Quick Sequential Organ Failure Assessment as a prognostic factor for infected patients outside the intensive care unit: a systematic review and meta-analysis

Quick Sequential Organ Failure Assessment (qSOFA) was proposed to replace SIRS as a new screening tool for the identification of septic patients at high mortality. However, researches from infected patients outside of ICU especially in Emergency Department (ED) drew contradictory conclusions on the prognostic value of qSOFA. This systematic review evaluated qSOFA as a prognostic marker of infected patients outside of ICU. The primary outcome was hospital mortality or 28- or 30-day mortality. Data were pooled based on sensitivity and specificity. Twenty-four trials with 121,237 participants were included. qSOFA had a poor sensitivity (0.58 [95% CI 0.47–0.67], 0.54 [95% CI 0.43–0.65]) and moderate specificity (0.69 [95% CI 0.48–0.84], 0.77 [95% CI 0.66–0.86]) for prediction of mortality in patients outside of ICU and ED patients only. Studies that used in-hospital mortality showed a higher sensitivity (0.61 [95% CI 0.50–0.71] vs 0.32 [95% CI 0.15–0.49]) and lower specificity (0.70 [95% CI 0.59–0.82] vs 0.92 [95% CI 0.85–0.99]) than studies that used 28 or 30-day mortality. Studies with overall mortality