qSOFA is a Poor Predictor of Short-Term Mortality in All Patients: A Systematic Review of 410,000 Patients

Abstract

Background: To determine the validity of the Quick Sepsis-Related Organ Failure Assessment (qSOFA) in the prediction of outcome (in-hospital and 1-month mortality, intensive care unit (ICU) admission, and hospital and ICU length of stay) in adult patients with or without suspected infections where qSOFA was calculated and reported; Methods: Cochrane Central of Controlled trials, EMBASE, BIOSIS, OVID MEDLINE, OVID Nursing Database, and the Joanna Briggs Institute EBP Database were the main databases searched. All studies published until 12 April 2018 were considered. All studies except case series, case reports, and conference abstracts were considered. Studies that included patients with neutropenic fever exclusively were excluded. Results: The median AUROC for in-hospital mortality (27 studies with 380,920 patients) was 0.68 (a range of 0.55 to 0.82). A meta-analysis of 377,623 subjects showed a polled AUROC of 0.68 (0.65 to 0.71); however, it also confirmed high heterogeneity among studies (I2 = 98.8%, 95%CI 98.6 to 99.0). The median sensitivity and specificity for in-hospital mortality (24 studies with 118,051 patients) was 0.52 (range 0.16 to 0.98) and 0.81 (0.19 to 0.97), respectively. Median positive and negative predictive values were 0.2 (range 0.07 to 0.38) and 0.94 (0.85 to 0.99), respectively.

Comparison of qSOFA Score, SOFA Score, and SIRS Criteria for the Prediction of Infection and Mortality Among Surgical Intermediate and Intensive Care Patients

“…However, until now, no prospective data, with su cient numbers of patients, is available. an AUCROC of 0.68 for the predictive value of in-hospital mortality for the qSOFA score, which is in line with our study ndings in surgical ICU and IMCU patients [21]. Furthermore, a meta-analysis of 229,480 patients compared the qSOFA score and SIRS criteria for their ability to predict patient mortality, and revealed only a slightly better performance of the qSOFA score, which supports the ndings of our study [23].…”

Comparison of qSOFA score, SOFA Score, and SIRS Criteria for the Prediction of Infection and Mortality Among Surgical Intermediate and Intensive Care Patients

“…Lo et al performed a literature review and retrospective data analysis of 380,920 patients, demonstrating an AUCROC of 0.68 for the predictive value of in-hospital mortality for the qSOFA score, which is in line with our study ndings in surgical ICU and IMCU patients [21]. Furthermore, a meta-analysis of 229,480 patients compared the qSOFA score and SIRS criteria for their ability to predict patient mortality, and revealed only a slightly better performance of the qSOFA score, which supports the ndings of our study [23].…”

“…According to the current recommendations of the Surviving Sepsis Campaign, the SOFA score should be used as a predictive tool for the detection of sepsis as well as for the risk strati cation of critically ill patients. In addition, the qSOFA score has been introduced for the identi cation of septic patients outside of the ICU [7,21,22]. However, to our knowledge, both scores have not been evaluated in the context of surgical IMCU patients.…”

Can qSOFA Perform Better If Combined With Frailty Measures in Elderly Patients?

“…In our recent systematic review of 410,000 patients, we also found that the qSOFA performed poorly with a median sensitivity of 0.52 and a median specificity of 0.81 for in-hospital mortality. 2 In our systematic review, we also investigated the use of the qSOFA in different settings including the ED, the ICU, and in-patient wards. Although there was no statistical difference between the in-hospital mortality and the location of patient recruitment, the diverse range of prognostic performance highlighted the limitation of using one simple score, such as the qSOFA, for sepsis screening and diagnosis in different patient locations.…”