Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea.
Crit Care. 2018 Feb 6;22(1):28. doi: 10.1186/s13054-018-1952-x.
The usefulness of the quick Sequential (Sepsis-related) Organ Failure Assessment (qSOFA) score in providing bedside criteria for early prediction of poor outcomes in patients with suspected infection remains controversial. We investigated the prognostic performance of a positive qSOFA score outside the intensive care unit (ICU) compared with positive systemic inflammatory response syndrome (SIRS) criteria.
A systematic literature search was performed using MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials. Data were pooled on the basis of sensitivity, specificity, and diagnostic OR. Overall test performance was summarized using a hierarchical summary ROC and the AUC. Meta-regression analysis was used to identify potential sources of bias.
We identified 23 studies with a total of 146,551 patients. When predicting in-hospital mortality in our meta-analysis, we identified pooled sensitivities of 0.51 for a positive qSOFA score and 0.86 for positive SIRS criteria, as well as pooled specificities of 0.83 for a positive qSOFA score and 0.29 for positive SIRS criteria. Discrimination for in-hospital mortality had similar AUCs between the two tools (0.74 vs. 0.71; P = 0.816). Using meta-regression analysis, an overall mortality rate ≥ 10% and timing of qSOFA score measurement could be significant sources of heterogeneity. For predicting acute organ dysfunction, although the AUC for a positive qSOFA score was higher than that for positive SIRS criteria (0.87 vs. 0.76; P < 0.001), the pooled sensitivity of positive qSOFA score was very low (0.47). In addition, a positive qSOFA score tended to be inferior to positive SIRS criteria in predicting ICU admission (0.63 vs. 0.78; P = 0.121).
A positive qSOFA score had high specificity outside the ICU in early detection of in-hospital mortality, acute organ dysfunction, and ICU admission, but low sensitivity may have limitations as a predictive tool for adverse outcomes. Because between-study heterogeneity was highly represented among the studies, our results should be interpreted with caution.
快速序贯器官衰竭评估（qSOFA）评分在疑似感染患者中提供床边标准以早期预测不良预后的有用性仍存在争议。我们研究了 qSOFA 评分在重症监护病房（ICU）以外的阳性预测值与全身性炎症反应综合征（SIRS）标准阳性预测值之间的差异。
使用 MEDLINE、Embase 和 Cochrane 对照试验中心注册库进行系统文献检索。根据敏感性、特异性和诊断 OR 进行数据汇总。使用层次汇总 ROC 和 AUC 总结总体测试性能。采用元回归分析识别潜在的偏倚来源。
我们确定了 23 项研究，共纳入 146551 例患者。在我们的荟萃分析中预测院内死亡率时，我们发现 qSOFA 评分阳性的合并敏感性为 0.51，SIRS 标准阳性的合并敏感性为 0.86，qSOFA 评分阳性的合并特异性为 0.83，SIRS 标准阳性的合并特异性为 0.29。两种工具预测院内死亡率的 AUC 相似（0.74 对 0.71；P=0.816）。使用元回归分析，总体死亡率≥10%和 qSOFA 评分测量时间可能是异质性的重要来源。对于预测急性器官功能障碍，尽管 qSOFA 评分阳性的 AUC 高于 SIRS 标准阳性（0.87 对 0.76；P<0.001），但 qSOFA 评分阳性的合并敏感性非常低（0.47）。此外，qSOFA 评分在预测 ICU 入院方面劣于 SIRS 标准（0.63 对 0.78；P=0.121）。
在 ICU 外，qSOFA 评分在早期检测院内死亡率、急性器官功能障碍和 ICU 入院方面具有高特异性，但敏感性低可能限制其作为不良预后预测工具的应用。由于研究间存在高度异质性，我们的结果应谨慎解读。
