Comparison of Prognostic Accuracy of the quick Sepsis-Related Organ Failure Assessment between Short- & Long-term Mortality in Patients Presenting Outside of The Intensive Care Unit - A Systematic Review & Meta-analysis

Abstract

ObjectiveIn year 2016, quick Sepsis-Related Organ Failure Assessment (qSOFA) was introduced as a better sepsis screening tool compared to systemic inflammatory response syndrome (SIRS).The purpose of this systematic review and meta-analysis is to evaluate the ability of the qSOFA in predicting short-and long-term mortality among patients outside the intensive care unit setting. MethodStudies reporting on the qSOFA and mortality from MEDLINE (published between 1946 and 15 th December 2017) and SCOPUS (published before 15 th December 2017). Hand-checking of the references of relevant articles was carried out. Studies were included if they involved inclusion of patients presenting to the ED; usage of Sepsis-3 definition with suspected infection; usage of qSOFA score for mortality prognostication; and written in English. Study details, patient demographics, qSOFA scores, short-term (<30 days) and long-term (≥30 days) mortality were extracted. Two reviewers conducted all reviews and data extraction independently. Results and DiscussionA total of 39 studies met the selection criteria for full text review and only 36 studies were included. Data on qSOFA scores and mortality rate were extracted from 36 studies from 15 countries. The pooled odds ratio was 5.5 and 4.7 for short-term and long-term mortality respectively. The overall pooled sensitivity and specificity for the qSOFA was 48% and 85% for short-term mortality and 32% and 92% for long-term mortality, respectively. Studies reporting on short-term mortality were heterogeneous (Tau=24%, I 2 =94%, P<0.001), while long-term mortality studies were homogenous (Tau=0%, I 2 <0.001, P=0.52). The factors contributing to heterogeneity may be wide age group, various clinical settings, variation in the timing of qSOFA scoring, and broad range of clinical diagnosis and criteria. There was no publication bias for short-term mortality analysis. ConclusionqSOFA score showed a poor sensitivity but moderate specificity for both short and long-term mortality prediction in patients with suspected infection. qSOFA score may be a cost-effective tool for sepsis prognostication outside of the ICU setting.

Validation of the qSOFA score compared to the CRB-65 score for risk prediction in community-acquired pneumonia

“…Additionally, the proposed qSOFA screening cut-off for sepsis of 2 was insufficiently sensitive, as has also been described by others for CAP [9] and sepsis [19,20]. Rather, for both scores, the presence of any of the included clinical criteria was associated with a positive likelihood ratio of >1.5 for mortality and/or mechanical ventilation, justifying additional evaluation for organ dysfunction by an evaluated organ dysfunction score like the minor criteria in CAP or the SOFA in sepsis.…”

Sensitivity and specificity of a quick sequential [Sepsis‐Related] organ failure assessment sepsis screening tool

“…These include whether there is a clinical variable that can improve the qSOFA‐based SS tool sensitivity, diverse populations to investigate, different methodological approaches and ways to use qSOFA. Recently, various systematic reviews have highlighted qSOFA strengths and limitations; included studies were largely secondary analysis, interrogation of retrospective data, and studies predominantly produced in the developed world 11,44‐46 . This evidence, while informative, may not be generalizable to the diverse developing settings; sepsis research should be representative of this diversity.…”

“…Recently, various systematic reviews have highlighted qSOFA strengths and limitations; included studies were largely secondary analysis, interrogation of retrospective data, and studies predominantly produced in the developed world. 11,[44][45][46] This evidence, while informative, may not be generalizable to the diverse developing settings; sepsis research should be representative of this diversity. In terms of methodological approaches, it has been proposed that in the absence of a reference standard the metrics such as sensitivity and specificity are not useful to evaluate parameters of sepsis; and, instead predictive validity and usefulness should be considered.…”