A large multicenter evaluation of quick Sequential Organ Failure Assessment (qSOFA) and Systemic Inflammatory Response Syndrome (SIRS) performance among hospitalized US Emergency Department patients with suspected infection

Background: Sepsis has caused a significant consumption of healthcare resources in the United States. Early recognition coupled with appropriate and timely therapy is critical for sepsis management. Systemic Inflammatory Response Syndrome (SIRS) and quick Sequential Organ Failure Assessment (qSOFA) have been recommended for rapid sepsis screening purposes but the optimal tool is still unclear. We sought to conduct the largest multicenter study of hospitalized US Emergency Department (ED) patients with suspected infection to evaluate the qSOFA ≥2 versus SIRS ≥2. Methods: We conducted a secondary analysis of the United States Critical Illness and Injury Trials Group-Lung Injury Prevention Study (USCIITG-LIPS) cohort. Primary outcome was hospital mortality. Baseline characteristics, odds ratio (OR) and area under the receiver operating characteristic curve (AUROC) of secondary outcomes were assessed. Results: Among 1,689 subjects with suspected infection, criteria for qSOFA ≥2 and SIRS ≥2 were met in 22% (372) and 90% (1,519), and in-hospital mortality rate 12.9% and 5.5%, respectively. After adjusting for SIRS ≥2 and qSOFA ≥2, the OR of qSOFA ≥2 vs. SIRS ≥2 for death was 4.6 (95% CI: 2.9–7.1, P=0.001) vs. 1.7 (95% CI: 0.6–4.9, P=0.29), and hospital mortality or intensive care unit (ICU) length of stay (LOS) ≥3 days, 5.3 (95% CI: 4.0–7.0, P=0.001) vs. 1.8 (95% CI: 1.1–3.2, P=0.02). Performance characteristics of qSOFA ≥2 plus SIRS ≥2 did not differ from qSOFA ≥2 alone for death [AUROC 0.67 (0.61–0.73) vs. 0.66 (0.60–0.73), P=0.55]. Sensitivity and specificity for death, was 55% and 80% for qSOFA ≥2 compared to 88% and 19% for SIRS ≥2. Conclusions: In this multicenter ED cohort, qSOFA ≥2 had about a four-fold enhanced performance compared to SIRS ≥2 in predicting hospital mortality and other outcomes. However, qSOFA ≥2 lacks sensitivity compared to SIRS ≥2. Neither tool appears sufficient for independent use in the prognostication of the ED patient with suspected infection.