Evaluation of qSOFA as a Predictor of Mortality Among ICU Patients With Positive Clinical Cultures—A Retrospective Cohort Study

Abstract

Objective: To compare the discriminative value of the quick-sequential organ failure assessment score (qSOFA) to SOFA in a critically ill population, in which a microbial pathogen was isolated within 48 hours of admission to intensive care. Design: Retrospective cohort study. Setting: Academic tertiary referral center from July 2008 to June 2017. Patients: Hospitalized patients admitted to intensive care unit. Interventions: None. Measurements and Main Results: The primary outcome was in-hospital mortality for all patients with confirmed positive microbiological cultures within 48 hours of admission to intensive care unit (ICU). Subgroup analysis was performed on patients with pathogenic bacteremia or positive cultures in cerebrospinal fluid. Of the 11 415 patients analyzed with positive microbiology specimens within 48 hours of admission, 2933 (25.7%) had a qSOFA ≥2. Of these, 16.6% reached the primary outcome of in-hospital mortality. Unsurprisingly, the discriminative value of qSOFA on admission was significantly worse than that of SOFA (0.73 vs 0.76; P = .0004), despite observing a significant association between qSOFA category and in-hospital mortality ( P < .0001). In secondary analyses, similar observations were found using qSOFA within 6 and 24 hours of ICU admission. When analysis was focused on patients with pathogenic bacteremia or positive cerebrospinal fluid (CSF) cultures (n = 1646), there was no significant difference between the discriminative value of qSOFA and SOFA (0.75 vs 0.78; P = .17). Conclusions: Quick-sequential organ failure assessment score at admission was not superior to SOFA in predicting in-hospital mortality in patients with positive clinical cultures within 48 hours of admission to ICU. Quick-sequential organ failure assessment score at admission to the ICU was associated with mortality and showed reasonable calibration and discrimination. When the analysis was focused on patients with pathogenic bacteremia or positive CSF cultures, qSOFA performed similarly to SOFA in discriminatory those who will die from sepsis.

Retrospective evaluation of the prognostic utility of quick sequential organ failure assessment scores in dogs with surgically treated sepsis (2011‐2018): 204 cases

“…Studies in people have demonstrated mixed results regarding the utility of the qSOFA when evaluating patients at risk for sepsis 10,11,14,15,17,18,25 . Freund et al found that ≥ 2 qSOFA was a better predictor of in‐hospital mortality among patients with suspected sepsis presenting to the emergency department (AUROC 0.80) vs SIRS (AUROC 0.65) and severe sepsis (AUROC 0.65) 11 .…”

“…In veterinary medicine, the incidence of sepsis is poorly described, with reported mortality rates of 20% to 71% 7–10 . Recent focus in human medicine has been on early detection and intervention in septic patients, as increases in sepsis‐related mortality are associated with delays in treatment 1,11–15 …”

“…The qSOFA score assigns 1 point each for systolic blood pressure < 100 mm Hg, altered mental status, and respiratory rate > 22/min 12,13,20 . The added value of these new criteria in the emergency department and specific clinical settings remains unclear in human medicine and is the basis of continued investigation 11,14,18,21 …”

Age, Frailty, Resuscitation and Intensive Care: With Reference to COVID-19

“…The scoring system is used to assist in decision-making and manage costs and resources [ 45 ]. The scores were not designed to be used at an individual level [ 46 ] but are helpful for standardizing research and comparing the quality of patient care across ICUs [ 47 ]. There are no specific algorithms available that accurately identify who should be admitted to ICU and prognostic scoring tools are generally not considered suitable for identifying those likely to have poor outcomes prior to admission to ICU [ 48 ].…”