“In 2016, the Sepsis-3 task force proposed the quick SOFA (qSOFA) score (2 or more of the following: hypotension, elevated respiratory rate, or altered mental status) as a bedside tool to efficiently identify patients with suspected infection at risk for poor outcomes,” explains Chanu Rhee, MD, MPH. “However, the precise role of qSOFA in sepsis screening and management has been a source of confusion and controversy. Part of the issue is that qSOFA has primarily been evaluated in patients already suspected to have infection, and so it remains unclear whether qSOFA criteria should be used to flag possible sepsis in undifferentiated patients. Furthermore, most research that has examined the accuracy of qSOFA for diagnosing sepsis have been small, single center studies. It is also unclear whether the prognostic significance of qSOFA is specific to patients with suspected infection or extends to all patients.”
To inform the role of qSOFA in sepsis identification and risk-stratification, Dr. Rhee and colleagues examined its epidemiology and prognostic value in 1 million adult patients with and without suspected infection using electronic health record data from over 100 hospitals. “Our main findings are that qSOFA is neither sensitive nor specific for sepsis and that its prognostic significance is not limited to patients with suspected infection,” says Dr. Rhee. “Specifically, we found that only one in three patients who were qSOFA-positive on admission had suspected infection and one in six had clinical evidence of sepsis. Conversely, qSOFA criteria were positive in less than one-half of patients with suspected infection and two out of three patients with sepsis. While qSOFA was good at predicting mortality overall, we found that its prognostic accuracy was actually higher in patients without suspected infection versus those with suspected infection.”
Dr. Rhee suggests that, based on the study findings, qSOFA may be better considered as a general marker of illness that identifies patients who merit close clinical attention rather than a sepsis-specific screening tool. “No sepsis screening tool is perfect. I believe all physicians who care for patients with sepsis should have a good understanding of the strengths and limitations of various sepsis criteria, including systemic inflammatory response syndrome criteria, qSOFA, and Sepsis-3,” he adds.
Epidemiology of Quick Sequential Organ Failure Assessment Criteria in Undifferentiated Patients and Association With Suspected Infection and Sepsis