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Meta-Analysis
. 2018 Oct;97(40):e12634.
doi: 10.1097/MD.0000000000012634.

Role of qSOFA in predicting mortality of pneumonia: A systematic review and meta-analysis

Jianjun Jiang  1 , Jin Yang  1 , Yongmei Jin  1 , Jiyu Cao  2 , Youjin Lu  1
Affiliations
Meta-Analysis

Role of qSOFA in predicting mortality of pneumonia: A systematic review and meta-analysis

Jianjun Jiang et al. Medicine (Baltimore). 2018 Oct.

Abstract

Background: The concept of sepsis was redefined recently, and a new screening system termed the quick Sequential Organ Failure Assessment (qSOFA) was recommended for identifying infected patients at high risk for death. However, the predictive value of qSOFA for mortality in patients with pneumonia remains unclear. Thus, we performed a meta-analysis with the aim of determining the prognostic value of qSOFA in predicting mortality in patients with pneumonia.

Methods: Embase, Google Scholar, and PubMed (up to March 2018) were searched for related articles. We constructed a 2 × 2 contingency table according to mortality and qSOFA scores (<2 and ≥2) in patients with pneumonia. Two investigators independently extracted data and assessed study eligibility. A bivariate meta-analysis model was used to determine the prognostic value of qSOFA in predicting mortality. I index and Q-test were used to assess heterogeneity.

Results: Six studies with 17,868 patients were included. A qSOFA score ≥2 was related to a higher risk for death in patients with pneumonia, with a pooled risk ratio (RR) was 3.35 (95% CI, 2.24-5.01) using a random-effects model (I = 89.4%). The pooled sensitivity and specificity of a qSOFA score ≥2 to predict mortality in patients with pneumonia were 0.43 (95% CI, 0.33-0.53) and 0.86 (95% CI, 0.76-0.92), respectively. The diagnostic OR was 4 (95% CI, 3-6). The area under the summary receiver operator characteristic (SROC) curve was 0.67 (95% CI, 0.63-0.71). When we calculated the community-acquired pneumonia (CAP) subgroup, the pooled sensitivity and specificity were 0.36 (95% CI, 0.26-0.48) and 0.91 (95% CI, 0.84-0.95), respectively. The area under the SROC curve was 0.70 (95% CI, 0.66-0.74).

Conclusions: A qSOFA score ≥2 is strongly associated with mortality in patients with pneumonia, but the poor sensitivity of qSOFA may have limitations in the early identification of mortality in patients with pneumonia.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Flow diagram of the study selection process.
Figure 2
Figure 2
Forest plot of qSOFA score ≥2 to predict mortality in pneumonia. qSOFA = quick sequential organ failure assessment.
Figure 3
Figure 3
Forest plot of the sensitivity and specificity of qSOFA score ≥2 for predicting mortality in pneumonia. qSOFA = quick sequential organ failure assessment.
Figure 4
Figure 4
Summary receiver operating characteristic graph of the included studies.
See this image and copyright information in PMC

References

    1. Guest JF, Morris A. Community-acquired pneumonia: the annual cost to the National Health Service in the UK. Eur Respir J 1997;10:1530–4. - PubMed
    1. Said MA, Johnson HL, Nonyane BA, et al. Estimating the burden of pneumococcal pneumonia among adults: a systematic review and meta-analysis of diagnostic techniques. PLoS One 2013;8:e60273. - PMC - PubMed
    1. Alberti C, Brun-Buisson C, Chevret S, et al. Systemic inflammatory response and progression to severe sepsis in critically ill infected patients. Am J Respir Crit Care Med 2005;171:461–8. - PubMed
    1. Restrepo MI, Jorgensen JH, Mortensen EM, et al. Severe community-acquired pneumonia: current outcomes, epidemiology, etiology, and therapy. Curr Opin Infect Dis 2001;14:703–9. - PubMed
    1. Dremsizov T, Clermont G, Kellum JA, et al. Severe sepsis in community-acquired pneumonia: when does it happen, and do systemic inflammatory response syndrome criteria help predict course? Chest 2006;129:968–78. - PubMed