Quick sequential organ failure assessment compared to systemic inflammatory response syndrome for predicting sepsis in emergency department

摘要

Abstract Purpose It is unclear whether quick sequential (sepsis-related) organ failure assessment (qSOFA) also has prognostic value for organ failure in patients with a suspected infection. The aim of this study was to determine whether qSOFA has prognostic value when compared to systemic inflammatory response syndrome (SIRS) in predicting organ failure in patients with a suspected infection in an emergency department (ED). Methods A retrospective observational study was conducted in an ED during a 9-year period. We analyzed the ability of qSOFA compared to SIRS to predict the development of organ failure in patients (defined as an increase in the SOFA score of 2 points or more) using the area under receiver operating characteristic (AUROC) curve. Results A total of 1009 patients with suspected infection were finally included in the study. The predictive validity of qSOFA for organ failure was higher than that of SIRS (AUROC=0.814 vs. AUROC=0.662, p =0.02). qSOFA was also superior to SIRS in predicting in-hospital mortality (AUROC=0.733 vs. AUROC=0.599, p =0.04). When the qSOFA score was equal to or >1, its sensitivity and specificity to predict organ failure was 75% and 82%, respectively. Conclusions qSOFA has a superior ability compared to SIRS in predicting the occurrence of organ failure in patients with a suspected infection. However, given the low sensitivity of qSOFA, further confirmatory tests for organ failure are needed. Highlights ? qSOFA at ED was superior than SIRS in predicting occurrence of organ failure in patients with suspected infection. ? qSOFA also has better prognostic validity at predicting in-hospital mortality than SIRS. ? The cutoff value of qSOFA equal to or more than 1 point is recommended to predict organ failure. ? However, confirmatory tests for organ failure are needed in terms of low sensitivity and NPV of qSOFA.