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

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.

Keywords: Emergency department; Organ failure; Sepsis; qSOFA.