Comparison of qSOFA score, SOFA Score, and SIRS Criteria for the Prediction of Infection and Mortality Among Surgical Intermediate and Intensive Care Patients

Abstract

Background It is crucial to rapidly identify sepsis so that adequate treatment may be initiated. Accordingly, the Sequential Organ Failure Assessment (SOFA) and the quick SOFA (qSOFA) score are used to evaluate intensive care unit (ICU) and non-ICU patients, respectively. As demand for ICU beds rises, the intermediate care unit (IMCU) carries greater importance as a bridge between the ICU and the regular ward. This study aimed to examine the ability of SOFA and qSOFA scores to predict sepsis and mortality in IMCU patients. Methods Retrospective data analysis included 13,780 surgical patients treated at the IMCU, ICU, or both between 01/01/2012 and 09/30/2018. Patients were screened for suspected infection (i.e., the commencement of broad-spectrum antibiotics) and then evaluated for the SOFA score, qSOFA score, and the 1992 defined systemic inflammatory response syndrome (SIRS) criteria. Results Suspected infection was detected in 1,306 (18.3%) of IMCU, 1,365 (35.5%) of ICU, and 1,734 (62.0%) of IMCU/ICU encounters. Overall, 458 (3.3%) patients died (IMCU: 45 [0.6%]; ICU: 250 [6.5%]; IMCU/ICU: 163 [5.8%]). All investigated scores failed to predict sepsis independently of the analyzed subgroup. Regarding mortality prediction, the qSOFA score performed sufficiently within the IMCU cohort (AUCROC SIRS: 0.72 [0.71-0.72]; SOFA: 0.52 [0.51-0.53]; qSOFA: 0.82 [0.79-0.84]), while the SOFA score was predictive in patients of the IMCU/ICU cohort (AUCROC SIRS 0.54 [0.53-0.54]; SOFA 0.73 [0.70-0.77]; qSOFA 0.59 [0.58-0.59]). Conclusions None of the assessed scores was sufficiently able to predict sepsis in surgical ICU or IMCU patients with suspected infection. While the qSOFA score is appropriate for mortality prediction in IMCU patients, SOFA score prediction quality is increased in critically ill patients.