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Prognostic Accuracy of the Quick Sequential Organ Failure Assessment for Mortality in Patients With Suspected Infection: A Systematic Review and Meta-analysis

Fernando, Shannon M., Tran, Alexandre, Taljaard, Monica, Cheng, Wei, Rochwerg, Bram, Seely, Andrew J.E., Perry, Jeffrey J.·2018·Annals of Internal Medicine

DOI 10.7326/m17-2820

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Abstract

Background: The quick Sequential Organ Failure Assessment (qSOFA) has been proposed for prediction of mortality in patients with suspected infection. Purpose: To summarize and compare the prognostic accuracy of qSOFA and the systemic inflammatory response syndrome (SIRS) criteria for prediction of mortality in adult patients with suspected infection. Data Sources: Four databases from inception through November 2017. Study Selection: English-language studies using qSOFA for prediction of mortality (in-hospital, 28-day, or 30-day) in adult patients with suspected infection in the intensive care unit (ICU), emergency department (ED), or hospital wards. Data Extraction: Two investigators independently extracted data and assessed study quality using standard criteria. Data Synthesis: Thirty-eight studies were included (n = 385 333). qSOFA was associated with a pooled sensitivity of 60.8% (95% CI, 51.4% to 69.4%) and a pooled specificity of 72.0% (CI, 63.4% to 79.2%) for mortality. The SIRS criteria were associated with a pooled sensitivity of 88.1% (CI, 82.3% to 92.1%) and a pooled specificity of 25.8% (CI, 17.1% to 36.9%). The pooled sensitivity of qSOFA was higher in the ICU population (87.2% [CI, 75.8% to 93.7%]) than the non-ICU population (51.2% [CI, 43.6% to 58.7%]). The pooled specificity of qSOFA was higher in the non-ICU population (79.6% [CI, 73.3% to 84.7%]) than the ICU population (33.3% [CI, 23.8% to 44.4%]). Limitation: Potential risk of bias in included studies due to qSOFA interpretation and patient selection. Conclusion: qSOFA had poor sensitivity and moderate specificity for short-term mortality. The SIRS criteria had sensitivity superior to that of qSOFA, supporting their use for screening of patients and as a prompt for treatment initiation. Primary Funding Source: Canadian Association of Emergency Physicians. (PROSPERO: CRD42017075964).

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Authors: Fernando, S. M., Tran, A., Taljaard, M., Cheng, W., Rochwerg, B., Seely, A. J. E., & Perry, J. J.
Affiliations: University of Ottawa (CA)
Ottawa Hospital Research Institute (CA)
McMaster University (CA)
ORCID: Fernando, Shannon M.
Tran, Alexandre
Taljaard, Monica
Cheng, Wei
Rochwerg, Bram
Seely, Andrew J.E.
Perry, Jeffrey J.
Venue: Annals of Internal Medicine
Publisher: American College of Physicians
Published: 2018-02-20
Volume: 168
Issue: 4
Pages: 266-275
ISSN: 0003-4819 (ISSN-L)
1539-3704
DOI: 10.7326/m17-2820
OpenAlex: W2788736459
Cited by: 281
References: 69
Citations by year: 2026: 24 · 2025: 18 · 2024: 23 · 2023: 36 · 2022: 34 · 2021: 33 · 2020: 38 · 2019: 49 · 2018: 25
FWCI: 5.18
Type: journal article
Language: en
Open access: closed
Licence: www.acpjournals.org/journal/aim/text-and-data-mining (tdm)
Locations: Annals of Internal Medicine (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Sepsis Diagnosis and Treatment
Life Sciences › Immunology and Microbiology › Immunology › Inflammation biomarkers and pathways
Health Sciences › Medicine › Surgery › Abdominal Surgery and Complications
Keywords: qSOFA, systemic inflammatory response syndrome, mortality prediction, suspected infection, prognostic accuracy, sensitivity and specificity, intensive care unit, emergency department, sepsis screening
MeSH terms: Decision Support Techniques, Emergency Service, Hospital, Humans, Intensive Care Units, Predictive Value of Tests, Prognosis, Hospital Mortality, Systemic Inflammatory Response Syndrome, Sepsis, Organ Dysfunction Scores

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Prognostic Accuracy of the Quick Sequential Organ Failure Assessment for Mortality in Patients With Suspected Infection: A Systematic Review and Meta-analysis

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