A prospective cohort study of the Quick Sequential Organ Failure Assessment (qSOFA) score versus Systemic Inflammatory Response Syndrome (SIRS) criteria in the determination and prognostication of sepsis in a Philippine Tertiary Hospital

ABSTRACT

@#<p style="text-align justify;"><strong>Background:</strong> Sepsis is a leading cause of mortality both locally and worldwide. Despite this, early diagnosis of sepsis remains challenging, with a significant number not fulfilling SIRS (Systemic Inflammatory Response Syndrome) criteria. In 2016, the Sepsis-3 guidelines modified its definition to include the qSOFA (Quick Sequential Organ Failure Assessment) score in an attempt to include a significant number of SIRS-negative septic patients.</p><p style="text-align justify;"><strong>Methods:</strong> To compare the two, 295 adult patients in the emergency room with suspected infection were included in the study and simultaneously determined their qSOFA score and SIRS criteria. Three infection specialists adjudicated the presence of sepsis, and outcomes within the first 48 hours were acquired. Sensitivity, specificity, positive predictive and negative predictive values for qSOFA and SIRS were computed using constructed confusion matrices, and overall predictive accuracy was measured by the Area under the Receiver Operating Characteristic (AUROC) curve.</p><p style="text-align justify;"><strong>Results:</strong> Of the 295 patients included in the study, 95 (32.2%) were deemed sepsis positive via adjudication. The qSOFA score was a specific (95.5%) but a poorly sensitive (46.3%) test compared to the SIRS criteria (sensitivity 73.7% and specificity 60%). Both qSOFA and the SIRS criteria significantly correlated with sepsis positivity, but the qSOFA score had superior overall predictive accuracy at 70.9% compared to the SIRS criteria. The adjudicators had moderate strength in agreement (Fleiss' kappa = 0.39) and a percentage agreement of 60%.</p><p style="text-align justify;"><strong>Conclusion:</strong> We concluded that the qSOFA score was a more accurate predictor of sepsis and a reliable pre-dictor of in-hospital mortality, but should not be used as a sepsis screening tool due to the low sensitivity. We recommend that the SIRS criteria be maintained as a screening tool and to use the qSOFA score concurrently for time management.</p><p style="text-align justify;"><strong>Key Words</strong> Sepsis, qSOFA, SIRS</p>