Sepsis prognosticating

A living systematic review

Clinical summary: This meta-analysis suggests that both qSOFA and SIRS are better than chance in predicting mortality. qSOFA is dends to be more accurate pverall due to improved specificity and SIRS tends to be more sensitive, but neither comparison is statistically significant. Both decision aids lose sensitivity and gain specificity when studied in settings outside of the ICU with low rates of death. Heterogeneity is difficult to measure in diagnostic tests assessments, but appears to be higher for qSOFA.

We encourage authors to publish in accordance to Standards for Reporting Diagnostic Accuracy (STARD). We had to exclude multiple original studies were excluded due to not reporting a cross tabulation of results in their publication. This data is a recommended element by STARD.

Keep current with this topic

Methods overview: This repository is an openMetaAnalysis that updates a previously published meta-analysis.(1) Newer studies included are listed in the references below. Rationale for newer studies excluded may be listed at the end of the references.

This repository is a limited review and contains outcomes data only without PICO and Risk of Bias Tables. This review does not include a GRADE Profile or Summary of Findings Table.

Methods overview: This repository is an openMetaAnalysis that updates a previously published review.(1) Newer studies included are listed in the references below. Rationale for newer trials excluded may be listed at the end of the references.

• Methods for openMetaAnalysis
• Evidence search for this review

Results: Details of the studies included are in the:

• Description of studies (PICO table) (under construction)
• Risk of bias assessment (under construction)
• Forest plots (source data)
• Reconciliation of conclusions and trials included with prior meta-analyses (under construction)

The forest plot for the primary outcome is below. Additional forest plots of secondary analyses may be available.

References:

Systematic review(s)

Most recent review at time of last revision of this repository

1. Fernando SM, Tran A, Taljaard M, Cheng W, Rochwerg B, Seely AJE, Perry JJ. Prognostic Accuracy of the Quick Sequential Organ Failure Assessment for Mortality in Patients With Suspected Infection: A Systematic Review and Meta-analysis. Ann Intern Med. 2018 Feb 20;168(4):266-275. doi: 10.7326/M17-2820. PMID: 29404582.
2. Liu D, Su L, Han G, Yan P, Xie L. Prognostic Value of Procalcitonin in Adult Patients with Sepsis: A Systematic Review and Meta-Analysis. PLoS One. 2015 Jun 15;10(6):e0129450. doi: 10.1371/journal.pone.0129450. PMID: 26076027 The Liu review is more uptodate that this repository.

Diagnostic test assessments

New studies not included in the most recent review above

1. Abdullah SMOB, Grand J, Sijapati A, Puri PR, Nielsen FE. qSOFA is a useful prognostic factor for 30-day mortality in infected patients fulfilling the SIRS criteria for sepsis. Am J Emerg Med. 2019 May 21. PMID: 31171438.
2. Usman OA, Usman AA, Ward MA. Comparison of SIRS, qSOFA, and NEWS for the early identification of sepsis in the Emergency Department. Am J Emerg Med. 2018 Nov 7. PMID: 30470600.
3. Redfern OC, Smith GB, Prytherch DR, Meredith P, Inada-Kim M, Schmidt PE. A Comparison of the Quick Sequential (Sepsis-Related) Organ Failure Assessment Score and the National Early Warning Score in Non-ICU Patients With/Without Infection. Crit Care Med. 2018 Dec;46(12):1923-1933. doi: 10.1097/CCM.0000000000003359. PMID: 30130262.
4. Schuetz P, Birkhahn R, Sherwin R, et al. Serial Procalcitonin Predicts Mortality in Severe Sepsis Patients: Results From the Multicenter Procalcitonin MOnitoring SEpsis (MOSES) Study. Crit Care Med. 2017 Mar 2. doi: 10.1097/CCM.0000000000002321. PMID 28257335.
5. Freund Y, Lemachatti N, Krastinova E, Van Laer M, Claessens YE, Avondo A,et al; French Society of Emergency Medicine Collaborators Group.. Prognostic Accuracy of Sepsis-3 Criteria for In-Hospital Mortality Among Patients With Suspected Infection Presenting to the Emergency Department. JAMA. 2017 Jan 17;317(3):301-308. PMID: 28114554.
6. Williams JM, Greenslade JH, McKenzie JV, Chu K, Brown AF, Lipman J. SIRS, qSOFA and organ dysfunction: insights from a prospective database of emergency department patients with infection. Chest. 2016 Nov 19. PMID: 27876592
7. April MD, Aguirre J, Tannenbaum LI, Moore T, Pingree A, Thaxton RE, Sessions DJ, Lantry JH. Sepsis Clinical Criteria in Emergency Department Patients Admitted to an Intensive Care Unit: An External Validation Study of Quick Sequential Organ Failure Assessment. J Emerg Med. 2016 Nov 4. PMID: 27823893
8. Churpek MM, Snyder A, Han X, Sokol S, Pettit N, Howell MD, Edelson DP. qSOFA, SIRS, and Early Warning Scores for Detecting Clinical Deterioration in Infected Patients Outside the ICU. Am J Respir Crit Care Med. 2016 Sep 20. PMID: 27649072

