Prognostic Accuracy of Sepsis-3 Criteria for In-Hospital Mortality Among Patients With Suspected Infection Presenting to the Emergency Department

Abstract

; for the French Society of Emergency Medicine Collaborators Group IMPORTANCE An international task force recently redefined the concept of sepsis. This task force recommended the use of the quick Sequential Organ Failure Assessment (qSOFA) score instead of systemic inflammatory response syndrome (SIRS) criteria to identify patients at high risk of mortality. However, these new criteria have not been prospectively validated in some settings, and their added value in the emergency department remains unknown. OBJECTIVE To prospectively validate qSOFA as a mortality predictor and compare the performances of the new sepsis criteria to the previous ones. DESIGN, SETTINGS, AND PARTICIPANTS International prospective cohort study, conducted in France, Spain, Belgium, and Switzerland between May and June 2016. In the 30 participating emergency departments, for a 4-week period, consecutive patients who visited the emergency departments with suspected infection were included. All variables from previous and new definitions of sepsis were collected. Patients were followed up until hospital discharge or death. EXPOSURES Measurement of qSOFA, SOFA, and SIRS. MAIN OUTCOMES AND MEASURES In-hospital mortality. RESULTS Of 1088 patients screened, 879 were included in the analysis. Median age was 67 years (interquartile range, 47-81 years), 414 (47%) were women, and 379 (43%) had respiratory tract infection. Overall in-hospital mortality was 8%: 3% for patients with a qSOFA score lower than 2 vs 24% for those with qSOFA score of 2 or higher (absolute difference, 21%; 95% CI, 15%-26%). The qSOFA performed better than both SIRS and severe sepsis in predicting in-hospital mortality, with an area under the receiver operating curve (AUROC) of 0.80 (95% CI, 0.74-0.85) vs 0.65 (95% CI, 0.59-0.70) for both SIRS and severe sepsis (P < .001; incremental AUROC, 0.15; 95% CI, 0.09-0.22). The hazard ratio of qSOFA score for death was 6.2 (95% CI, 3.8-10.3) vs 3.5 (95% CI, 2.2-5.5) for severe sepsis. CONCLUSIONS AND RELEVANCE Among patients presenting to the emergency department with suspected infection, the use of qSOFA resulted in greater prognostic accuracy for in-hospital mortality than did either SIRS or severe sepsis. These findings provide support for the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) criteria in the emergency department setting.

Surviving sepsis campaign: research priorities for sepsis and septic shock

“…Subsequent studies appear to validate the criteria in both low-middle and developing countries [109][110][111], although this is relatively limited in scope. There are also two large prospective evaluations of the predictive model in the literature from the United States and Australia [112,113]. In addition, goals for a screening tool may vary by setting, as high-resource environments might potentially trade under-triage for better accuracy, whereas low-resource environments might benefit from initial over-triage, so as not to miss high-risk cases.…”

SIRS, qSOFA and new sepsis definition

“…A new large retrospective cohort analysis among 184,875 patients in 182 Australian and New Zealand intensive care units (ICUs) found SOFA score had superiority in prediction of in-hospital mortality but it showed SIRS criteria has greater prognostic accuracy for in-hospital mortality than qSOFA score (13). Other Emergency room study among 879 patients presenting to the emergency department with suspected infection found the use of qSOFA resulted in greater prognostic accuracy for inhospital mortality than did either SIRS or severe sepsis (14).…”

Diagnosis, Management and Treatment of Septic Shock from Early Diagnosis to Infection Focus Control

“…For this reason, it has been introduced a simple bed-side score, called quick-SOFA (qSOFA), characterized by three clinical variables [6]:…”