Comparison of different versions of the quick sequential organ failure assessment for predicting in-hospital mortality of sepsis patients: A retrospective observational study

doi:10.5847/wjem.j.1920-8642.2022.027

Abstract

Abstract:

BACKGROUND: The quick sequential organ failure assessment (qSOFA) is recommended to identify sepsis and predict sepsis mortality. However, some studies have recently shown its poor performance in sepsis mortality prediction. To enhance its effectiveness, researchers have developed various revised versions of the qSOFA by adding other parameters, such as the lactate-enhanced qSOFA (LqSOFA), the procalcitonin-enhanced qSOFA (PqSOFA), and the modified qSOFA (MqSOFA). This study aimed to compare the performance of these versions of the qSOFA in predicting sepsis mortality in the emergency department (ED).
METHODS: This retrospective study analyzed data obtained from an electronic register system of adult patients with sepsis between January 1 and December 31, 2019. Receiver operating characteristic (ROC) curve analyses were performed to determine the area under the curve (AUC), with sensitivity, specificity, and positive and negative predictive values calculated for the various scores.
RESULTS: Among the 936 enrolled cases, there were 835 survivors and 101 deaths. The AUCs of the LqSOFA, MqSOFA, PqSOFA, and qSOFA were 0.740, 0.731, 0.712, and 0.705, respectively. The sensitivity of the LqSOFA, MqSOFA, PqSOFA, and qSOFA were 64.36%, 51.40%, 71.29%, and 39.60%, respectively. The specificity of the four scores were 70.78%, 80.96%, 61.68%, and 91.62%, respectively. The LqSOFA and MqSOFA were superior to the qSOFA in predicting in-hospital mortality.
CONCLUSIONS: Among patients with sepsis in the ED, the performance of the PqSOFA was similar to that of the qSOFA and the values of the LqSOFA and MqSOFA in predicting in-hospital mortality were greater compared to qSOFA. As the added parameter of the MqSOFA was more convenient compared to the LqSOFA, the MqSOFA could be used as a candidate for the revised qSOFA to increase the performance of the early prediction of sepsis mortality.

Key words: Quick sequential organ failure assessment, In-hospital mortality, Sepsis, Lactate- enhanced qSOFA, Modified qSOFA

Hai Hu, Jing-yuan Jiang, Ni Yao. Comparison of different versions of the quick sequential organ failure assessment for predicting in-hospital mortality of sepsis patients: A retrospective observational study[J]. World Journal of Emergency Medicine, 2022, 13(2): 114-119.

Figures/Tables 5

Figure 1.

Table 1

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Figure 2.

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Variables	Survivors (n=835)	Non-survivors (n=101)	P value
Male	509 (60.96)	68 (67.33)	0.234
Age (years)	50.13±18.32	58.91±20.92	<0.001
Temperature (°C)	36.10±5.58	36.95±0.88	0.121
Pulse (beats/min)	105.46±69.60	103.27±24.76	0.753
RR (breaths/min)	21.62±5.96	22.74±5.49	0.072
SBP (mmHg)	113.19±37.60	107.18±36.63	0.129
Mental status
Alert	835 (100.0)	51 (50.5)	<0.001
Altered mentation	0 (0.0)	50 (49.5)
SpO₂ (%)	95 (90-96)	93 (89-94)	<0.001
PCT (ng/mL)	0.98 (0.66-5.91)	1.23 (0.73-5.28)	0.215
Serum lactate (mmol/L)	2.1 (1.7-2.8)	2.5 (2.0-4.3)	<0.001
SOFA	4 (3-5)	6 (5-8)	<0.001
qSOFA	1 (0-1)	1 (1-2)	<0.001
LqSOFA	1 (0-2)	2 (1-3)	<0.001
PqSOFA	1 (1-2)	2 (1-3)	<0.001
MqSOFA	2 (1-2)	3 (2-4)	<0.001

Score	AUC	95%CI	P value	Cut-off	Sen (%)	Spe (%)	PPV (%)	NPV (%)	Youden’s index
qSOFA	0.705	0.645-0.764	<0.001	1	80.20	42.16	14.36	94.62	0.224
				2	39.60	91.62	36.36	92.62	0.312^*
				3	6.93	98.08	30.44	89.70	0.050
LqSOFA	0.740	0.686-0.794	<0.001	1	94.06	25.63	13.27	97.27	0.197
				2	64.36	70.78	21.04	94.26	0.351^*
				3	28.71	95.57	43.94	91.72	0.243
				4	3.96	98.08	20.00	89.41	0.020
PqSOFA	0.712	0.653-0.771	<0.001	1	91.09	17.13	11.74	94.08	0.082
				2	71.29	61.68	18.37	94.67	0.330^*
				3	31.68	93.89	38.55	91.91	0.256
				4	1.98	98.08	11.11	89.22	0.001
MqSOFA	0.731	0.675-0.787	<0.001	1	86.14	39.76	14.75	95.95	0.259
				2	51.49	80.96	24.65	93.24	0.324^*
				3	25.74	97.01	50.98	91.53	0.227
				4	5.94	98.08	27.27	89.61	0.040
				5	/	98.08	/	89.02	/

Pairs of scores	ΔAUC	S.E.	95%CI	P value
qSOFA vs. LqSOFA	0.0353	0.0162	0.0035 to 0.0671	0.0295^*
qSOFA vs. MqSOFA	0.0266	0.0134	0.0003 to 0.0529	0.0478^*
qSOFA vs. PqSOFA	0.0072	0.0143	-0.0208 to 0.0353	0.6129
LqSOFA vs. MqSOFA	0.0087	0.0178	-0.0262 to 0.0436	0.6243
LqSOFA vs. PqSOFA	0.0281	0.0230	-0.0170 to 0.0731	0.2218
MqSOFA vs. PqSOFA	0.0193	0.0201	-0.0201 to 0.0588	0.3369

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