Comparison of qSOFA, SIRS, and NEWS scoring systems for diagnosis, mortality, and morbidity of sepsis in emergency department

Oduncu, Ali Fuat; Kiyan, Güçlü Selahattin; Yalçınlı, Sercan

doi:10.1016/j.ajem.2021.04.006

Cited by 38 publications

(41 citation statements)

References 23 publications

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“…However, high sensitivity is more important than high specificity in predicting sepsis mortality. [23] This is due to the higher risk and cost of false negativity compared to false positivity in patients with high mortality risk. [23,24] Based on previous studies, researchers have recently added simplely available indices to the qSOFA to improve sensitivity.…”

Section: Discussionmentioning

confidence: 99%

“…[23] This is due to the higher risk and cost of false negativity compared to false positivity in patients with high mortality risk. [23,24] Based on previous studies, researchers have recently added simplely available indices to the qSOFA to improve sensitivity. In a retrospective study of 836 patients, Liu et al [10] introduced bedside serum lactate and put forward the LqSOFA, which was shown to be superior to the qSOFA.…”

Section: Discussionmentioning

confidence: 99%

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

Hu¹,

Jiang²,

Ni³

2022

World Journal of Emergency Medicine

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

Hu¹,

Jiang²,

Ni³

2022

World Journal of Emergency Medicine

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“…These scores helped to identify septic patients better than previous criteria, such as systemic inflammatory response symptoms (SIRS) [6,7]. As previously reported in our previous study [8], some authors raised concern about the prognostic value of the qSOFA and SOFA in terms of mortality [9][10][11][12][13][14][15][16][17], thus proposing new predicting scores [8,[17][18][19][20][21] or laboratory tests [22][23][24][25][26][27] to assess the risk of IHM in septic patients. In our previous study [8], we developed a modified version of qSOFA (MqSOFA) by adding SpO2/FiO2 ratio to the previous score criteria.…”

Section: Introductionmentioning

confidence: 80%

A 2-year retrospective analysis of the prognostic value of MqSOFA compared to lactate, NEWS and qSOFA in patients with sepsis

et al. 2022

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Purpose Sepsis is a life-threating organ dysfunction caused by a dysregulated host response to infection. Being a time-dependent condition, the present study aims to compare a recently established score, i.e., modified quick SOFA (MqSOFA), with other existing tools commonly applied to predict in-hospital mortality. Methods All cases of sepsis and septic shock consecutively observed at St. Anna University Hospital of Ferrara, Italy, from January 2017 to December 2018 were included in this study. Each patient was evaluated with MqSOFA, lactate assay, NEWS and qSOFA. Accurate statistical and logistic regression analyses were applied to our database. Results A total of 1001 consecutive patients with sepsis/septic shock were retrieved. Among them, 444 were excluded for incomplete details about vital parameters; thus, 556 patients were eligible for the study. Data analysis showed that MqSOFA, NEWS and lactate assay provided a better predictive ability than qSOFA in terms of in-hospital mortality (p < 0.001). Aetiology-based stratification in 5 subgroups demonstrated the superiority of NEWS vs. other tools in predicting fatal outcomes (p = 0.030 respiratory, p = 0.036 urinary, p = 0.044 abdominal, p = 0.047 miscellaneous and p = 0.041 for indeterminate causes). After Bonferroni’s correction, MqSOFA was superior to qSOFA over respiratory (p < 0.001) and urinary (p < 0.001) aetiologies. Age was an independent factor for negative outcomes (p < 0.001). Conclusions MqSOFA, NEWS and lactate assay better predicted in-hospital mortality compared to qSOFA. Since sepsis needs a time-dependent assessment, an easier and non-invasive score, i.e., MqSOFA, could be used to establish patients’ outcome in the emergency setting.

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“…Five studies (20,24,27,31,32) were relatively small in sample size (<400), and 10 studies (19, 23, 26, 28-30, 33, 36, 37, 40) enrolled more than 1,000 patients. Ten studies (19,21,22,(27)(28)(29)(32)(33)(34)(35) included patients with suspected infection, and others focused on patients with suspected sepsis. Six studies investigated general ward patients (23,29,(31)(32)(33)39), and others evaluated emergency patients.…”

Section: Study Selection and Characteristicsmentioning

confidence: 99%

“…Three studies (21,23,31) used the NEWS2, an updated version of NEWS, and others still used the original NEWS. In addition, 16 studies (20, 21, 24-29, 31-37, 39) estimated the prognostic performance of qSOFA, 10 studies (25-27, 29, 32, 34-37, 39) estimated the prognostic performance of SIRS, and five studies (26,30,34,37,38) also estimated the prognostic performance of NEWS for predicting the ICU admission. Other relevant information is recorded in Supplementary File 4.…”

Section: Study Selection and Characteristicsmentioning

confidence: 99%

National Early Warning Score Does Not Accurately Predict Mortality for Patients With Infection Outside the Intensive Care Unit: A Systematic Review and Meta-Analysis

Zhang

Ding

et al. 2021

Front. Med.

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Background: The prognostic value of the national early warning score (NEWS) in patients with infections remains controversial. We aimed to evaluate the prognostic accuracy of NEWS for prediction of in-hospital mortality in patients with infections outside the intensive care unit (ICU).Methods: We searched PubMed, Embase, and Scopus for related articles from January 2012 to April 2021. Sensitivity, specificity, and likelihood ratios were pooled by using the bivariate random-effects model. Overall prognostic performance was summarized by using the area under the curve (AUC). We performed subgroup analyses to assess the prognostic accuracy of NEWS in selected populations.Results: A total of 21 studies with 107,008 participants were included. The pooled sensitivity and specificity of NEWS were 0.71 and 0.60. The pooled AUC of NEWS was 0.70, which was similar to quick sequential organ failure assessment (qSOFA, AUC: 0.70) and better than systemic inflammatory response syndrome (SIRS, AUC: 0.60). However, the sensitivity (0.55) and AUC (0.63) of NEWS were poor in elder patients. The NEWS of 5 was more sensitive, which was a better threshold for activating urgent assessment and treatment.Conclusions: The NEWS had good diagnostic accuracy for early prediction of mortality in patients with infections outside the ICU, and the sensitivity and specificity were more moderate when compared with qSOFA and SIRS. Insufficient sensitivity and poor performance in the elder population may have limitations as an early warning score for adverse outcomes. NEWS should be used for continuous monitoring rather than a single time point predictive tool.

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Comparison of qSOFA, SIRS, and NEWS scoring systems for diagnosis, mortality, and morbidity of sepsis in emergency department

Cited by 38 publications

References 23 publications

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

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

A 2-year retrospective analysis of the prognostic value of MqSOFA compared to lactate, NEWS and qSOFA in patients with sepsis

National Early Warning Score Does Not Accurately Predict Mortality for Patients With Infection Outside the Intensive Care Unit: A Systematic Review and Meta-Analysis

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