qSOFA score not predictive of in-hospital mortality in emergency patients with decompensated liver cirrhosis

Abstract

Background: Quick sequential organ failure assessement (qSOFA) has been validated for patients with presumed sepsis and the general emergency department (ED) population. However, it has not been validated in specific subgroups of ED patients with a high mortality. We aimed to investigate the prognostic performance of qSOFA with respect to in-hospital mortality, intensive care unit (ICU) admission, and length of hospitalisation in patients with decompensated liver cirrhosis. Furthermore, we compared qSOFA to systemic inflammatory response syndrome (SIRS), model of end stage liver disease score (MELD), and Child-Pugh criteria and evaluated whether addition of sodium (Na⁺) levels to qSOFA increases its prognostic performance.

Methods: This observational study included patients admitted with the diagnosis of decompensated liver cirrhosis. All patients with a complete set of vital parameters were included in this study.

Results: A total of 186 patients were included. A positive qSOFA score was not associated with in-hospital mortality, ICU admission, or length of hospitalisation (all p > 0.15). MELD scores reliably predicted need for ICU admission and in-hospital mortality (both p < 0.01), but not the length of hospitalisation. qSOFA-Na+ only moderately increased the diagnostic performance of qSOFA with regard to need for ICU admission (AUC_ICU[qSOFA] = 0.504 vs. AUC_ICU[qSOFA-Na+] = 0.609, p = 0.03), but not for in-hospital mortality (AUC_death[qSOFA] = 0.513 vs. AUC_death[qSOFA-Na+] = 0.592, p = 0.054).

Conclusion: qSOFA does not predict in-hospital mortality, ICU admission or length of hospitalisation in patients with decompensated liver cirrhosis. Extension of qSOFA with a disease-specific component, the qSOFA-Na+, moderately increased the diagnostic ability of qSOFA.

Keywords: Critical illness; Electrolyte disorder; Emergency admissions; Mortality prediction; QSOFA extended; Sodium.