HealthDay News — For patients with an infection-related primary admission to the intensive care unit (ICU), a change of 2 or more points in the Sequential [Sepsis-related] Organ Failure Assessment (SOFA) score offers greater discrimination for in-hospital mortality than systemic inflammatory response syndrome (SIRS) criteria or the quick SOFA (qSOFA) score, according to a study published in the Journal of the American Medical Association.

Eamon P. Raith, MBBS, from the Alfred Hospital in Melbourne, Australia, and colleagues conducted a retrospective analysis of 184,875 patients with an infection-related primary admission diagnosis. Data were reviewed for patients from 182 Australian and New Zealand ICUs from 2000 through 2015.

The researchers found that 18.7% of the patients died in the hospital. Overall, 90.1% had a SOFA score increase of 2 or more points; 86.7% manifested two or more SIRS criteria; and 54.4% had a qSOFA score of 2 or more points. Compared with SIRS criteria or qSOFA, SOFA demonstrated significantly greater discrimination for in-hospital mortality (area under the receiver operating characteristic curve, 0.753 vs 0.589 and 0.607, respectively; <.001). For the secondary end point of in-hospital mortality or ICU length of stay of 3 days or more, SOFA outperformed the other scores.

“These findings suggest that SIRS criteria and qSOFA may have limited utility for predicting mortality in an ICU setting,” the authors write.

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Raith EP, Udy AA, Bailey M, et al; Australian and New Zealand Intensive Care Society (ANZICS) Centre for Outcomes and Resource Evaluation (CORE). Prognostic accuracy of the SOFA score, SIRS criteria, and qSOFA score for in-hospital mortality among adults with suspected infection admitted to the intensive care unit. JAMA. 2017;317:290-300. doi: 10.1001/jama.2016.20328