Comparison of QSOFA and sirs scores for the prediction of adverse outcomes of secondary peritonitis among patients admitted on the adult surgical ward in a tertiary teaching hospital in Uganda: a prospective cohort study

Abstract

Background SIRS and qSOFA are two ancillary scoring tools that have been used globally, inside and outside of ICU to predict adverse outcomes of infections such as secondary peritonitis. A tertiary teaching hospital in Uganda uses SIRS outside the ICU to identify patients with secondary peritonitis, who are at risk of adverse outcomes. However, there are associated delays in decision making given SIRS partial reliance on laboratory parameters which are often not quickly available in a resource limited emergency setting. In response to the practical limitations of SIRS, the sepsis-3 task force recommends qSOFA as a better tool. However, its performance in patients with secondary peritonitis in comparison to that of SIRS has not been evaluated in a resource limited setting of a tertiary teaching hospital in a low and middle income country like Uganda. Objective To compare the performance of qSOFA and SIRS scores in predicting adverse outcomes of secondary peritonitis among patients on the adult surgical wards in a tertiary teaching hospital in Uganda. Methods This was a prospective cohort study of patients with clinically confirmed secondary peritonitis, from March 2018 to January 2019 at the Accident and Emergency unit and the adult surgical wards of a tertiary teaching hospital in Uganda. QSOFA and SIRS scores were generated for each patient, with a score of ≥2 recorded as high risk, while a score of < 2 recorded as low risk for the adverse outcome respectively. After surgery, patients were followed up until discharge or death. In-hospital mortality and prolonged hospital stay were the primary and secondary adverse outcomes, respectively. Sensitivity, specificity, PPV, NPV and accuracy at 95% confidence interval were calculated for each of the scores using STATA v.13. Results A total of 153 patients were enrolled. Of these, 151(M: F, 2.4:1) completed follow up and were analysed, 2 were excluded. Mortality rate was 11.9%. Fourty (26.5%) patients had a prolonged hospital stay. QSOFA predicted in-hospital mortality with AUROC of 0.52 versus 0.62, for SIRS. Similarly, qSOFA predicted prolonged hospital stay with AUROC of 0.54 versus 0.57, for SIRS. Conclusion SIRS is superior to qSOFA in predicting both mortality and prolonged hospital stay among patients with secondary peritonitis. However, overall, both scores showed a poor discrimination for both adverse outcomes and therefore not ideal tools.

Systemic Inflammation after Aneurysmal Subarachnoid Hemorrhage

“…The SIRS score, derived from the number of SIRS criteria met in terms of inflammatory activity [ 122 ], has been used to predict outcomes in septic and trauma patients [ 126 , 127 ]. Hokari et al found that patients with aSAH with a higher SIRS score on day 3 of aSAH had worse functional outcome (modified Rankin Scale (mRS) ≥ 3) upon 3-month follow-up [ 122 ].…”

Comparison of the PIPAS severity score tool and the QSOFA criteria for predicting in-hospital mortality of peritonitis in a tertiary hospital in Uganda: a prospective cohort study

“…The in-hospital mortality rate (12.5%) in this cohort of peritonitis patients is in the 10-20% range of peritonitis mortality generally reported in the sub-Saharan African region [25][26][27][28][29] but still higher than those reported in the western world [5,30]. The most likely explanation for this is the difference in the quality of the health care system…”

“…Furthermore, we found the PIPAS severity score tool to have a higher sensitivity than the qSOFA criteria although the latter tool is more specific. Several recent observational studies have also indicated that qSOFA criteria have low sensitivity but high specificity for identifying septic patients who are at high risk of mortality [18][19][20][21][22]25]. The implication of this in practice is that the use of the qSOFA criteria as the sole initial prognostic tool for potentially septic patients would miss out on a significant number of otherwise high-risk patients for sepsis-related mortality.…”

Embracing a New Evidence-Based Thought Paradigm of Sepsis

“…2 Systemic inflammatory response syndrome is not a specific response to sepsis but rather an adaptive response to several stressors triggering an increased oxygen demand, including but not limited to infection. 3 Among other conditions that activate SIRS are trauma, hypovolemia, emotional stress, and childbirth, and for this reason, SIRS has been criticized as overly sensitive for sepsis identification. 4 The SIRS response is a hypermetabolic state, activating the sympathetic nervous system and the innate immune system.…”