Best Diagnosis for Sepsis May Be a 2-Step Approach With qSOFA and SIRS

The association of both quick Sepsis-related Organ Failure Assessment (qSOFA) and systemic inflammatory response syndrome (SIRS) criteria could provide a better model to initiate or escalate therapy in patients with sepsis, according to a study published in Chest.¹ 

There is a need to validate qSOFA in different settings because its ability to predict poor outcomes, mortality, and longer intensive care unit stay may occur at the expense of lower sensitivity, which could delay diagnosis and prescription of antibiotics.^2-5 Using meta-analysis and a systematic review of the literature, this study compared qSOFA and SIRS for the diagnosis of sepsis and their ability to predict hospital mortality. 

MEDLINE, CINAHL, and the Web of Science database were searched from February 23, 2016, until June 30, 2017. Included studies compared the qSOFA and SIRS and their sensitivity or specificity in diagnosing sepsis, along with hospital and intensive care unit length of hospital stay and hospital mortality. A total of 10 studies (2 prospective and 8 retrospective) met the inclusion criteria and data from a total of 229,480 patients were evaluated. 

Results showed that comparing SIRS and qSOFA in sensitivity for the diagnosis of sepsis, SIRS was superior (P <.0001). This may highlight the clinical impact of SIRS because it may be able to correctly identify one-third more patients with sepsis than qSOFA but also has the potential for overdiagnosis.

Conversely, qSOFA (97.3%) was superior in specificity for the diagnosis of infection compared with SIRS (84.4%), according to one study. Furthermore, qSOFA also showed superiority as a predictor of in-hospital mortality compared with SIRS (P =.002). This suggests that qSOFA can identify a sicker population.

Overall, results suggest that a 2-step approach with a highly sensitive screening tool for diagnosis (SIRS) and a better predictor of outcome for resource allocation (qSOFA) could be tested.

The study authors concluded that “future studies should focus on the prospective evaluation of more homogeneous methodologies comparing both criteria as a part of the decision-making process for clinicians caring for patients [with sepsis].”

References

1. Serafim R, Gomes JA, Salluh J, Póvoa P. A comparison of the quick-SOFA and systemic inflammatory response syndrome criteria for the diagnosis of sepsis and prediction of mortality: a systematic review and meta-analysis. Chest. 2018;153(3):646-655. 
2. Sprung CL, Schein RMH, Balk RA. The new sepsis consensus definitions: the good, the bad and the ugly. Intensive Care Med. 2016;42(12):2024-2026.
3. Carneiro AH, Póvoa P, Gomes JA. Dear sepsis-3, we are sorry to say that we don’t like you. Rev Bras Ter Intensiva. 2017;29(1):4-8.
4. Cortés-Puch I, Hartog CS. Opening the debate on the new sepsis definition change is not necessarily progress: revision of the sepsis definition should be based on new scientific insights. Am J Respir Crit Care Med. 2016;194(1):16-18.
5. Simpson SQ. New sepsis criteria: a change we should not make. Chest. 2016;149(5):1117-1118.