qSOFA is a Poor Predictor of Short-Term Mortality in All Patients: A Systematic Review of 410,000 Patients

Ronson S L Lo, Ling Yan Leung, Mikkel Brabrand, Chun Yu Yeung, Suet Yi Chan, Cherry C Y Lam, Kevin K C Hung, Colin A Graham, Ronson S L Lo, Ling Yan Leung, Mikkel Brabrand, Chun Yu Yeung, Suet Yi Chan, Cherry C Y Lam, Kevin K C Hung, Colin A Graham

Abstract

Background: To determine the validity of the Quick Sepsis-Related Organ Failure Assessment (qSOFA) in the prediction of outcome (in-hospital and 1-month mortality, intensive care unit (ICU) admission, and hospital and ICU length of stay) in adult patients with or without suspected infections where qSOFA was calculated and reported; Methods: Cochrane Central of Controlled trials, EMBASE, BIOSIS, OVID MEDLINE, OVID Nursing Database, and the Joanna Briggs Institute EBP Database were the main databases searched. All studies published until 12 April 2018 were considered. All studies except case series, case reports, and conference abstracts were considered. Studies that included patients with neutropenic fever exclusively were excluded.

Results: The median AUROC for in-hospital mortality (27 studies with 380,920 patients) was 0.68 (a range of 0.55 to 0.82). A meta-analysis of 377,623 subjects showed a polled AUROC of 0.68 (0.65 to 0.71); however, it also confirmed high heterogeneity among studies (I² = 98.8%, 95%CI 98.6 to 99.0). The median sensitivity and specificity for in-hospital mortality (24 studies with 118,051 patients) was 0.52 (range 0.16 to 0.98) and 0.81 (0.19 to 0.97), respectively. Median positive and negative predictive values were 0.2 (range 0.07 to 0.38) and 0.94 (0.85 to 0.99), respectively.

Keywords: prognosis; qSOFA; sepsis.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure A1
Figure A1
In-hospital Mortality, All Comers vs. Infection.
Figure A2
Figure A2
In-hospital Mortality, Recruitment Location.
Figure A3
Figure A3
In-hospital Mortality, Altered Mentation.
Figure A4
Figure A4
In-hospital mortality, Timing of qSOFA.
Figure 1
Figure 1
Study Flow.
Figure 2
Figure 2
AUROC for in-hospital mortality.
Figure 3
Figure 3
AUROC for 1-month mortality.
Figure 4
Figure 4
AUROC for ICU admission.

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