Systemic inflammatory response syndrome criteria may be more sensitive than quick sequential organ failure assessment for predicting mortality in patients with suspected infection

1. For predicting short-term mortality in patients with suspected infection, quick Sequential Organ Failure Assessment (qSOFA) had moderate specificity and poor sensitivity.

2. The systemic inflammatory response syndrome (SIRS) criteria were poorly specific but more sensitive than qSOFA, which supports the use of the SIRS criteria as a screening tool for patients with infection who are in danger of further decline.

Evidence Rating Level: 1 (Excellent)     

Study Rundown: Sepsis is one of the key causes of morbidity and mortality all over the world.  In order to enable timely treatment, it is important to detect patients with infection who are in danger of further decline.  The qSOFA is a suggested method for predicting mortality in patients who are suspected to have infection.  The authors of this systematic review and meta-analysis evaluated the prognostic accuracy of qSOFA and the SIRS criteria for such mortality predictions.  Using study information from four databases, the authors found that for predicting short-term mortality, qSOFA had moderate specificity and poor sensitivity.  Although the SIRS criteria were poorly specific, they had better sensitivity that qSOFA, which supports the use of the SIRS criteria as a screening tool for patients with infection who are at risk of further decline.

Strengths of the study include a thorough multiple-database search, clear criteria for inclusion and exclusion, and use of many sensitivity and subgroup analyses.  A limitation of the study is the possible risk of bias for the chosen studies caused by heterogeneous application of qSOFA.

Click to read the study in Annals of Internal Medicine

Click to read an accompanying editorial in Annals of Internal Medicine

Relevant Reading: Quick sepsis-related organ failure assessment, systemic inflammatory response syndrome, and early warning scores for detecting clinical deterioration in infected patients outside the intensive care unit

In-Depth [systematic review and meta-analysis]: Using PubMed, the Cochrane Database of Systematic Reviews, MEDLINE, and EMBASE, the authors searched for articles published prior to 19 November 2017.  Inclusion criteria included articles written in English that used qSOFA for mortality prediction (in-hospital, 28 days, or 30 days) in patients at least 16 years of age who were suspected to have infection in the hospital wards, emergency department, or intensive care unit.  Exclusion criteria included studies that assessed all-cause mortality over follow-up periods that were unspecified or over a longer range.  The authors included 38 studies (385 333 patients) in their analysis.  For mortality, qSOFA was linked to a pooled sensitivity and pooled specificity of 60.8% and 72.0%, respectively.  The SIRS criteria were linked to a pooled sensitivity and pooled specificity of 88.1% and 25.8%, respectively.  qSOFA had a higher pooled sensitivity in the ICU population (87.2%) compared to the non-ICU population (51.2%).  However, qSOFA had a higher pooled specificity in the non-ICU population (79.6%) compared to the ICU population (33.3%).

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