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Quick Sequential Organ Failure Assessment as a prognostic factor for infected patients outside the intensive care unit: a systematic review and meta-analysis

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Abstract

Quick Sequential Organ Failure Assessment (qSOFA) was proposed to replace SIRS as a new screening tool for the identification of septic patients at high mortality. However, researches from infected patients outside of ICU especially in Emergency Department (ED) drew contradictory conclusions on the prognostic value of qSOFA. This systematic review evaluated qSOFA as a prognostic marker of infected patients outside of ICU. The primary outcome was hospital mortality or 28- or 30-day mortality. Data were pooled based on sensitivity and specificity. Twenty-four trials with 121,237 participants were included. qSOFA had a poor sensitivity (0.58 [95% CI 0.47–0.67], 0.54 [95% CI 0.43–0.65]) and moderate specificity (0.69 [95% CI 0.48–0.84], 0.77 [95% CI 0.66–0.86]) for prediction of mortality in patients outside of ICU and ED patients only. Studies that used in-hospital mortality showed a higher sensitivity (0.61 [95% CI 0.50–0.71] vs 0.32 [95% CI 0.15–0.49]) and lower specificity (0.70 [95% CI 0.59–0.82] vs 0.92 [95% CI 0.85–0.99]) than studies that used 28 or 30-day mortality. Studies with overall mortality < 10% showed higher specificity (0.89 [95% CI 0.82–0.95] vs 0.62 [95% CI 0.48–0.76]) than studies with overall mortality ≥ 10%. There is no difference in the accuracy of diagnosis of sepsis between positive qSOFA scores and SIRS criteria. qSOFA was poor sensitivity and moderate specificity in predicting mortality of infected patients outside of ICU especially in ED. Combining qSOFA and SIRS may be helpful in predicting mortality.

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Acknowledgements

We thank professor Shu-Zhang Cui of Emergency Department of Tianjin Medical University General Hospital for the guidance of analysis.

Funding

This study was supported by grants from the National Natural Science Foundation (nos. 81601714, 81701931, 81871593).

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  1. Yan-Cun Liu and Yuan-Yuan Luo contributed equally to the study.

Authors and Affiliations

  1. Department of Emergency Medicine, Tianjin Medical University General Hospital, 154 An-Shan Road, Tianjin, 300052, People’s Republic of China

    Yan-Cun Liu, Yuan-Yuan Luo, Song-Tao Shou, Yu-Lei Gao, Bin Lu, Chen Li & Yan-Fen Chai

  2. Department of Surgery, Emory University School of Medicine, Atlanta, 30322, USA

    Xingyu Zhang

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Contributions

Y-CL had the idea for and designed the study, searched the scientific literature, collected, analyzed, and interpreted data, and wrote critically revised the report. Y-YL searched the scientific literature, collected data, and drafted and critically revised the report. XZ statistically analyzed and interpreted the data. S-TS, Y-LG, BL and CL helped to search the scientific literature and collect the data. Y-FC had the idea for and designed the study, supervised the study, and gave administrative, technical, and material support.

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Correspondence to Yan-Cun Liu or Yan-Fen Chai.

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Liu, YC., Luo, YY., Zhang, X. et al. Quick Sequential Organ Failure Assessment as a prognostic factor for infected patients outside the intensive care unit: a systematic review and meta-analysis. Intern Emerg Med 14, 603–615 (2019). https://doi.org/10.1007/s11739-019-02036-0

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