The SIRS criteria have better performance for predicting infection than qSOFA scores in the emergency department

Abstract

Kiyotsugu takuma 14 , Kazuma Yamakawa 15 & the Japanese Association for Acute Medicine (JAAM) Sepsis prognostication in intensive care Unit and emergency Room (Spice) (JAAM Spice) Study Group* Systemic inflammatory response syndrome (SIRS) reportedly has a low performance for distinguishing infection from non-infection. We explored the distribution of the patients diagnosed by SIRS (SIRS patients) or a quick sequential organ failure assessment (qSOFA) (qSOFA patients) and confirmed the performance of the both for predicting ultimate infection after hospital admission. We retrospectively analyzed the data from a multicenter prospective study. When emergency physicians suspected infection, SIRS or the qSOFA were applied. The area under the receiver operating characteristic curves (AUC) was used to assess the performance of the SIRS and qSOFA for predicting established infection. A total of 1,045 patients were eligible for this study. The SIRS patients accounted for 91.6% of qSOFA patients and they showed a higher rate of final infection than that of non-SIRS patients irrespective of the qSOFA diagnosis. The AUCs for predicting infection with SIRS and a qSOFA were 0.647 and 0.582, respectively. The SIRS significantly predicted an ultimate infection (AUC, 0.675; p = 0.018) in patients who met the SIRS and qSOFA simultaneously. In conclusion, the SIRS patients included almost all qSofA patients. SiRS showed a better performance for predicting infection for qSofA in those who met both definitions. Since the announcement of the third international consensus definitions for sepsis and septic shock (Sepsis-3), much debate has been had on the accuracy of the quick sequential organ failure assessment (qSOFA) score for predicting mortality due to sepsis compared with the systemic inflammatory response syndrome (SIRS)

Comparison of qSOFA score, SOFA Score, and SIRS Criteria for the Prediction of Infection and Mortality Among Surgical Intermediate and Intensive Care Patients

“…Since the SOFA score consists of much more detailed intensive care variables than the qSOFA score and the SIRS criteria, the speci city is higher, but sensitivity remains low. These arguments are in accordance with the ndings of Gando et al as well as Krebs et al, who demonstrated that the SIRS criteria, SOFA score, and qSOFA score were not able to predict sepsis in the emergency department or surgical ICU [18,26].…”

“…Another study showed that these scores are also not able to predict infection in the emergency room [26]. Based on the ndings of our study, the use of the qSOFA score as a predictor of mortality can be supported, while its predictive power for the detection of sepsis can be doubted in postsurgical IMCU patients, which might be caused by surgery-induced systemic in ammation.…”

“…These ndings are supported by Krebs et al, who also evaluated the qSOFA and SOFA scores as well as the SIRS criteria in 1,942 prospective patient days within a cohort of surgical trauma ICU patients, concluding that all scores failed to predict the development of new infections [18]. But, also in an out-of-ICU setting, a failure of the qSOFA score (and SIRS criteria) has already been described in a collective of patients attending the emergency room (n = 1,045) [26]. Moreover, another large retrospective analysis failed to prove a high predictive power of the qSOFA score and the SIRS criteria in patients admitted to the emergency department [27].…”

Comparison of qSOFA Score, SOFA Score, and SIRS Criteria for the Prediction of Infection and Mortality Among Surgical Intermediate and Intensive Care Patients

“…Another study showed that these scores are also not able to predict infection in the emergency room [26].…”

Potential Lipid Signatures for Diagnosis and Prognosis of Sepsis and Systemic Inflammatory Response Syndrome

“…Satisfying the two minimum criteria for a SIRS diagnosis is relatively common in some infectious or non-infectious diseases (i.e., pancreatitis or trauma) [ 10 ]. However, the importance of assessing the presence of these factors has generated different results and, at the very least, they are intriguing due to the evident selectivity in terms of when and where they are most useful [ 11 ].…”