Comparing the Predictive Value of SOFA and SIRS for Mortality in the Early Hours of Hospitalization of Sepsis Patients: A Systematic Review and Meta-analysis

• Published in: Archives of Iranian medicine Vol. 27; no. 8; pp. 439 - 446
• Main Authors: Majidazar, Mahdi, Hamidi, Farzaneh, Masoudi, Nazanin, Vand-Rajabpour, Zahra, Paknezhad, Seyed Pouya
• Format: Journal Article
• Language: English
• Published: Iran Academy of Medical Sciences of I.R. Iran 01.08.2024
• Subjects: Area Under Curve; Hospital Mortality; Hospitalization - statistics & numerical data; Humans; Organ Dysfunction Scores; Predictive Value of Tests; Sepsis - diagnosis; Sepsis - mortality; Systematic Review; Systemic Inflammatory Response Syndrome - diagnosis; Systemic Inflammatory Response Syndrome - mortality; Infection; Predictive Value; Mortality; Critical care; Sepsis; Systematic review; Morbidity
• ISSN: 1029-2977; 1735-3947
• 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.