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...
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| Veröffentlicht in: | Internal and emergency medicine 2019-06, Vol.14 (4), p.603-615 |
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| creator | Liu, Yan-Cun Luo, Yuan-Yuan Zhang, Xingyu Shou, Song-Tao Gao, Yu-Lei Lu, Bin Li, Chen Chai, Yan-Fen |
| description | 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 |
| doi_str_mv | 10.1007/s11739-019-02036-0 |
| format | Article |
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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 < 10% showed higher specificity (0.89 [95% CI 0.82–0.95] vs 0.62 [95% CI 0.48–0.76]) than studies with overall mortality ≥ 10%. There is no difference in the accuracy of diagnosis of sepsis between positive qSOFA scores and SIRS criteria. qSOFA was poor sensitivity and moderate specificity in predicting mortality of infected patients outside of ICU especially in ED. Combining qSOFA and SIRS may be helpful in predicting mortality.</description><identifier>ISSN: 1828-0447</identifier><identifier>EISSN: 1970-9366</identifier><identifier>DOI: 10.1007/s11739-019-02036-0</identifier><identifier>PMID: 30725323</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>CE- Systematic review ; Clinical trials ; Emergency medical services ; Hospital Mortality ; Humans ; Infections - diagnosis ; Infections - physiopathology ; Internal Medicine ; Mass Screening - methods ; Mass Screening - standards ; Medical prognosis ; Medicine ; Medicine & Public Health ; Meta-analysis ; Mortality ; Organ Dysfunction Scores ; Prognosis ; Sensitivity ; Sensitivity and Specificity ; Sepsis ; Systematic review ; Time Factors</subject><ispartof>Internal and emergency medicine, 2019-06, Vol.14 (4), p.603-615</ispartof><rights>Società Italiana di Medicina Interna (SIMI) 2019</rights><rights>Internal and Emergency Medicine is a copyright of Springer, (2019). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c441t-bddaa0a5f3e7948a67bd1381bff302de37ae2282907874042eb3022a914662fa3</citedby><cites>FETCH-LOGICAL-c441t-bddaa0a5f3e7948a67bd1381bff302de37ae2282907874042eb3022a914662fa3</cites><orcidid>0000-0003-1164-7427</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s11739-019-02036-0$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s11739-019-02036-0$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30725323$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Liu, Yan-Cun</creatorcontrib><creatorcontrib>Luo, Yuan-Yuan</creatorcontrib><creatorcontrib>Zhang, Xingyu</creatorcontrib><creatorcontrib>Shou, Song-Tao</creatorcontrib><creatorcontrib>Gao, Yu-Lei</creatorcontrib><creatorcontrib>Lu, Bin</creatorcontrib><creatorcontrib>Li, Chen</creatorcontrib><creatorcontrib>Chai, Yan-Fen</creatorcontrib><title>Quick Sequential Organ Failure Assessment as a prognostic factor for infected patients outside the intensive care unit: a systematic review and meta-analysis</title><title>Internal and emergency medicine</title><addtitle>Intern Emerg Med</addtitle><addtitle>Intern Emerg Med</addtitle><description>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 < 10% showed higher specificity (0.89 [95% CI 0.82–0.95] vs 0.62 [95% CI 0.48–0.76]) than studies with overall mortality ≥ 10%. There is no difference in the accuracy of diagnosis of sepsis between positive qSOFA scores and SIRS criteria. qSOFA was poor sensitivity and moderate specificity in predicting mortality of infected patients outside of ICU especially in ED. Combining qSOFA and SIRS may be helpful in predicting mortality.</description><subject>CE- Systematic review</subject><subject>Clinical trials</subject><subject>Emergency medical services</subject><subject>Hospital Mortality</subject><subject>Humans</subject><subject>Infections - diagnosis</subject><subject>Infections - physiopathology</subject><subject>Internal Medicine</subject><subject>Mass Screening - methods</subject><subject>Mass Screening - standards</subject><subject>Medical prognosis</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Meta-analysis</subject><subject>Mortality</subject><subject>Organ Dysfunction Scores</subject><subject>Prognosis</subject><subject>Sensitivity</subject><subject>Sensitivity and Specificity</subject><subject>Sepsis</subject><subject>Systematic review</subject><subject>Time