Comparison of Prognostic Accuracy of the quick Sepsis-Related Organ Failure Assessment between Short- & Long-term Mortality in Patients Presenting Outside of the Intensive Care Unit \u2013 A Systematic Review & Meta-analysis

Toh Leong Tan,Ying Jing Tang,Hui-Min Neoh,Noraidatulakma Abdullah,Ling Jing Ching

doi:10.1038/s41598-018-35144-6

Abstract

The purpose of this meta-analysis was to compare the ability of the qSOFA in predicting short- (≤30 days or in-hospital mortality) and long-term (>30 days) mortality among patients outside the intensive care unit setting. Studies reporting on the qSOFA and mortality were searched using MEDLINE and SCOPUS. Studies were included if they involved patients presenting to the ED with suspected infection and usage of qSOFA score for mortality prognostication. Data on qSOFA scores and mortality rates were extracted from 36 studies. The overall pooled sensitivity and specificity for the qSOFA were 48% and 86% for short-term mortality and 32% and 92% for long-term mortality, respectively. Studies reporting on short-term mortality were heterogeneous (Odd ratio, OR = 5.6; 95% CI = 4.6–6.8; Higgins’s I2 = 94%), while long-term mortality studies were homogenous (OR = 4.7; 95% CI = 3.5–6.1; Higgins’s I2 = 0%). There was no publication bias for short-term mortality analysis. The qSOFA score showed poor sensitivity but moderate specificity for both short and long-term mortality, with similar performance in predicting both short- and long- term mortality. Geographical region was shown to have nominal significant (p = 0.05) influence on qSOFA short-term mortality prediction.

Highlights

The purpose of this meta-analysis was to compare the ability of the quick Sepsis-Related Organ Failure Assessment (qSOFA) in predicting short- (≤30 days or in-hospital mortality) and long-term (>30 days) mortality among patients outside the intensive care unit setting
Several studies have suggested that qSOFA lacks accuracy for predicting mortality in patients both outside and inside the intensive care unit compared to Sequential Organ Failure Assessment (SOFA), Logistic Organ Dysfunction System (LODS), and other early scoring systems[5,6,7]
Performing further analysis for these two groups, we found that qSOFA was able to significantly predict both short- and long-term mortality with the odds ratio (OR) of 5.5

Summary

Introduction

The purpose of this meta-analysis was to compare the ability of the qSOFA in predicting short- (≤30 days or in-hospital mortality) and long-term (>30 days) mortality among patients outside the intensive care unit setting. The SOFA scoring is sophisticated and time consuming, Sepsis-3 proposed the parsimonious quick Sepsis-Related Organ Failure Assessment (qSOFA) which depends only on clinical signs to distinguish patients having organ failure in sepsis[1]. Several studies have suggested that qSOFA lacks accuracy for predicting mortality in patients both outside and inside the intensive care unit compared to SOFA, Logistic Organ Dysfunction System (LODS), and other early scoring systems[5,6,7]. A study from Lemay et al showed that long-term mortality rate for sepsis with organ failure was 30.6% for one year post sepsis and 43% for two years post sepsis, respectively[10]. As qSOFA is a relatively new scoring system, the clinical practicality of this scoring system for predicting short- and long-term sepsis mortality has not been fully evaluated

Methods

Results

Conclusion