qSOFA is a poor predictor of short-term mortality in all patients: A systematic review of 410,000 patients
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AbstractBackground: To determine the validity of the Quick Sepsis-Related Organ Failure Assessment (qSOFA) in the prediction of outcome (in-hospital and 1-month mortality, intensive care unit (ICU) admission, and hospital and ICU length of stay) in adult patients with or without suspected infections where qSOFA was calculated and reported;
Methods: Cochrane Central of Controlled trials, EMBASE, BIOSIS, OVID MEDLINE, OVID Nursing Database, and the Joanna Briggs Institute EBP Database were the main databases searched. All studies published until 12 April 2018 were considered except case series, reports, and conference abstracts. Studies that included patients with neutropenic fever exclusively were excluded. Risk of bias were assessed using an adapted version of the Quality In Prognosis Studies instrument. Six potential bias domains were explored and were graded as “high risk”, “low risk”, or “unclear”.
Results: 45 papers were included in the final analysis (27 were retrospective cohorts, 13 had data prospectively collected but retrospectively analyzed, and 5 were prospective cohorts). The studies recruited a total of 413,634 patients from Europe, North America, Asia and Australasia with median age ranging from 49 to 80 years.
Median AUROC for in-hospital mortality (27 studies with 380,920 patients) was 0.68 (range 0.55 to 0.82). Meta-analysis of 377,623 subjects showed polled AUROC of 0.68 (0.65 to 0.71), however it also confirmed high heterogeneity among studies (I²=98.8%, 95%CI 98.6 to 99.0). Median sensitivity and specificity for in-hospital mortality (24 studies with 118,051 patients) was 0.52 (range 0.16 to 0.98) and 0.81 (0.19 to 0.97), respectively. Median positive and negative predictive values were 0.2 (range 0.07 to 0.38) and 0.94 (0.85 to 0.99), respectively.
Conclusion: qSOFA is not a clinically useful prognostic tool for in-hospital, 1-month mortality or ICU admission for patients with or without suspected infection.
All Author(s) ListRonson S. L. LO, Ling Yan LEUNG, Mikkel BRABRAND, Chun Yu YEUNG, Suet Yi CHAN, Cherry C.Y. LAM, Kevin K. C. HUNG, Colin A. GRAHAM
Name of ConferenceThe First Cochrane Hong Kong Symposium
Start Date of Conference23/05/2019
End Date of Conference24/05/2019
Place of ConferenceHong Kong
Country/Region of ConferenceHong Kong
Proceedings TitleThe First Cochrane Hong Kong Symposium
Year2019
Month5
Pages28 - 28
LanguagesEnglish-United Kingdom

Last updated on 2019-10-12 at 16:41