The Association of qSOFA, SOFA, and SIRS with Mortality in Emergency Department Pneumonia

Abstract

The 2016 Sepsis-3 consensus statement removed the Systemic Inflammatory Response Syndrome (SIRS) criteria from the definition of sepsis, in part for its poor specificity. (1, 2) In its place, Sepsis-3 recommended the Sequential Organ Failure Assessment (SOFA) be used to assist in identifying sepsis among patients with infection. SOFA was selected based on a detailed analysis of its performance in contrast to the Sepsis-2 definition derived from expert opinion. The SOFA score better identified patients at risk of sepsis, as well as its associated organ dysfunction and mortality risk. (3) Because SOFA is more time and resource intensive than SIRS and is not fully calculable pre-hospital or at initial emergency department (ED) triage, the Sepsis-3 group developed the quick SOFA (qSOFA). qSOFA has three clinical components and offers clinicians the ability to rapidly assess a patient without need of laboratory results. Pneumonia is the leading infectious cause of hospitalization among U.S. adults, and the most common cause of severe sepsis. (4, 5) Several pneumonia mortality risk scores are used in the ED to guide disposition and management. Because we anticipate calculation of qSOFA and SOFA will soon become common in the ED, we investigated whether these scores would offer any value in pneumonia triage. We sought to investigate qSOFA's association with mortality in pneumonia patients, and its potential to inform ED decision making as an alternative to traditional pneumonia severity and mortality risk scores. In a large population of ED patients with pneumonia, we aimed to determine how well SIRS, SOFA, and qSOFA correlate with 30 day all-cause mortality, ED disposition, and intensive care unit (ICU) admission.

The Impact of Risk Factors on Treatment Outcomes of Nosocomial Pneumonia Due to Gram-Negative Bacteria in the Intensive Care Unit

“…NP was defined as pneumonia 48 h or more after admission with: the presence of new or worsened pulmonary infiltrates on chest X-ray and at least one of the following criteria: leukocyte count above 12,000/mm 3 Pulm Ther 4000/mm 3 or temperature above 38.3 °C, and at least two clinical criteria: purulent sputum; cough, or dyspnea; declining oxygenation or increased oxygen-requirement or need for respiratory assistance. NP included hospital-acquired pneumonia (HAP) and ventilatorassociated pneumonia (VAP) [20]. HAP was an episode of NP that was not associated with mechanical ventilation for at least 48 h. VAP is defined as a condition developed more than 48 h after intubation and ventilation [13,23].…”

Tinjauan Literatur :PERBANDINGAN qSOFA DAN SIRS DALAM MENGIDENTIFIKASI PASIEN DENGAN SEPSIS DAN MEMPREDIKSI MORTALITASNYA: REVIEW ARTIKEL

“…Di sisi lain, qSOFA lebih baik dalam mengidentifikasi pasien infeksi yang berisiko mengalami kematian sebab qSOFA memasukkan disfungsi organ dalam penilaiannya, sedangkan SIRS tidak memasukkan disfungsi organ yang dialami oleh pasien dengan infeksi berat. 6,18,19 Skor qSOFA dengan nilai spesifisitas yang tinggi menunjukkan bahwa qSOFA bermanfaat untuk mengidentifikasi pasien terinfeksi yang berisiko mengalami perburukan kondisi. Oleh karena itu, qSOFA dapat digunakan sebagai pertimbangan untuk dilakukannya pemeriksaan lebih lanjut terhadap kondisi disfungsi organ pada pasien yang terinfeksi, memulai meningkatkan terapi yang sesuai, dan sebagai pertimbangan untuk merujuk pasien ke ruang rawat intensif.…”