Emergency and Trauma Care Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
Arch Iran Med. 2024 Aug 1;27(8):439-446. doi: 10.34172/aim.28567.
Sepsis, a deadly infection causing organ failure and Systemic Inflammatory Response Syndrome (SIRS), is detected early in hospitalization using the SIRS criteria, while sequential organ failure (SOFA) assesses organ failure severity. A systematic review and meta-analysis was evaluated to investigate the predictive value of the SIRS criteria and the SOFA system for mortality in early hospitalization of sepsis patients.
Inclusion criteria were full reports in peer-reviewed journals with data on sepsis assessment using SOFA and SIRS, and their relationship with outcomes. For quality assessment, we considered study population, sepsis diagnosis criteria, and outcomes. The area under the curve (AUC) of these criteria was extracted for separate meta-analysis and forest plots.
Twelve studies met the inclusion criteria. The studies included an average of 56.1% males and a mean age of 61.9 (±6.1) among 32,979 patients. The pooled AUC was 0.67 (95% CI: 0.60-0.73) for SIRS and 0.79 (95% CI: 0.73-0.84) for SOFA. Significant heterogeneity between studies was indicated by an I2 above 50%, leading to a meta-regression analysis. This analysis, with age and patient number as moderators, revealed age as the major cause of heterogeneity in comparing the predictive value of the SOFA score with SIRS regarding the in-hospital mortality of sepsis patients (<0.05).
The SOFA score outperformed the SIRS criteria in predicting mortality, emphasizing the need for a holistic approach that combines clinical judgment and other diagnostic tools for better patient management and outcomes.
败血症是一种致命的感染，可导致器官衰竭和全身炎症反应综合征（SIRS）。在住院期间，SIRS 标准可早期检测败血症，而序贯器官衰竭评估（SOFA）则评估器官衰竭的严重程度。我们进行了一项系统评价和荟萃分析，旨在研究 SIRS 标准和 SOFA 系统对败血症患者住院早期死亡率的预测价值。
纳入标准为在同行评审期刊上发表的全文报告，报告中包含使用 SOFA 和 SIRS 评估败血症的数据，以及这些数据与结局的关系。我们对研究人群、败血症诊断标准和结局进行了质量评估。分别对这些标准的曲线下面积（AUC）进行了荟萃分析和森林图提取。
符合纳入标准的研究共有 12 项。这些研究共纳入了 32979 例患者，其中男性平均占 56.1%，平均年龄为 61.9（±6.1）岁。SIRS 的汇总 AUC 为 0.67（95%CI：0.60-0.73），SOFA 的汇总 AUC 为 0.79（95%CI：0.73-0.84）。研究间存在显著的异质性（I2>50%），因此进行了元回归分析。该分析以年龄和患者数量为调节因素，结果表明年龄是 SOFA 评分与 SIRS 比较预测败血症患者住院死亡率时异质性的主要原因（<0.05）。
SOFA 评分在预测死亡率方面优于 SIRS 标准，这强调了需要采取整体方法，结合临床判断和其他诊断工具，以实现更好的患者管理和结局。
