Head-to-head comparison of qSOFA and SIRS criteria in predicting the mortality of infected patients in the emergency department: a meta-analysis

Abstract

BackgroundRecently, the concept of sepsis was redefined by an international task force. This international task force of experts recommended using the quick Sequential Organ Failure Assessment (qSOFA) criteria instead of the systemic inflammatory response syndrome (SIRS) criteria to classify patients at high risk for death. However, the added value of these new criteria in the emergency department (ED) remains unclear. Thus, we performed this meta-analysis to determine the diagnostic accuracy of the qSOFA criteria in predicting mortality in ED patients with infections and compared the performance with that of the SIRS criteria.MethodsPubMed, EMBASE and Google Scholar (up to April 2018) were searched for related articles. A 2 × 2 contingency table was constructed according to mortality and qSOFA score (< 2 and ≥ 2) or SIRS score (< 2 and ≥ 2) in ED patients with infections. Two investigators independently assessed study eligibility and extracted data. We used a bivariate meta-analysis model to determine the prognostic value of qSOFA and SIRS in predicting mortality. We used the I2 index to test heterogeneity. The bivariate random-effects regression model was used to pool the individual sensitivity, specificity, diagnostic odds ratio (DOR), positive likelihood ratio (PLR), and negative likelihood ratio (NLR). The summary receiver operating characteristic curve (SROC) was constructed to assess the overall diagnostic accuracy.ResultsEight studies with a total of 52,849 patients were included. A qSOFA score ≥ 2 was associated with a higher risk of mortality in ED patients with infections, with a pooled risk ratio (RR) of 4.55 (95% CI, 3.38–6.14) using a random-effects model (I2 = 91.1%). A SIRS score ≥ 2 was a prognostic marker of mortality in ED patients with infections, with a pooled RR of 2.75 (95% CI, 1.96–3.86) using a random-effects model (I2 = 89%). When comparing the performance of qSOFA and SIRS in predicting mortality, a qSOFA score ≥ 2 was more specific; however a SIRS score ≥ 2 was more sensitive. The initial qSOFA values were of limited prognostic value in ED patients with infections.ConclusionsA qSOFA score ≥ 2 and SIRS score ≥ 2 are strongly associated with mortality in ED patients with infections. However, it is also clear that qSOFA and SIRS have limitations as risk stratification tools for ED patients with infections.Electronic supplementary materialThe online version of this article (10.1186/s13049-018-0527-9) contains supplementary material, which is available to authorized users.

Prehospital quick Sequential Organ Failure Assessment for predicting prognosis in patients with sepsis or suspected sepsis: a population-based ORION registry

“…The reason for the ability to predict prognosis from qSOFA in the prehospital setting not being high might be due to the less frequent measurement of vital signs in the ambulance and the effect of treatment in the hospital not being taken into consideration. Most of the studies reporting the high prognostic ability of qSOFA have used 'worst value' in the emergency room in their calculation [11][12][13]. In contrast, most of the studies that used the 'initial value' in the emergency room for the calculation reported that the predictive power of qSOFA for prognosis was not high [4,11,[14][15][16][17], and we considered this result to be supported by the results of the present study.…”

Accuracy of the qSOFA Score and RED Sign in Predicting Critical Care Requirements in Patients with Suspected Infection in the Emergency Department: A Retrospective Observational Study

“…Our study was consistent with previous studies and suggests that qSOFA alone has limitations for evaluating patients with suspected infection in the ED. Therefore, qSOFA should be interpreted with caution [18,19].…”

Characteristics and Risk Factors Associated with Early Mortality in Patients with Polymicrobial Bloodstream Infection: A Retrospective Clinical Study

“…SIRS is used to describe the complex pathophysiologic response when at least 2 of the following four symptoms appeared: tachypnea, tachycardia, leukopenia or leukocytosis and fever or hypothermia (17).…”

“…The qSOFA was calculated by following criteria: systolic arterial blood pressure ≤ 100 mmHg; respiratory rate > 21 breaths/min; or altered mental status (17). The SAPS II includes 12 physiology variables, age, type of admission and three underlying disease variables (18).…”