Factors</subject><issn>1828-0447</issn><issn>1970-9366</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp9kcFu1TAQRS0EoqXwAyyQJTZsAmM7sRN2VUUBqVKFgHU0SSYPl8R5eJyi9zH8Kw6vgMSCxciW75k7tq8QTxW8VADuFSvlTFOAyqXB2ALuiVPVOCgaY-39vK91XUBZuhPxiPkGoKqscg_FiQGnK6PNqfjxYfX9V_mRvq0UksdJXscdBnmJflojyXNmYp6zJpElyn1cdmHh5Hs5Yp-WKMdcPozUJxrkHpPPLMtlTewHkukLZTVRYH9LssdsuQafXmcrPnCiGTerSLeevksMg5wpYYEBpwN7fiwejDgxPblbz8TnyzefLt4VV9dv31-cXxV9WapUdMOACFiNhlxT1mhdNyhTq24cDeiBjEPSutYNuNqVUGrq8rnGRpXW6hHNmXhx9M3Pyx_BqZ099zRNGGhZudV669W2gow-_we9WdaY75sp5WzlwMFG6SPVx4U50tjuo58xHloF7RZeewyvzeG1v8Jrt6Znd9ZrN9Pwp-V3WhkwR4CzFHYU_87-j-1PldKm9A</recordid><startdate>20190601</startdate><enddate>20190601</enddate><creator>Liu, Yan-Cun</creator><creator>Luo, Yuan-Yuan</creator><creator>Zhang, Xingyu</creator><creator>Shou, Song-Tao</creator><creator>Gao, Yu-Lei</creator><creator>Lu, Bin</creator><creator>Li, Chen</creator><creator>Chai, Yan-Fen</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-1164-7427</orcidid></search><sort><creationdate>20190601</creationdate><title>Quick Sequential Organ Failure Assessment as a prognostic factor for infected patients outside the intensive care unit: a systematic review and meta-analysis</title><author>Liu, Yan-Cun ; Luo, Yuan-Yuan ; Zhang, Xingyu ; Shou, Song-Tao ; Gao, Yu-Lei ; Lu, Bin ; Li, Chen ; Chai, Yan-Fen</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c441t-bddaa0a5f3e7948a67bd1381bff302de37ae2282907874042eb3022a914662fa3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>CE- Systematic review</topic><topic>Clinical trials</topic><topic>Emergency medical services</topic><topic>Hospital Mortality</topic><topic>Humans</topic><topic>Infections - diagnosis</topic><topic>Infections - physiopathology</topic><topic>Internal Medicine</topic><topic>Mass Screening - methods</topic><topic>Mass Screening - standards</topic><topic>Medical prognosis</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Meta-analysis</topic><topic>Mortality</topic><topic>Organ Dysfunction Scores</topic><topic>Prognosis</topic><topic>Sensitivity</topic><topic>Sensitivity and Specificity</topic><topic>Sepsis</topic><topic>Systematic review</topic><topic>Time Factors</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Liu, Yan-Cun</creatorcontrib><creatorcontrib>Luo, Yuan-Yuan</creatorcontrib><creatorcontrib>Zhang, Xingyu</creatorcontrib><creatorcontrib>Shou, Song-Tao</creatorcontrib><creatorcontrib>Gao, Yu-Lei</creatorcontrib><creatorcontrib>Lu, Bin</creatorcontrib><creatorcontrib>Li, Chen</creatorcontrib><creatorcontrib>Chai, Yan-Fen</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Immunology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Internal and emergency medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Liu, Yan-Cun</au><au>Luo, Yuan-Yuan</au><au>Zhang, Xingyu</au><au>Shou, Song-Tao</au><au>Gao, Yu-Lei</au><au>Lu, Bin</au><au>Li, Chen</au><au>Chai, Yan-Fen</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Quick Sequential Organ Failure Assessment as a prognostic factor for infected patients outside the intensive care unit: a systematic review and meta-analysis</atitle><jtitle>Internal and emergency medicine</jtitle><stitle>Intern Emerg Med</stitle><addtitle>Intern Emerg Med</addtitle><date>2019-06-01</date><risdate>2019</risdate><volume>14</volume><issue>4</issue><spage>603</spage><epage>615</epage><pages>603-615</pages><issn>1828-0447</issn><eissn>1970-9366</eissn><abstract>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 < 10% showed higher specificity (0.89 [95% CI 0.82–0.95] vs 0.62 [95% CI 0.48–0.76]) than studies with overall mortality ≥ 10%. There is no difference in the accuracy of diagnosis of sepsis between positive qSOFA scores and SIRS criteria. qSOFA was poor sensitivity and moderate specificity in predicting mortality of infected patients outside of ICU especially in ED. Combining qSOFA and SIRS may be helpful in predicting mortality.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>30725323</pmid><doi>10.1007/s11739-019-02036-0</doi><tpages>13</tpages><orcidid>https://orcid.org/0000-0003-1164-7427</orcidid></addata></record> |
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| ispartof | Internal and emergency medicine, 2019-06, Vol.14 (4), p.603-615 |
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| subjects | CE- Systematic review Clinical trials Emergency medical services Hospital Mortality Humans Infections - diagnosis Infections - physiopathology Internal Medicine Mass Screening - methods Mass Screening - standards Medical prognosis Medicine Medicine & Public Health Meta-analysis Mortality Organ Dysfunction Scores Prognosis Sensitivity Sensitivity and Specificity Sepsis Systematic review Time Factors |
| title | Quick Sequential Organ Failure Assessment as a prognostic factor for infected patients outside the intensive care unit: a systematic review and meta-analysis |
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