SOFA and qSOFA at admission to the emergency department: Diagnostic sensitivity and relation with prognosis in patients with suspected infection

Rodrigo de Freitas Garbero; Analice Alves Simões; Gabriela Alves Martins; Ludmilla Vale da Cruz; Vinícius Gabriel Monteiro von Zuben

doi:10.1016/j.tjem.2019.05.002

Rodrigo de Freitas Garbero, Analice Alves Simões, Gabriela Alves Martins, Ludmilla Vale da Cruz, Vinícius Gabriel Monteiro von Zuben

Faculty of Medicine, Superior School of Health Sciences, Brasília, Federal District, Brazil

Keywords: Organ dysfunction scores, Sepsis, Prognosis, Patient outcome assessment, Critical illness, Emergency service

Abstract

Objective: To evaluate the adequacy of SOFA and qSOFA for predicting unfavorable outcomes, and of qSOFA as a screening tool for sepsis in patients admitted to the emergency department (ED) of a Brazilian public hospital.

Methods: This was a single-center retrospective study conducted on a cohort of patients admitted to a Brazilian public hospital between August 2016 and November 2017 due to suspected infection. Exclusion criteria were: age <18 years, admission to the ED after 24 h of hospitalization, lack of information in the medical records, advanced comorbidities, or request of limited invasive care.

Results: A total of 184 patients were included; 84.24% had a SOFA score of 2 or higher. The relative risk of death, need for intensive care unit (ICU) and mechanical ventilation (MV) related to a positive SOFA on admission were: 5.17 (2.11–12.87), 1.45 (1.09–2.15) and 2.74 (1.63–5.16), respectively; sensitivity was 93.7% for death, 88.5% for ICU need and 93.6% for undergoing MV. The mean length of hospital stay was 38.83 days for patients with a positive SOFA score and 8.95 days for patients with a negative score (p = 0.02). The median SOFA value was higher for the patients who died; 41% of the patients had a positive qSOFA and its sensitivity for a positive SOFA was 46.4%. The relative risk of death, ICU and MV need related to qSOFA at admission were 1.83 (1.39–2.44), 0.98 (0.82–1.16) and 1.60 (1.23–1.97), respectively, and its sensitivity was 56.8% for death, 41.4% for ICU need and 53.6% for MV.

Conclusion: qSOFA did not perform well as a screening tool for sepsis and for predicting a poor prognosis in the ED. SOFA, on the other hand, showed reasonable sensitivity for predicting unfavorable outcomes and scores ≥2 were related to a poor prognosis.