The prognostic performance of qSOFA for community-acquired pneumonia

Quick Sepsis-related Organ Failure Assessment (qSOFA) is a new screening system for sepsis. The prognostic performance of qSOFA for patients with suspected infections outside the intensive care unit (ICU) is similar to that of full SOFA; however, its performance for community-acquired pneumonia (CAP) has not yet been evaluated in detail.The objectives of the present study were to compare the prognostic performance of qSOFA with existing pneumonia severity scores, such as CURB-65 (confusion, blood urea nitrogen > 19 mg/dL, respiratory rate ≥ 30/min, systolic blood pressure < 90 mmHg, or diastolic blood pressure ≤ 60 mmHg, age ≥ 65 years) and the pneumonia severity index (PSI), and examine its usefulness for predicting mortality and ICU admission in patients with CAP of high severity and mortality that requires hospitalization.

We performed a secondary analysis of data from a prospective observational study of adult patients who were admitted to our hospital between October 2010 and June 2016. We compared the prognostic performance of qSOFA, CURB-65, and PSI for predicting in-hospital mortality and ICU admission using the C statistics.

The median age of the 1045 enrolled patients was 77 (68-83) years, and 71.4% were males. The in-hospital mortality and ICU admission rates of the entire cohort were 6.1 and 7.9%, respectively. All scores were significantly higher in non-survivors and ICU admission patients than in survivors and non-ICU admission patients (p < 0.001). The C statistics of qSOFA for predicting in-hospital mortality was 0.69 (95% CI 0.63-0.75), and no significant differences were observed between CURB-65 (C statistics, 0.75; 95% CI 0.69-0.81) and PSI (C statistics, 0.74; 95% CI 0.69-0.80). The C statistics of qSOFA for predicting ICU admission was 0.76 (95% CI 0.71-0.80), and no significant differences were noted between CURB-65 (C statistics, 0.73; 95% CI 0.67-0.79) and PSI (C statistics, 0.72; 95% CI 0.66-0.78).

Regarding hospitalized CAP, the prognostic performance of qSOFA for in-hospital mortality and ICU admission was not significantly different from those of CURB-65 and PSI. qSOFA only requires a few items and vital signs, and, thus, may be particularly useful for emergency department or non-respiratory specialists.