Studies included in the review above

None

Studies undergoing assessment

1. Usul E, Korkut S, Kayipmaz AE, Halici A, Kavalci C. The role of the quick sequential organ failure assessment score (qSOFA) and modified early warning score (MEWS) in the pre-hospitalization prediction of sepsis prognosis. Am J Emerg Med. 2020 Sep 30:S0735-6757(20)30844-5. doi: 10.1016/j.ajem.2020.09.049. Epub ahead of print. PMID: 33071081
2. Abdullah SMOB, Sørensen RH, Dessau RBC, Sattar SMRU, Wiese L, Nielsen FE. Prognostic accuracy of qSOFA in predicting 28-day mortality among infected patients in an emergency department: a prospective validation study. Emerg Med J. 2019 Dec;36(12):722-728. doi: 10.1136/emermed-2019-208456. Epub 2019 Oct 25. PMID: 31653692.
3. Shim BS, Yoon YH, Kim JY, Cho YD, Park SJ, Lee ES, Choi SH. Clinical Value of Whole Blood Procalcitonin Using Point of Care Testing, Quick Sequential Organ Failure Assessment Score, C-Reactive Protein and Lactate in Emergency Department Patients with Suspected Infection. J Clin Med. 2019 Jun 12;8(6). PMID: 31212806.
4. Choi A, Park YS, Shin TG, Han KS, Kim WY, Kang GH, Kim K, Choi SH, Lim TH, Suh GJ; Korean Shock Society (KoSS) Investigators. Prognostic performance of disease severity scores in patients with septic shock presenting to the emergency department. Am J Emerg Med. 2018 Aug 21. PMID: 30220642.
5. Shu E, Ives Tallman C, Frye W, Boyajian JG, Farshidpour L, Young M, Campagne D. Pre-hospital qSOFA as a predictor of sepsis and mortality. Am J Emerg Med. 2018 Sep 18. pii: S0735-6757(18)30759-9. doi: 10.1016/j.ajem.2018.09.025. PMID: 30322666.
6. Kievlan DR, Zhang LA, Chang CH, Angus DC, Seymour CW. Evaluation of Repeated Quick Sepsis-Related Organ Failure Assessment Measurements Among Patients With Suspected Infection. Crit Care Med. 2018 Aug 20. doi: 10.1097/CCM.0000000000003360. PMID: 30130261.
7. Redfern OC, Smith GB, Prytherch DR, Meredith P, Inada-Kim M, Schmidt PE. A Comparison of the Quick Sequential (Sepsis-Related) Organ Failure Assessment Score and the National Early Warning Score in Non-ICU Patients With/Without Infection. Crit Care Med. 2018 Aug 20. doi: 10.1097/CCM.0000000000003359. PMID: 30130262.
8. Goulden R, Hoyle MC, Monis J, Railton D, Riley V, Martin P, Martina R, Nsutebu E. qSOFA, SIRS and NEWS for predicting inhospital mortality and ICU admission in emergency admissions treated as sepsis. Emerg Med J. 2018 Jun;35(6):345-349. doi: 10.1136/emermed-2017-207120. PMID: 29467173.
9. Serafim R, Gomes JA, Salluh J, Póvoa P. A Comparison of the Quick-SOFA and Systemic Inflammatory Response Syndrome Criteria for the Diagnosis of Sepsis and Prediction of Mortality: A Systematic Review and Meta-Analysis. Chest. 2018 Mar;153(3):646-655. doi: 10.1016/j.chest.2017.12.015. Epub 2017 Dec 28. PMID: 29289687.
10. Fernando SM, Tran A, Taljaard M, Cheng W, Rochwerg B, Seely AJE, Perry JJ. Prognostic Accuracy of the Quick Sequential Organ Failure Assessment for Mortality in Patients With Suspected Infection: A Systematic Review and Meta-analysis. Ann Intern Med. 2018 Feb 6. doi: 10.7326/M17-2820. PMID: 29404582
11. Song JU, Sin CK, Park HK, Shim SR, Lee J. Performance of the quick Sequential (sepsis-related) Organ Failure Assessment score as a prognostic tool in infected patients outside the intensive care unit: a systematic review and meta-analysis. Crit Care. 2018 Feb 6;22(1):28. doi: 10.1186/s13054-018-1952-x. PMID: 29409518
12. Hwang SY, Jo IJ, Lee SU, Lee TR, Yoon H, Cha WC, Sim MS, Shin TG. Low Accuracy of Positive qSOFA Criteria for Predicting 28-Day mortality in Critically Ill Septic Patients During the Early Period After Emergency Department Presentation. Ann Emerg Med. 2017 Jun 29. pii: S0196-0644(17)30658-3. doi: 10.1016/j.annemergmed.2017.05.022. PMID: 28669551.
13. Piano S, Bartoletti M, Tonon M, Baldassarre M, Chies G, Romano A, Viale P, Vettore E, Domenicali M, Stanco M, Pilutti C, Frigo AC, Brocca A, Bernardi M, Caraceni P, Angeli P. Assessment of Sepsis-3 criteria and quick SOFA in patients with cirrhosis and bacterial infections. Gut. 2017 Aug 31. doi: 10.1136/gutjnl-2017-314324. PMID: 28860348.
14. Jouffroy R, Saade A, Carpentier A, Ellouze S, Philippe P, Idialisoa R, Carli P, Vivien B. Triage of Septic Patients Using qSOFA Criteria at the SAMU Regulation: A Retrospective Analysis. Prehosp Emerg Care. 2017 Aug 9:1-7. doi: 10.1080/10903127.2017.1347733. PMID: 28792256.
15. Bahloul M, Baccouch N, Chtara K, Turki M, Turki O, Hamida CB, Chelly H, Ayedi F, Chaari A, Bouaziz M. Value of Serum Cholinesterase Activity in the Diagnosis of Septic Shock Due to Bacterial Infections. J Intensive Care Med. 2017 Jun;32(5):346-352. doi: 10.1177/0885066616636549. PMID: 26951579.
16. Fang X, Wang Z, Yang J, Cai H, Yao Z, Li K, Fang Q. Clinical Evaluation of Sepsis-1 and Sepsis-3 in the ICU. Chest. 2018 May;153(5):1169-1176. doi:10.1016/j.chest.2017.06.037. PMID: 28711593
17. Rudd KE, Seymour CW, Aluisio AR, et al. Association of the Quick Sequential (Sepsis-Related) Organ Failure Assessment (qSOFA) Score With Excess Hospital Mortality in Adults With Suspected Infection in Low- and Middle-Income Countries. JAMA. 2018 May 20. pii: 2681801. doi: 10.1001/jama.2018.6229
18. Valik JK, Mellhammar L, Sundén-Cullberg J, Ward L, Unge C, Dalianis H, Henriksson A, Strålin K, Linder A, Nauclér P. Peripheral Oxygen Saturation Facilitates Assessment of Respiratory Dysfunction in the Sequential Organ Failure Assessment Score With Implications for the Sepsis-3 Criteria. Crit Care Med. 2021 Aug 18. doi: 10.1097/CCM.0000000000005318. Epub ahead of print. PMID: 34406170.

