Background: The quick Sequential Organ Failure Assessment (qSOFA) has been proposed for prediction of mortality in patients with suspected infection.
Purpose: To summarize and compare the prognostic accuracy of qSOFA and the systemic inflammatory response syndrome (SIRS) criteria for prediction of mortality in adult patients with suspected infection.
Data Sources: Four databases from inception through November 2017. Study Selection: English-language studies using qSOFA for prediction of mortality (in-hospital, 28-day, or 30-day) in adult patients with suspected infection in the intensive care unit (ICU), emergency department (ED), or hospital wards.
Data Extraction: Two investigators independently extracted data and assessed study quality using standard criteria.
Data Synthesis: Thirty-eight studies were included (n =385 333). qSOFA was associated with a pooled sensitivity of 60.8% (95% CI, 51.4% to 69.4%) and a pooled specificity of 72.0% (CI, 63.4% to 79.2%) for mortality. The SIRS criteria were associated with a pooled sensitivity of 88.1% (CI, 82.3% to 92.1%) and a pooled specificity of 25.8% (CI, 17.1% to 36.9%). The pooled sensitivity of qSOFA was higher in the ICU population (87.2% [CI, 75.8% to 93.7%]) than the non-ICU population (51.2% [CI, 43.6% to 58.7%]). The pooled specificity of qSOFA was higher in the non-ICU population (79.6% [CI, 73.3% to 84.7%]) than the ICU population (33.3% [CI, 23.8% to 44.4%]).
Limitation: Potential risk of bias in included studies due to qSOFA interpretation and patient selection.
Conclusion: qSOFA had poor sensitivity and moderate specificity for short-term mortality. The SIRS criteria had sensitivity superior to that of qSOFA, supporting their use for screening of patients and as a prompt for treatment initiation.
Commentary:
Sorry to be flogging a “Dead horse”, however i believe this is an important study that complements the recent study by Serafim et al posted on this website. The whole idea behind qSOFA is that it was supposed to be a better predictor of death than the SIRS criteria. This current study does not support this contention. The ROC curves (above) highlight the better diagnostic accuracy of the SIRS criteria. From my myopic viewpoint it is now time to dump qSOFA. SEPSIS-3 should be placed in the same waste-bin as SEP-1, EGDRx and the SSC 3 and 6 hour bundles.
Paul Marik
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[…] Marik reports on a recent meta-analysis comparing SIRS vs qSOFA in screening patients for mortality. Bottom Line: SIRS was better. […]
The numbers give me a positive LR of 2.17 for qSOFA and a positive LR of 1.19 for SIRS…. I don´t see why SIRS should be more useful? btw LR- is about 0.5 for both …
interesting. darshan and nikolai express their frustrations well, i think. But one of the interesting things that Dr Marik has us do is to at least question what the heck is going on… with definitions, proposed treatments, mandated treatments, beliefs (eg, what is the value of the numerical value of lactic acid?), and all the rest. i think sepsis 3 collaborative was done without the “collaboration” of any ED docs. As scott weingart has said (i hope i got this right, or he’ll kick my butt): SIRS still is a pretty good tool to use “up front” to screen for “who are we going to think a bit harder” about this sepsis thing. sensitivity is high, specificity in the dumps, but its a starting point. qSOFA is cool tool, but maybe better in the ICU? and what does “altered mentation” mean? you all should consider reading the weingart and faust chapter in Clinics of North America for Emerg Med , the “sepsis” issue ( nov 2017), last chapter. very cool, as was the entire edition. amongst other things he discusses the problems with sep-1 criteria. sep-3 came out soon after, but i think some of the issues are still pertinent.… Read more »
I agree that the high hopes put into qSOFA don’t seem to stand a test with reality. However, I personally find SIRS useless, due to its low specificity. I need a tool that my junior doctors can use to early identify septic patients.
It’s easy to critize qSOFA but what do you propose we use instead?
Daniel: I suggest a bit of common sense (which is not very common) together with clinical judgement. A thoughtful doctor at the bedside is better than any scoring system
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