Comparison of different versions of the quick sequential organ failure assessment for predicting in-hospital mortality of sepsis patients: A retrospective observational study

Abstract

BACKGROUND:The quick sequential organ failure assessment (qSOFA) is recommended to identify sepsis and predict sepsis mortality. However, some studies have recently shown its poor performance in sepsis mortality prediction. To enhance its effectiveness, researchers have developed various revised versions of the qSOFA by adding other parameters, such as the lactate-enhanced qSOFA (LqSOFA), the procalcitonin-enhanced qSOFA (PqSOFA), and the modified qSOFA (MqSOFA). This study aimed to compare the performance of these versions of the qSOFA in predicting sepsis mortality in the emergency department (ED).METHODS: This retrospective study analyzed data obtained from an electronic register system of adult patients with sepsis between January 1 and December 31, 2019. Receiver operating characteristic (ROC) curve analyses were performed to determine the area under the curve (AUC), with sensitivity, specificity, and positive and negative predictive values calculated for the various scores.RESULTS: Among the 936 enrolled cases, there were 835 survivors and 101 deaths. The AUCs of the LqSOFA, MqSOFA, PqSOFA, and qSOFA were 0.740, 0.731, 0.712, and 0.705, respectively. The sensitivity of the LqSOFA, MqSOFA, PqSOFA, and qSOFA were 64.356%, 51.485%, 71.287%, and 39.604% , respectively. The specificity of the four scores were 70.778%, 80.958%, 61.677%, and 91.617%, respectively. Among the three revisions, the LqSOFA and MqSOFA were superior to the qSOFA in predicting in-hospital mortality.CONCLUSION: Among patients with sepsis in the ED, the performance of the PqSOFA was similar to that of the qSOFA and the values of the LqSOFA and MqSOFA in predicting in-hospital mortality were greater compared to qSOFA. As the added parameter of the MqSOFA was more convenient compared to the LqSOFA, the MqSOFA could be used as a candidate for the revised qSOFA to increase the performance of the early prediction of sepsis mortality.

Prognostic evaluation of quick sequential organ failure assessment score in ICU patients with sepsis across different income settings

“…In contrast to previous studies, addition of lactate measurement did not improve qSOFA sepsis mortality prediction [ 17 – 21 ]. Our discrepant results do not discount the utility of lactate measurement as there are several methodological and cohort differences between this study and previous reports.…”

“…Whether qSOFA has prognostic value for patients with sepsis in low resourced ICUs where Acute Physiology and Chronic Health Evaluation (APACHE) II score or SOFA may not be practical has not been robustly assessed [ 10 , 11 ]. Recent evidence from low resource settings does suggest qSOFA is associated with mortality in hospitalized patients with infection [ 12 – 16 ].The addition of lactate has also been shown to improve qSOFA sepsis mortality prediction in all income settings [ 17 – 21 ].…”

Role of serum lactate as prognostic marker of mortality among emergency department patients with multiple conditions: A systematic review

“…In predicting in-hospital mortality, the lactate-enhanced qSOFA and modified qSOFA outperformed the qSOFA with the area under the curve (AUC) of 0.740 and 0.731, a sensitivity of 64.36% and 51.40%, and a specificity of 70.78% and 80.96%, respectively. 27 Similarly, Guarino et al used qSOFA, MqSOFA along with lactate assay, and national early warning score (NEWS) to analyze data of sepsis and septic shock patients (n = 556). The author found that MqSOFA, NEWS, and lactate assay scores are more significant predictors of in-hospital mortality than qSOFA, with p < 0.001.…”

Prognostic Accuracy of Quick Sequential Organ Failure Assessment (qSOFA)-lactate for Mortality of Adult with Infection: a Systematic Review and Meta-Analysis

“…Another subgroup analysis was undertaken by classifying the index test (qSOFA-lactate) into score or criteria groups. In the qSOFA-lactate score group (19,21,27,29,31,35,(37)(38)(39)(40)43), the pooled sensitivity and speci city were 80.1% (95% CI 65.9%, 89.3%; I 2 = 97%, p < 0.01) and 66.1% (95% CI 49.5%, 79.5%; I 2 = 100%, p = 0), with AUC = 0.78 (95% CI 0.73, 0.82), whereas in the qSOFA-lactate criteria group (16,20,21,26,28,32,33,36,41,42), the pooled sensitivity and speci city were 81.6% (95% CI 70.1%, 89.4%; I 2 = 98%, p < 0.01) and 59.1% (95% CI 44.1%, 72.5%; I 2 = 100%, p = 0), with AUC = 0.76 (95% CI 0.73, 0.79).…”