Prognostic Accuracy of the Quick Sequential Organ Failure Assessment for Mortality in Patients With Suspected Infection

Fernando, Shannon M.; Tran, Alexandre; Taljaard, Monica; Cheng, Wei; Rochwerg, Bram; Seely, Andrew J. E.; Perry, Jeffrey J.

doi:10.7326/m17-2820

Cited by 221 publications

(182 citation statements)

References 66 publications

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“…The funnel plot revealed no publication bias for the studies investigating qSOFA in predicting short-term mortality. Recently, three new publications reported on qSOFA short-term mortality prediction with similar findings [42][43][44] . Nevertheless, these studies did not perform further analysis on qSOFA long-term mortality prediction nor compared its prognostic accuracy with shortterm mortality.…”

Section: Discussionsupporting

confidence: 55%

Comparison of Prognostic Accuracy of the quick Sepsis-Related Organ Failure Assessment between Short- & Long-term Mortality in Patients Presenting Outside of The Intensive Care Unit - A Systematic Review & Meta-analysis

Tan

Tang

Ching

et al. 2018

Preprint

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ObjectiveIn year 2016, quick Sepsis-Related Organ Failure Assessment (qSOFA) was introduced as a better sepsis screening tool compared to systemic inflammatory response syndrome (SIRS).The purpose of this systematic review and meta-analysis is to evaluate the ability of the qSOFA in predicting short-and long-term mortality among patients outside the intensive care unit setting. MethodStudies reporting on the qSOFA and mortality from MEDLINE (published between 1946 and 15 th December 2017) and SCOPUS (published before 15 th December 2017). Hand-checking of the references of relevant articles was carried out. Studies were included if they involved inclusion of patients presenting to the ED; usage of Sepsis-3 definition with suspected infection; usage of qSOFA score for mortality prognostication; and written in English. Study details, patient demographics, qSOFA scores, short-term (<30 days) and long-term (≥30 days) mortality were extracted. Two reviewers conducted all reviews and data extraction independently. Results and DiscussionA total of 39 studies met the selection criteria for full text review and only 36 studies were included. Data on qSOFA scores and mortality rate were extracted from 36 studies from 15 countries. The pooled odds ratio was 5.5 and 4.7 for short-term and long-term mortality respectively. The overall pooled sensitivity and specificity for the qSOFA was 48% and 85% for short-term mortality and 32% and 92% for long-term mortality, respectively. Studies reporting on short-term mortality were heterogeneous (Tau=24%, I 2 =94%, P<0.001), while long-term mortality studies were homogenous (Tau=0%, I 2 <0.001, P=0.52). The factors contributing to heterogeneity may be wide age group, various clinical settings, variation in the timing of qSOFA scoring, and broad range of clinical diagnosis and criteria. There was no publication bias for short-term mortality analysis. ConclusionqSOFA score showed a poor sensitivity but moderate specificity for both short and long-term mortality prediction in patients with suspected infection. qSOFA score may be a cost-effective tool for sepsis prognostication outside of the ICU setting.

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Section: Discussionsupporting

confidence: 55%

Comparison of Prognostic Accuracy of the quick Sepsis-Related Organ Failure Assessment between Short- & Long-term Mortality in Patients Presenting Outside of The Intensive Care Unit - A Systematic Review & Meta-analysis

Tan

Tang

Ching

et al. 2018

Preprint

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“…Univariate tests for heterogeneity in sensitivity and specificity are not recommended by the Cochrane Handbook for Systematic Reviews of Diagnostic Test Accuracy, as they do not account for heterogeneity explained by phenomena such as positive threshold effects . Instead, it is preferable to demonstrate heterogeneity graphically through the ROC curve and forest plots and through the use of multiple subgroup and sensitivity analyses, as done previously . We conducted subgroup analyses of studies utilizing: 6‐week incidence of MACE versus 30‐day incidence of MACE, ED physician‐interpreted ECG versus cardiologist‐interpreted ECG, and patients presenting with chest pain versus patients presenting with “suspected ACS.” We conducted sensitivity analyses excluding studies with high‐sensitivity troponin and those with high risk of bias.…”

Section: Methodsmentioning

confidence: 99%

Prognostic Accuracy of the HEART Score for Prediction of Major Adverse Cardiac Events in Patients Presenting With Chest Pain: A Systematic Review and Meta‐analysis

