Critical Care and Shock

The quick sequential organ failure assessment score for predicting outcome in patients with sepsis and evidence of multiorgan failure at the time of emergency department presentation

Abstract

Background: Sepsis is defined as a life-threatening organ dysfunction due to an inflammatory immune response triggered by an infection. In 2016, a shortened sequential organ failure assessment score (SOFA score), known as the quick SOFA (qSOFA) score, replaced the systemic inflammatory response syndrome (SIRS) system of diagnosis.

Objective: The aim of our work was to investigate the validity of qSOFA in predicting the outcome of patients with sepsis in the emergency department (ED).

Methods: This prospective comparative study was conducted on 100 patients from August 2017 to August 2018, with sepsis and evidence of multi-organ failure (MOF) at the time of emergency department presentation, who was admitted to the critical care department, Cairo University, Egypt, to evaluate the qSOFA score for predicting outcome in septic patients.

Results: The mean age of all patients was 67.55±13.3 years and the majority (74%) of patients were males. The predominant cause of sepsis was pneumonia (87%). Multiple regression analysis showed that qSOFA at day-0 had an independent effect on increasing organ dysfunction (p<0.05).

The overall mortality was 32%. By using receiver operating characteristic (ROC) curve analysis, qSOFA score at day-0 predicted patients’ mortality with poor accuracy (sensitivity=43% and specificity=70%) (p=0.042). SOFA score at day-1 predicted patients’ mortality with good accuracy (sensitivity=84% and specificity=76%) (p<0.01). The Acute Physiology and Chronic Health Evaluation II (APACHE II) score predicted patients’ mortality with good accuracy (sensitivity=87% and specificity=72%) (p<0.01).

Conclusion: qSOFA at admission is a useful predictor of sepsis and evidence of multi-organ failure in critically ill patients in ED. qSOFA had poor sensitivity and moderate specificity for short-term mortality.