Follow-Up Studies Support New Sepsis-3 Definitions' Prognostic Value

February 9, 2017

Follow-Up Studies Support New Sepsis-3 Definitions' Prognostic Value

  1. Patricia Kritek, MD

SOFA (sequential organ failure assessment) score performed best in the intensive care unit, and quick SOFA performed best in the emergency department.

  1. Patricia Kritek, MD
Sepsis-3 Validation Studies
SOFA: sequential organ failure assessment; qSOFA: quick SOFA; SIRS: systemic inflammatory response syndrome
Sepsis-3 Validation Studies

SOFA: sequential organ failure assessment; qSOFA: quick SOFA; SIRS: systemic inflammatory response syndrome

In 2016, new definitions for sepsis and septic shock (Sepsis-3) were published, including endorsement for using sequential organ failure assessment (SOFA) and quick SOFA (qSOFA) scores to assess prognosis (NEJM JW Gen Med Mar 15 2016 and JAMA 2016; 315:801). In two new studies, investigators examined use of these scores in emergency department (ED) and intensive care unit (ICU) populations (Figure).

In one study, European investigators examined 879 patients who presented to the ED with clinically suspected, potentially serious infections. Overall mortality for the cohort was 8%; however, 24% of patients with qSOFA scores ≥2 died. Compared with ≥2 systemic inflammatory response syndrome elements (SIRS), severe sepsis (SIRS + organ dysfunction), or SOFA score ≥2, qSOFA ≥2 was best at predicting in-hospital death. Results were similar for predicting ICU admission and long ICU stay (≥72 hours). Adding lactate level measurement to qSOFA did not improve its prognostic value.

Investigators from Australia and New Zealand performed similar studies in a population of 185,000 patients admitted to ICUs with infection-related diagnoses. In contrast to qSOFA's superior performance in an ED population (as described above), qSOFA did not perform well in this ICU population. Instead, an increase of ≥2 points in SOFA score within 24 hours of admission to the ICU was the best predictor of in-hospital mortality. The same was true for predicting long ICU stays.

Comment

These two studies support the findings published with the unveiling of Sepsis-3. In the ED, qSOFA works well as an indicator of who is really sick. What we need to know now is whether qSOFA scores help providers intervene earlier and modify outcomes in patients who present with sepsis; studies to examine this question likely will be forthcoming. In the ICU, qSOFA is of limited value: I would argue that, although calculation of a SOFA score might help with prognostication, I'm not convinced its use will change management and improve survival.

Editor Disclosures at Time of Publication

  • Disclosures for Patricia Kritek, MD at time of publication Speaker’s Bureau American College of Chest Physicians (Critical Care Board Review Course)

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