Fernando

Tran

Cheng

et al. 2018

Academic Emergency Medicine

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Objective: The HEART score has been proposed for emergency department (ED) prediction of major adverse cardiac events (MACE). We sought to summarize all studies assessing the prognostic accuracy of the HEART score for prediction of MACE in adult ED patients presenting with chest pain.Methods: We searched MEDLINE, PubMed, EMBASE, Scopus, Web of Science, and the Cochrane Database of Systematic Reviews from inception through May 2018 and included studies using the HEART score for the prediction of short-term MACE in adult patients presenting to the ED with chest pain. The main outcome was short-term (i.e., 30-day or 6-week) incidence of MACE. We secondarily evaluated the prognostic accuracy of the HEART score for prediction of mortality and myocardial infarction (MI). Where available, accuracy of the Thrombolysis in Myocardial Infarction (TIMI) score was determined. Results:We included 30 studies (n = 44,202) in analysis. A HEART score above the low-risk threshold (≥4) had a sensitivity of 95.9% (95% confidence interval [CI] = 93.3%-97.5%) and specificity of 44.6% (95% CI = 38.8%-50.5%) for MACE. A high-risk HEART score (≥7) had a sensitivity of 39.5% (95% CI = 31.6%-48.1%) and specificity of 95.0% (95% CI = 92.6%-96.6%) for MACE, whereas a TIMI score above the low-risk threshold (≥2) had a sensitivity of 87.8% (95% CI = 80.2%-92.8%) and specificity of 48.1% (95% CI = 38.9%-57.5%) for MACE. A high-risk TIMI score (≥6) was 2.8% sensitive (95% CI = 0.8%-9.6%), but 99.6% (95% CI = 98.5%-99.9%) specific for MACE. A HEART score ≥ 4 had a sensitivity of 95.0% (95% CI = 87.2%-98.2%) for prediction of mortality and 97.5% (95% CI = 93.7%-99.0%) for prediction of MI.

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“…Two large recently published meta-analyses estimating mortality show a poor sensitivity for the qSOFA score (0.51 and 0.60) but a higher specificity (0.83 and 0.72) while the old Systemic Inflammatory Response Syndrome (SIRS) criteria show a high sensitivity (0.86 and 0.88) but a poor specificity (0.25 and 0.29) [13,14]. The newly introduced qSOFA score certainly facilitates bedside screening for sepsis by the simple, compressed, and fast calculation.…”

Section: Definitionmentioning

confidence: 99%

“…Severity of illness scores (e.g., qSOFA score, SOFA score) can be used for describing groups of patients or estimate mortality. Therefore, those scores should not be used for individual diagnosis or for the decision for ICU admission, but can help to identify neutropenic septic patients [12][13][14].…”

Section: Diagnosismentioning

confidence: 99%

Management of sepsis in neutropenic cancer patients: 2018 guidelines from the Infectious Diseases Working Party (AGIHO) and Intensive Care Working Party (iCHOP) of the German Society of Hematology and Medical Oncology (DGHO)

et al. 2019

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Sepsis and septic shock are major causes of mortality during chemotherapy-induced neutropenia for malignancies requiring urgent treatment. Thus, awareness of the presenting characteristics and prompt management is most important. Improved management of sepsis during neutropenia may reduce the mortality of cancer therapies. However, optimal management may differ between neutropenic and non-neutropenic patients. The aim of the current guideline is to give evidence-based recommendations for hematologists, oncologists, and intensive care physicians on how to manage adult patients with neutropenia and sepsis.

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Prognostic Accuracy of the Quick Sequential Organ Failure Assessment for Mortality in Patients With Suspected Infection

Cited by 221 publications

References 66 publications

Comparison of Prognostic Accuracy of the quick Sepsis-Related Organ Failure Assessment between Short- & Long-term Mortality in Patients Presenting Outside of The Intensive Care Unit - A Systematic Review & Meta-analysis

Comparison of Prognostic Accuracy of the quick Sepsis-Related Organ Failure Assessment between Short- & Long-term Mortality in Patients Presenting Outside of The Intensive Care Unit - A Systematic Review & Meta-analysis

Prognostic Accuracy of the HEART Score for Prediction of Major Adverse Cardiac Events in Patients Presenting With Chest Pain: A Systematic Review and Meta‐analysis

Management of sepsis in neutropenic cancer patients: 2018 guidelines from the Infectious Diseases Working Party (AGIHO) and Intensive Care Working Party (iCHOP) of the German Society of Hematology and Medical Oncology (DGHO)

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