University of Ottawa, Ottawa, Ontario, Canada (S.M.F., A.T.).
University of Ottawa and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada (M.T., A.J.S., J.J.P.).
Ann Intern Med. 2018 Feb 20;168(4):266-275. doi: 10.7326/M17-2820. Epub 2018 Feb 6.
The quick Sequential Organ Failure Assessment (qSOFA) has been proposed for prediction of mortality in patients with suspected infection.
To summarize and compare the prognostic accuracy of qSOFA and the systemic inflammatory response syndrome (SIRS) criteria for prediction of mortality in adult patients with suspected infection.
Four databases from inception through November 2017.
English-language studies using qSOFA for prediction of mortality (in-hospital, 28-day, or 30-day) in adult patients with suspected infection in the intensive care unit (ICU), emergency department (ED), or hospital wards.
Two investigators independently extracted data and assessed study quality using standard criteria.
Thirty-eight studies were included (n = 385 333). qSOFA was associated with a pooled sensitivity of 60.8% (95% CI, 51.4% to 69.4%) and a pooled specificity of 72.0% (CI, 63.4% to 79.2%) for mortality. The SIRS criteria were associated with a pooled sensitivity of 88.1% (CI, 82.3% to 92.1%) and a pooled specificity of 25.8% (CI, 17.1% to 36.9%). The pooled sensitivity of qSOFA was higher in the ICU population (87.2% [CI, 75.8% to 93.7%]) than the non-ICU population (51.2% [CI, 43.6% to 58.7%]). The pooled specificity of qSOFA was higher in the non-ICU population (79.6% [CI, 73.3% to 84.7%]) than the ICU population (33.3% [CI, 23.8% to 44.4%]).
Potential risk of bias in included studies due to qSOFA interpretation and patient selection.
qSOFA had poor sensitivity and moderate specificity for short-term mortality. The SIRS criteria had sensitivity superior to that of qSOFA, supporting their use for screening of patients and as a prompt for treatment initiation.
Canadian Association of Emergency Physicians. (PROSPERO: CRD42017075964).
快速序贯器官衰竭评估（qSOFA）已被提出用于预测疑似感染患者的死亡率。
总结并比较 qSOFA 与全身炎症反应综合征（SIRS）标准对预测疑似感染的成年患者死亡率的预后准确性。
从创建到 2017 年 11 月的四个数据库。
使用 qSOFA 预测疑似感染患者在重症监护病房（ICU）、急诊部（ED）或医院病房中死亡率（住院、28 天或 30 天）的英语语言研究。
两名调查员独立提取数据并使用标准标准评估研究质量。
纳入了 38 项研究（n=385333）。qSOFA 与死亡率的汇总敏感性为 60.8%（95%CI，51.4%至 69.4%），汇总特异性为 72.0%（CI，63.4%至 79.2%）。SIRS 标准与死亡率的汇总敏感性为 88.1%（CI，82.3%至 92.1%）和汇总特异性为 25.8%（CI，17.1%至 36.9%）。qSOFA 的 ICU 人群的汇总敏感性（87.2%[CI，75.8%至 93.7%]）高于非 ICU 人群（51.2%[CI，43.6%至 58.7%]）。qSOFA 的汇总特异性在非 ICU 人群（79.6%[CI，73.3%至 84.7%]）高于 ICU 人群（33.3%[CI，23.8%至 44.4%]）。
由于 qSOFA 解释和患者选择，纳入研究存在潜在偏倚风险。
qSOFA 对短期死亡率的敏感性差，特异性中等。SIRS 标准的敏感性优于 qSOFA，支持将其用于筛选患者和作为治疗启动的提示。
加拿大急诊医师协会。（PROSPERO：CRD42017075964）。
