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Evaluation of qSOFA as a Predictor of Mortality Among ICU Patients With Positive Clinical Cultures-A Retrospective
Barry Kelly1, Johann Patlak1, Shahzad Shaefi1
1The Department of Anesthesia, Critical Care and Pain Medicine at 1859Beth Israel Deaconess Medical Center, Boston, MA, USA.
Objective:
To compare the discriminative value of the quick-sequential organ failure assessment score (qSOFA) to SOFA in a critically ill population, in which a microbial pathogen was isolated within 48 hours of admission to intensive care.
Design:
Retrospective cohort study.
Setting:
Academic tertiary referral center from July 2008 to June 2017.
Patients:
Hospitalized patients admitted to intensive care unit.
Interventions:
None.
Measurements And Main Results:
The primary outcome was in-hospital mortality for all patients with confirmed positive microbiological cultures within 48 hours of admission to intensive care unit (ICU). Subgroup analysis was performed on patients with pathogenic bacteremia or positive cultures in cerebrospinal fluid. Of the 11 415 patients analyzed with positive microbiology specimens within 48 hours of admission, 2933 (25.7%) had a qSOFA ≥2. Of these, 16.6% reached the primary outcome of in-hospital mortality. Unsurprisingly, the discriminative value of qSOFA on admission was significantly worse than that of SOFA (0.73 vs 0.76; P = .0004), despite observing a significant association between qSOFA category and in-hospital mortality (P < .0001). In secondary analyses, similar observations were found using qSOFA within 6 and 24 hours of ICU admission. When analysis was focused on patients with pathogenic bacteremia or positive cerebrospinal fluid (CSF) cultures (n = 1646), there was no significant difference between the discriminative value of qSOFA and SOFA (0.75 vs 0.78; P = .17).
Conclusions:
Quick-sequential organ failure assessment score at admission was not superior to SOFA in predicting in-hospital mortality in patients with positive clinical cultures within 48 hours of admission to ICU. Quick-sequential organ failure assessment score at admission to the ICU was associated with mortality and showed reasonable calibration and discrimination. When the analysis was focused on patients with pathogenic bacteremia or positive CSF cultures, qSOFA performed similarly to SOFA in discriminatory those who will die from sepsis.
Insights
The quick-sequential organ failure assessment score (qSOFA) is not superior to the SOFA score for predicting mortality in critically ill patients with infections. However, qSOFA showed similar performance to SOFA in patients with bloodstream infections or meningitis.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Clinical Scoring Systems
Background:
- The quick-sequential organ failure assessment (qSOFA) score is a tool used to assess the risk of death in patients with suspected infection.
- The standard sequential organ failure assessment (SOFA) score is more comprehensive but requires laboratory data.
- Comparing the discriminative value of qSOFA and SOFA in critically ill patients with confirmed infections is crucial for clinical practice.
Purpose of the Study:
- To compare the discriminative ability of the qSOFA score versus the SOFA score in predicting in-hospital mortality.
- To evaluate the performance of qSOFA in a specific subgroup of patients with pathogenic bacteremia or positive cerebrospinal fluid cultures.
Main Methods:
- Retrospective cohort study conducted at an academic tertiary referral center.
- Inclusion of hospitalized patients admitted to the intensive care unit (ICU) with a microbial pathogen isolated within 48 hours of admission.
- Analysis of in-hospital mortality as the primary outcome, with subgroup analyses for specific infection types.
Main Results:
- The qSOFA score (≥2) was present in 25.7% of the 11,415 analyzed patients with positive microbiology within 48 hours of ICU admission.
- In-hospital mortality was 16.6% for patients with qSOFA ≥2.
- The discriminative value of qSOFA was significantly worse than SOFA overall (0.73 vs 0.76; P = .0004), but similar in patients with pathogenic bacteremia or positive CSF cultures (0.75 vs 0.78; P = .17).
Conclusions:
- The qSOFA score is not superior to the SOFA score in predicting in-hospital mortality in critically ill patients with positive clinical cultures within 48 hours of ICU admission.
- qSOFA demonstrated reasonable calibration and discrimination for mortality in this population.
- In patients with pathogenic bacteremia or positive CSF cultures, qSOFA performed similarly to SOFA in discriminating mortality risk.
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