For mortality prediction, qSOFA has poor sensitivity, moderate specificity, review finds

The comparison between the quick Sequential Organ Failure Assessment (qSOFA) and systemic inflammatory response syndrome (SIRS) criteria supports the use of SIRS for screening and initiating treatment for sepsis, study authors said.

The quick Sequential Organ Failure Assessment (qSOFA) score had poor sensitivity and moderate specificity for predicting short-term mortality in hospital and ED patients with suspected infection, according to a recent review.

The systematic review and meta-analysis included 38 studies (n=385,333) that used qSOFA to predict in-hospital, 28-day, or 30-day mortality of patients with suspected infection in the ICU, ED, or hospital wards. The prognostic accuracy of qSOFA was compared with the systemic inflammatory response syndrome (SIRS) criteria. Results were published Feb. 6 by Annals of Internal Medicine.

The pooled sensitivity for qSOFA was 60.8% (95% CI, 51.4% to 69.4%), and specificity was 72.0% (95% CI, 63.4% to 79.2%). In comparison, the SIRS criteria had a pooled sensitivity of 88.1% (95% CI, 82.3% to 92.1%) and specificity of 25.8% (95% CI, 17.1% to 36.9%). The pooled sensitivity of qSOFA was higher in the ICU population (87.2%; 95% CI, 75.8% to 93.7%) than the non-ICU population (51.2%; 95% CI, 43.6% to 58.7%), while the pooled specificity had the opposite pattern—higher in the non-ICU population (79.6%; 95% CI, 73.3% to 84.7%) than the ICU population (33.3%; 95% CI, 23.8% to 44.4%).

The study authors concluded that their findings support the use of SIRS for screening and initiating treatment for sepsis. “This extensive review of the literature provides the best available assessment of the prognostic accuracy of the novel qSOFA tool,” they wrote. They noted that the Sepsis-3 Task Force did not intend to replace the SIRS criteria when it proposed qSOFA but intended the latter as “an early warning risk stratification tool for identification and escalation of care in patients at high risk for death.”

It's unclear why the qSOFA was far more sensitive but far less specific in the ICU than outside it, but understanding how qSOFA performs differently in these settings is critical, the authors said. They noted several limitations of the review, primarily relating to the quality of the included studies, including potential lack of blinding, very specific patient populations, and differing definitions of suspected infection.

An accompanying editorial described qSOFA as “by far the most controversial and, alas, the most misunderstood aspect” of Sepsis-3. “The utility of qSOFA as a clinical decision support tool needs to be established. However, an advantage over the SIRS criteria is that qSOFA does not require laboratory tests and can be used quickly and repeatedly,” the editorialists wrote. They recommended that the two screening tools be viewed as complementary rather than competing.