Studies excluded - selected list of important studies

1. Raith EP, Udy AA, Bailey M, McGloughlin S, MacIsaac C, Bellomo R, Pilcher DV; Australian and New Zealand Intensive Care Society (ANZICS) Centre for Outcomes and Resource Evaluation (CORE). Prognostic Accuracy of the SOFA Score, SIRS Criteria, and qSOFA Score for In-Hospital Mortality Among Adults With Suspected Infection Admitted to the Intensive Care Unit. JAMA. 2017 Jan 17;317(3):290-300. PMID: 28114553 Could not extract data for two-by-two table from publication. This data is a recommended element in the reporting of diagnostic and predictive studies according to the Standards for Reporting Diagnostic Accuracy (STARD)
2. Giamarellos-Bourboulis EJ, Tsaganos T, Tsangaris I, Lada M, Routsi C, Sinapidis D, et al; Hellenic Sepsis Study Group. Validation of the new Sepsis-3 definitions: proposal for improvement in early risk identification. Clin Microbiol Infect. 2016 Nov 14. PMID: 27856268 All patients met SIRS criteria
3. Nguyen HB, Rivers EP, Knoblich BP, Jacobsen G, Muzzin A, Ressler JA, Tomlanovich MC. Early lactate clearance is associated with improved outcome in severe sepsis and septic shock. Crit Care Med. 2004 PMID: 15286537 Could not extract data for two-by-two table from publication. This data is a recommended element in the reporting of diagnostic and predictive studies according to the Standards for Reporting Diagnostic Accuracy (STARD)
4. Singer AJ, Ng J, Thode HC Jr, Spiegel R, Weingart S. Quick SOFA Scores Predict Mortality in Adult Emergency Department Patients With and Without Suspected Infection. Ann Emerg Med. 2017 Jan 19. pii: S0196-0644(16)31219-7. doi: 10.1016/j.annemergmed.2016.10.007. PMID: 28110990 Could not extract data for two-by-two table from publication. This data is a recommended element in the reporting of diagnostic and predictive studies according to the Standards for Reporting Diagnostic Accuracy (STARD)

Cited by

This repository is cited by:

1. WikiDoc contributors.Sepsis natural history, complications and prognosis. WikiDoc. Jan 26, 2017. Available at: http://www.wikidoc.org/index.php/Sepsis_natural_history,_complications_and_prognosis#cite_note-7. Accessed January 26, 2017.

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