Related Experiment Video
Updated: Sep 3, 2025
A Data-Driven Approach to Quantifying Immune States in Sepsis
Published on: February 7, 2025
Prognostic accuracy of SOFA and qSOFA for mortality among children with infection: a meta-analysis
Zhili Wang1, Yu He1, Xiaolong Zhang2
1Department of Respiratory Medicine Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, 400014, China.
Insights
The age-adjusted Sequential Organ Failure Assessment (SOFA) score effectively predicts mortality in children with sepsis. The age-adjusted quick SOFA (qSOFA) score showed low sensitivity, limiting its utility for predicting adverse outcomes in pediatric sepsis.
Area of Science:
- Pediatric critical care medicine
- Infectious disease diagnostics
- Clinical outcome prediction
Background:
- The Systemic Inflammatory Response Syndrome (SIRS) criteria are used to identify sepsis in children.
- Age-adjusted Sequential Organ Failure Assessment (SOFA) and age-adjusted quick SOFA (qSOFA) scores have been developed as potential predictors of poor outcomes in pediatric infection.
- This study aimed to compare the prognostic performance of age-adjusted SOFA and age-adjusted qSOFA scores against SIRS criteria for predicting mortality in children with infection.
Approach:
- A systematic review and meta-analysis of 14 studies involving 70,194 participants was conducted.
- Bivariate random-effects regression models were used to synthesize diagnostic test data.
- The sensitivity, specificity, and area under the summary receiver operating characteristic curve (AUSROC) were calculated for each scoring system.
Key Points:
- The pooled sensitivity for age-adjusted SOFA, age-adjusted qSOFA, and SIRS were 0.82, 0.46, and 0.79, respectively.
- The pooled specificity for age-adjusted SOFA, age-adjusted qSOFA, and SIRS were 0.62, 0.90, and 0.39, respectively.
- The AUSROC values were 0.82 for age-adjusted SOFA, 0.66 for age-adjusted qSOFA, and 0.64 for SIRS, indicating superior predictive performance for age-adjusted SOFA.
Conclusions:
- The age-adjusted SOFA score is a valuable tool for predicting mortality in children with sepsis or suspected sepsis.
- The low sensitivity of the age-adjusted qSOFA score limits its usefulness as a simple predictive tool for adverse outcomes in this population.
- Further development of enhanced or modified bedside tools with higher sensitivity may be necessary for improved pediatric sepsis prediction.
Background:
Age-adjusted Sequential Organ Failure Assessment (SOFA) and age-adjusted quick SOFA (qSOFA) scores have been developed to predict poor outcomes in children with infection. We investigated the prognostic performance of age-adjusted SOFA and age-adjusted qSOFA scores and compared them with the systemic inflammatory response syndrome (SIRS) criteria for predicting mortality in children with infection.
Methods:
A bivariate random-effects regression model was used for synthesis of diagnostic test data.
Results:
A total of 14 studies invoing 70,194 participants were included. The pooled sensitivity for age-adjusted SOFA, age-adjusted qSOFA, and SIRS were 0.82 (95% CI, 0.74-0.88), 0.46 (95% CI, 0.22-0.71), and 0.79 (95% CI, 0.66-0.88), respectively. The pooled specificity for age-adjusted SOFA, age-adjusted qSOFA, and SIRS were 0.62 (95% CI, 0.45-0.77), 0.90 (95% CI, 0.66-0.98), and 0.39 (95% CI, 0.26-0.54), respectively. The area under the summary receiver operating characteristic curve (AUSROC) for age-adjusted SOFA, age-adjusted qSOFA, and SIRS were 0.82 (95% CI, 0.79-0.85), 0.66 (95% CI, 0.62-0.70), and 0.64 (95% CI, 0.60-0.68), respectively. Different baseline populations, different SOFA adaptation methods and different cut-offs used for age-adjusted SOFA may be potential sources of heterogeneity.
Conclusions:
Age adjusted SOFA score is a useful tool for predicting mortality in children with sepsis/suspected sepsis.
Impact:
First study to investigate the prognostic performance of age-adjusted sequential organ failure assessment (SOFA) and age adjusted quick SOFA (qSOFA) scores in comparison to the systemic inflammatory response criteria (SIRS) for the prediction of mortality in children with sepsis. The age-adjusted SOFA score predicts poor outcomes with high sensitivity in children with sepsis Low sensitivity limits the utility of age-adjusted qSOFA as a simple predictive tool for adverse outcomes. Developing another enhanced or modified bedside tool with higher sensitivity may be necessary.
Related Concept Videos
01:30Pneumonia III: Complications and Assessment
01:26Factors Affecting the Risk of Infection
The integrity and count of the white blood cells help the body resist pathogens and fight infection. When impaired, it reduces the body's resistance to pathogens. The acidic pH levels of the gastrointestinal, genitourinary tracts, and skin...