Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jun;172(9-10):211-219.
doi: 10.1007/s10354-021-00856-4. Epub 2021 Jun 29.

qSOFA score poorly predicts critical progression in COVID-19 patients

Sven Heldt  1 , Matthias Neuböck  1 , Nora Kainzbauer  1 , Guangyu Shao  1 , Thomas Tschoellitsch  2 , Martin Duenser  2 , Bernhard Kaiser  1 , Markus Winkler  3 , Christian Paar  4 , Jens Meier  2 , Bernd Lamprecht  1 , Helmut J F Salzer  5
Affiliations

qSOFA score poorly predicts critical progression in COVID-19 patients

Sven Heldt et al. Wien Med Wochenschr. 2022 Jun.

Abstract
in English, German

Background: In December 2019, the new virus infection coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged. Simple clinical risk scores may improve the management of COVID-19 patients. Therefore, the aim of this pilot study was to evaluate the quick Sequential Organ Failure Assessment (qSOFA) score, which is well established for other diseases, as an early risk assessment tool predicting a severe course of COVID-19.

Methods: We retrospectively analyzed data from adult COVID-19 patients hospitalized between March and July 2020. A critical disease progress was defined as admission to intensive care unit (ICU) or death.

Results: Of 64 COVID-19 patients, 33% (21/64) had a critical disease progression from which 13 patients had to be transferred to ICU. The COVID-19-associated mortality rate was 20%, increasing to 39% after ICU admission. All patients without a critical progress had a qSOFA score ≤ 1 at admission. Patients with a critical progress had in only 14% (3/21) and in 20% (3/15) of cases a qSOFA score ≥ 2 at admission (p = 0.023) or when measured directly before critical progression, respectively, while 95% (20/21) of patients with critical progress had an impairment oxygen saturation (SO2) at admission time requiring oxygen supplementation.

Conclusion: A low qSOFA score cannot be used to assume short-term stable or noncritical disease status in COVID-19.

Zusammenfassung: GRUNDLAGEN: Im Dezember 2019 kam es zum Auftreten der neuen Virusinfektion „coronavirus disease 2019“ (COVID-19), hervorgerufen durch das „severe acute respiratory syndrome coronavirus 2“ (SARS-CoV-2). Einfache klinische Scores zur frühzeitigen Risikostratifizierung könnten das Management von COVD-19-Patient(inn)en verbessern. Ziel dieser Pilotstudie war es daher, den für andere Erkrankungen etablierten qSOFA-Score („quick sequential organ failure assessment score“) als frühzeitige Risikobewertung für kritische Krankheitsverläufe bei COVID-19 zu evaluieren.

Methodik: Es erfolgte eine retrospektive Datenanalyse von hospitalisierten COVID-19-Patient(inn)en aus dem Zeitraum März bis Juli 2020. Ein kritischer Krankheitsverlauf wurde als Aufnahme auf die Intensivstation (ICU) oder Tod definiert.

Ergebnisse: Von 64 COVID-19-Erkrankten wiesen 33 % (21/64) einen kritischen Krankheitsverlauf auf, wovon 13 Patient(inn)en auf die ICU verlegt wurden. Die COVID-19-assoziierte Sterblichkeitsrate betrug 20 % und stieg nach ICU-Aufnahme auf 39 % an. Bei allen Patient(inn)en ohne kritischen Verlauf war bei Aufnahme der qSOFA-Score ≤ 1. Patient(inn)en mit einem kritischen Verlauf hatten in nur 14 % (3/21) der Fälle bei Aufnahme (p = 0,023) bzw. in 20 % (3/15) der Fälle direkt vor kritischer Verschlechterung einen qSOFA-Score ≥ 2, wohingegen 95 % (20/21) der Patienten und Patientinnen mit einem kritischen Verlauf zum Zeitpunkt der Aufnahme eine reduzierte Sauerstoffsättigung (SO2) aufwiesen, mit der Notwendigkeit der zusätzlichen Sauerstoffgabe.

Schlussfolgerung: Bei einem niedrigen qSOFA-Score kann nicht von einem kurzfristig stabilen oder unkritischen Krankheitsverlauf von COVID-19 ausgegangen werden.

Keywords: Austria; Death; Intensive care unit; Organ dysfunction scores; SARS-CoV-2.

PubMed Disclaimer

Conflict of interest statement

S. Heldt, M. Neuböck, N. Kainzbauer, G. Shao, T. Tschoellitsch, M. Duenser, B. Kaiser, M. Winkler, C. Paar, J. Meier, B. Lamprecht and H. J. F. Salzer declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Percentage of quick Sequential Organ Failure Assessment (qSOFA) scores at the time of hospital admission in patients without and with critical progression of coronavirus disease 2019 (COVID-19) defined as intensive care unit (ICU) admission and/or death. Numbers within the bars show the number of cases
Fig. 2
Fig. 2
Highest qSOFA scores within the first 7 days of hospitalization on the normal ward in coronavirus disease 2019 (COVID-19) cases with and without critical progression. Only patients with a deterioration within 7 days after admission were included. The highest qSOFA scores of the first 7 days on the normal ward were chosen. Critical progression of COVID-19 was defined as intensive care unit (ICU) admission and/or death. Numbers within the bars show the number of cases. qSOFA quick Sequential Organ Failure Assessment
Fig. 3
Fig. 3
qSOFA scores measured directly before critical progression of coronavirus disease 2019 (COVID-19) defined as intensive care unit (ICU) admission and/or death. Numbers within the bars show the number of cases. qSOFA quick Sequential Organ Failure Assessment
Fig. 4
Fig. 4
Oxygen saturation or need of oxygen supplementation at the time of hospital admission in patients without and with critical progression of coronavirus disease 2019 (COVID-19) defined as Intensive care unit (ICU) admission and/or death. Numbers within the bars show the number of cases. SO2 peripheral oxygen saturation
See this image and copyright information in PMC

References

    1. Kluge S, Janssens U, Welte T, Weber-Carstens S, Schälte G, Spinner C, et al. S2k-Leitlinie – Empfehlungen zur stationären Therapie von Patienten mit COVID-19. 2020. https://www.awmf.org/uploads/tx_szleitlinien/113-001l_S2k_Empfehlungen_s.... Accessed 7 Feb 2021. - PubMed
    1. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (sepsis-3) JAMA. 2016;315(8):801–810. doi: 10.1001/jama.2016.0287. - DOI - PMC - PubMed
    1. Jiang J, Yang J, Jin Y, Cao J, Lu Y. Role of qSOFA in predicting mortality of pneumonia: a systematic review and meta-analysis. Medicine. 2018;97(40):e12634. doi: 10.1097/MD.0000000000012634. - DOI - PMC - PubMed
    1. Grosse C, Grosse A, Salzer HJF, Dunser MW, Motz R, Langer R. Analysis of cardiopulmonary findings in COVID-19 fatalities: high incidence of pulmonary artery thrombi and acute suppurative bronchopneumonia. Cardiovasc Pathol. 2020;49:107263. doi: 10.1016/j.carpath.2020.107263. - DOI - PMC - PubMed
    1. Farsalinos K, Barbouni A, Poulas K, Polosa R, Caponnetto P, Niaura R. Current smoking, former smoking, and adverse outcome among hospitalized COVID-19 patients: a systematic review and meta-analysis. Ther Adv Chronic Dis. 2020;11:2040622320935765. doi: 10.1177/2040622320935765. - DOI - PMC - PubMed