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Non-utility of sepsis scores for identifying infection in surgical intensive care unit patients

Elizabeth D Krebs1, Taryn E Hassinger1, Christopher A Guidry2

  • 1Department of Surgery, The University of Virginia Health System, Charlottesville, VA, USA.

American Journal of Surgery
|December 17, 2018
PubMed
Abstract

Insights

In surgical patients, Sequential Organ Failure Assessment (SOFA) and quick SOFA (qSOFA) scores did not correlate with new infections. These sepsis indicators may be less useful in populations with high existing inflammation.

Area of Science:

  • Critical Care Medicine
  • Surgical Infections
  • Sepsis Biomarkers

Background:

  • The Sequential Organ Failure Assessment (SOFA) and quick SOFA (qSOFA) scores are widely used for sepsis definition and management.
  • Their utility in identifying new infections within surgical populations remains under-investigated.
  • The Systemic Inflammatory Response System (SIRS) criteria are being replaced by SOFA and qSOFA.

Purpose of the Study:

  • To evaluate the correlation between SOFA, qSOFA, and SIRS scores and the incidence of new infections in critically ill surgical patients.
  • To determine if these commonly used scores can effectively identify new infections in this specific patient cohort.

Main Methods:

  • A prospective study was conducted in a surgical/trauma intensive care unit (ICU).
  • Daily SOFA, qSOFA, and SIRS scores were collected for 1942 patient-days.
  • Multivariable analysis controlled for ICU type and pre-existing infection to assess the relationship between scores and new infections.

Main Results:

  • A total of 120 new infections were identified among 1942 patient-days.
  • Scores were globally elevated across the patient population, with high percentages meeting SOFA (≥2), qSOFA (≥2), and SIRS (≥2) criteria.
  • Neither univariate nor multivariate analyses demonstrated a significant correlation between SOFA, qSOFA, or SIRS scores and the occurrence of new infections.

Conclusions:

  • Daily SOFA, qSOFA, and SIRS scores did not correlate with new infections in critically ill surgical patients.
  • The high prevalence of existing inflammation in this population may contribute to elevated scores, potentially masking new infectious processes.
  • These findings suggest limitations in using SOFA, qSOFA, and SIRS for early infection detection in surgical ICU settings.
Keywords:
SOFA infectionSepsis ICU surgery

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