). MEWS had the lowest sensitivity of 0.49 (0.40–0.59) and the highest specificity of 0.82 (0.78–0.86).ConclusionsAmong SOFA, MEWS, and SIRS criteria, SOFA showed moderate sensitivity and specificity for predicting mortality in patients with sepsis, the highest sensitivity of SIRS and the strongest specificity of MEWS for predicting mortality in patients with sepsis. The future research direction is to combine the relevant indicators of MEWS and SIRS to develop a measurement tool with high reliability and validity.Relevance to clinical practiceThe review provides useful insights into the prognostic accuracy of different assessment tools in predicting mortality in sepsis patients, which will help clinicians choose the most appropriate tool for early identification and treatment of sepsis. The findings may also contribute to the development of more accurate and reliable prognostic models for sepsis.

Predictive Value of Multiple Scoring Systems in the Prognosis of Septic Patients with Different Infection Sites: Analysis of the Medical Information Mart for the Intensive Care IV Database

“…The SOFA score is an established diagnostic criterion for sepsis 3.0, and is commonly used to evaluate the prognosis of sepsis patients [1]. Prior studies have supported its effectiveness in assessing the prognosis of sepsis cases [21][22][23][24]. Despite its integration into the diagnostic criteria for sepsis 3.0, our findings may suggest that it may not always be the optimal selection to predict the prognosis of sepsis patients, especially those with specific infection sites, including pneumonia, abdominal infection, or bacteremia.…”