Quick Sequential Organ Failure Assessment Score for the Detection of Incipient Sepsis in Diabetic Skin and Soft-tissue Infections

Abstract

Abstract Background: Skin and soft-tissue infections (SSTIs) are the common complications in diabetes, often posing a high risk of progressing to sepsis due to weakened immune defences. Recognising and treating sepsis early is crucial. With recent understanding of sepsis, the sepsis 3 guidelines defines it as life-threatening organ dysfunction due to uncontrolled response to infection with the introduction of the quick sequential organ failure assessment (qSOFA) criteria, a simple tool for identifying adult patients with suspected infections who may have poor outcomes. Aim: To analyse the performance of qSOFA and systemic inflammatory response syndrome (SIRS) criteria in detecting incipient sepsis in diabetics with SSTIs at initial presentation. Materials and Methods: A prospective, observational study was conducted involving 143 patients with diabetic SSTIs at our tertiary care. Patients underwent a standardised sepsis investigation according to the hospital protocol. Relevant data were collected to establish infection and calculate qSOFA, SOFA and SIRS scores. Patients with a SOFA score of 2 points or higher were classified as having sepsis. The study evaluated the performance of qSOFA and SIRS criteria by comparing the proportion of patients in sepsis who met these criteria. Results: qSOFA as a diagnostic or screening tool had a sensitivity of 79.7% and a specificity of 100% with area under the receiver operating characteristic (AUROC) curves 0.899 (95% confidence interval [CI], 0.849–0.949) vs. 100%), making it a fairly good screening method considering its simplicity. It has a 100% positive predictive value (PPV) and an 80% negative predictive value (NPV) with an accuracy of 88.8%. On the contrary, SIRS criteria had a higher sensitivity of 100% but poor specificity of 17.2% with AUROC curves 0.586 (95% CI: 0.536–0.636). It had a 100% NPV with a 59.8% PPV with an accuracy of 62.9%. Conclusion: We recommend the use of qSOFA as a quick and simple assessment score and screening criteria for the early detection of incipient sepsis in a population of diabetics with SSTI.