Abstract
This study aimed to assess the value of quick sequential organ failure assessment (qSOFA) combined with other risk factors in predicting in-hospital mortality in patients presenting to the emergency department with suspected infection. This post-hoc analysis of a prospective multicenter study dataset included 34 emergency departments across Japan (December 2017 to February 2018). We included adult patients (age ≥16 years) who presented to the emergency department with suspected infection. qSOFA was calculated and recorded by senior emergency physicians when they suspected an infection. Different types of sepsis-related risk factors (demographic, functional, and laboratory values) were chosen from prior studies. A logistic regression model was used to assess the predictive value of qSOFA for in-hospital mortality in models based on the following combination of predictors: 1) qSOFA-Only; 2) qSOFA+Age; 3) qSOFA+Clinical Frailty Scale (CFS); 4) qSOFA+Charlson Comorbidity Index (CCI); 5) qSOFA+lactate levels; 6) qSOFA+Age+CCI+CFS+lactate levels. We calculated the area under the receiver operating characteristic curve (AUC) and other key clinical statistics at Youden's index, where the sum of sensitivity and specificity is maximized. Following prior literature, an AUC >0.9 was deemed to indicate high accuracy; 0.7-0.9, moderate accuracy; 0.5-0.7, low accuracy; and 0.5, a chance result. Of the 951 patients included in the analysis, 151 (15.9%) died during hospitalization. The AUC for predicting in-hospital mortality was 0.627 (95% confidence interval [CI]: 0.580-0.673) for the qSOFA-Only model. Addition of other variables only marginally improved the model's AUC; the model that included all potentially relevant variables yielded an AUC of only 0.730 (95% CI: 0.687-0.774). Other key statistic values were similar among all models, with sensitivity and specificity of 0.55-0.65 and 0.60-0.75, respectively. In this post-hoc data analysis from a prospective multicenter study based in Japan, combining qSOFA with other sepsis-related risk factors only marginally improved the model's predictive value.
Highlights
Sepsis is an overwhelming host reaction to infection leading to life-threatening organ failure
In 2016, sepsis was defined based on changes to the sequential organ failure assessment (SOFA) score; concurrently, the quick SOFA score was introduced as a simple bedside tool to consider the possibility of sepsis in non-intensive care unit (ICU) settings [1]
The landmark study conducted by Seymour and his colleagues [1] compared the prognostic value of quick SOFA (qSOFA) with that of SIRS (Systemic Inflammatory Response Syndrome) score; this was followed by various validation studies [2,3,4] that assessed the predictive value of qSOFA for in-hospital mortality in patients with suspected infection
Summary
Sepsis is an overwhelming host reaction to infection leading to life-threatening organ failure. It is associated with high rates of mortality and morbidity. To provide a parsimonious score for bedside use, qSOFA was originally developed with only three variables (i.e., systolic blood pressure, respiratory rate, and Glasgow Coma Scale) that are readily available in emergency departments; many retrospective studies suggested to augment qSOFA by adding a number of sepsis risk factors to improve its prognostic performance [5,6,7,8,9,10,11,12]. As qSOFA focuses on acute physiological values, the suggested risk scores include patient demographic variables (e.g., age [5] and comorbidities [1]), functional variables (e.g., frailty scores [6]), and laboratory results (e.g., lactate [1, 8,9,10,11] and procalcitonin levels [7, 12])
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