Prognostic Accuracy of SOFA, qSOFA, and SIRS for Mortality Among Emergency Department Patients with Infections

• Published in: Infection and drug resistance Vol. 14; pp. 2763 - 2775
• Main Authors: Abdullah, SM Osama Bin, Sørensen, Rune Husås, Nielsen, Finn Erland
• Format: Journal Article
• Language: English
• Published: Macclesfield Dove Medical Press Limited 01.01.2021; Taylor & Francis Ltd; Dove; Dove Medical Press
• Subjects: Accuracy; Analysis; Antibiotics; Blood pressure; Chronic diseases; Chronic illnesses; Comorbidity; Creatinine; Dementia; Denmark; Disease; emergency department; Emergency medical care; Emergency service; Family physicians; Glasgow Coma Scale; Hospitals; Infection; Infections; infectious disease; Inflammation; Laboratories; Medical research; Medicine, Experimental; Mortality; Original Research; Patient outcomes; Patients; Prognosis; prognostic accuracy; qsofa; Registration; Sepsis; sirs; sofa; Systemic inflammatory response syndrome; Denmark
• ISSN: 1178-6973; 1178-6973
• DOI: 10.2147/IDR.S304952

Objective: This study aimed to determine the prognostic accuracy of SOFA in comparison to quick-SOFA (qSOFA) and systemic inflammatory response syndrome (SIRS) in predicting 28-day mortality in the emergency department (ED) patients with infections. Methods: A secondary analysis of data from a prospective study of adult patients with documented or suspected infections admitted to an ED in Denmark from Oct-2017 to Mar-2018. The SOFA scores were calculated after adjustment for chronic diseases. The prognostic accuracy was assessed by analysis of sensitivity, specificity, predictive values, likelihood ratios, and area under the receiver operating characteristic curve (AUROC) with 95% confidence intervals (CI). Results: A total of 2045 patients with a median age of 73.2 (IQR: 60.9-82.1) years were included. The overall 28-day mortality was 7.7%. In patients meeting a SOFA score [greater than or equal to]2, qSOFA score [greater than or equal to]2, and SIRS criteria [greater than or equal to]2 the 28-day mortality was 13.6% (11.2-16.3), 17.8% (12.4-24.3) and 8.3% (6.7-10.2), respectively. SOFA [greater than or equal to]2 had a sensitivity of 61.4% (53.369.0) and specificity of 67.3% (65.1-69.4), qSOFA [greater than or equal to]2 had a sensitivity of 19.6% (13.7-26.7) and specificity of 92.4% (91.1-93.6), and SIRS [greater than or equal to]2 had a sensitivity of 52.5% (44.4-60.5) and specificity of 51.5% (49.2-53.7). The AUROC for SOFA compared to SIRS was: 0.68 vs 0.52; p<0.001 and compared to qSOFA: 0.68 vs 0.63; p=0.018. Conclusion: A SOFA score of at least two had better prognostic accuracy for 28-day mortality than SIRS and qSOFA. However, the overall accuracy of SOFA was poor for the prediction of 28-day mortality. Keywords: emergency department, infectious disease, SOFA, SIRS, qSOFA, sepsis, mortality, prognostic accuracy