The role of Quick Sequential Organ Failure Assessment (qSOFA) criteria in sepsis screening and management is controversial, particularly as they were derived only in patients with suspected infection. We examined the epidemiology and prognostic value of qSOFA in undifferentiated patients.
We identified patients with ≥2 qSOFA criteria within 1 day of admission among all adults admitted to 85 U.S. hospitals from 2012-2015 and assessed for suspected infection using clinical cultures and antibiotics and sepsis using Sepsis-3 criteria. We also examined qSOFA's discrimination for in-hospital mortality in patients with and without suspected infection using regression models.
Of 1,004,347 hospitalized patients, 271,500 (27.0%) were qSOFA-positive on admission. Compared to qSOFA-negative patients, qSOFA-positive patients were older (median 65 vs 58 years), required ICU admission more often (28.5% vs 6.5%) and had higher mortality (6.7% vs 0.8%) (p<0.001 for all comparisons). Sensitivities of qSOFA for suspected infection and sepsis were 41.3% (95% CI 41.1-41.5%) and 62.8% (95% CI 62.4-63.1%), respectively; positive predictive values were 31.3% (95% CI 30.8-31.1%) and 17.4% (95% CI 17.2-17.5%). The area under the receiver operating characteristic for mortality for qSOFA was lower in patients with suspected infection versus those without (0.814 vs 0.875, p<0.001).
Only 1 in 3 patients who are qSOFA-positive on admission have suspected infection and 1 in 6 have sepsis. qSOFA also has low sensitivity for identifying suspected infection and sepsis and its prognostic significance is not specific to infection. More sensitive and specific tools for sepsis screening and risk-stratification are needed.