qSOFA score for prediction of sepsis outcome in emergency department

Abstract

Objective: The third international consensus definition for sepsis and septic shock (sepsis 3) task force recently introduced qSOFA (quick sequential organ failure assessment) as a score for detection of patients at risk of sepsis outside of intensive care units. We performed this study to evaluate the validity of qSOFA for early detection and risk stratification of septic patients in emergency department.
 Methods: We conducted this study in an emergency department of the largest university affiliated hospital in northwest of Iran from Sept 2015 to Sept 2016. One hundred and forty patients who were SIRS positive with a suspected infection without alternative diagnosis and a microbiological proven infection were enrolled in this study. qSOFA was calculated for each patient and correlated with sepsis grades and mortality.
 Results: From 140 patients 84 (60%) had positive qSOFA score and 56 (40%) patients had negative qSOFA score. Our results showed that near half of patients with positive qSOFA expired during their stay in hospital while this was about 5% for patients with negative qSOFA. ROC curve of study regarding prediction of outcome with qSOFA showed an area under curve of 0.59. (P value: 0.04). Time spent to sepsis detection was 16 minutes shorter with qSOFA score compared to SIRS criteria in this study.
 Conclusion: In patients with suspected sepsis, qSOFA has acceptable value for risk stratification of severity, multi organ failure and mortality. It seems that education of medical staff and frequent screening of patients for warning signs can help to increase the value of qSOFA in prediction of mortality in critically ill septic patients.
 doi: https://doi.org/10.12669/pjms.36.4.2031
 How to cite this:Shahsavarinia K, Moharramzadeh P, Arvanagi RJ, Mahmoodpoor A. qSOFA score for prediction of sepsis outcome in emergency department. Pak J Med Sci. 2020;36(4):---------. doi: https://doi.org/10.12669/pjms.36.4.2031
 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Trends in bacterial sepsis incidence and mortality in France between 2015 and 2019 based on National Health Data System (Système National des données de Santé (SNDS)): a retrospective observational study

“…In 2016, the Third International Consensus Definition of Sepsis (Sepsis-3) defined sepsis as a ‘life-threatening organ dysfunction due to a dysregulated host response to infection’ 5. Indeed, organ dysfunction was found to have better ability to predict in-hospital mortality or to target patients with higher risk of adverse outcomes than the original Systemic Inflammatory Response Syndrome (SIRS) criteria and the previous Sepsis-2 definition 6–10. However, the successive changes in sepsis definition made it difficult to identify the true incidence of sepsis and to assess the variation in incidence over time and across countries 1 2…”

Association of Serum Calprotectin Concentrations with Mortality in Critically Ill and Septic Patients

“…Moreover, during the course of sepsis, clinical markers are needed to improve diagnosis and risk-adaptive treatment in critically ill patients. Besides clinical assessment and scores to evaluate organ failure [ 16 ], biomarkers may indicate patients at risk for unfavorable courses as well as impaired short- and long-term survival.…”

Effect of a tailored sepsis treatment protocol on patient outcomes in the Tikur Anbessa Specialized Hospital, Ethiopia: results of an interrupted time series analysis

“…At the time of development of our protocol, the qSOFA was relatively new and was therefore selected primarily based on its feasibility in the TASH-ED setting, where lactate (recommended by many protocols as part of septic workup) is expensive and not routinely available and turnaround of laboratory results could lead to important delays in initiating care. Several studies conducted in LMICs have since found the qSOFA to have good predictive ability [ 35 , 40 ] and to reduce time to diagnosis [ 40 ]. Informal assessment of the application of qSOFA and accuracy of diagnosis in the first few months of implementation found the qSOFA was being appropriately applied, and that sepsis cases were being accurately captured.…”