Hidden Risk Factors Overlooked by qSOFA in Emergency Department Sepsis Patients: A Multicenter Retrospective Cohort

Area of Science:

• Emergency Medicine
• Critical Care
• Sepsis Research

Background:

• The Quick Sequential Organ Failure Assessment (qSOFA) score is widely used for sepsis prognosis in emergency departments (EDs).
• Existing research highlights limitations of qSOFA in accurately predicting sepsis outcomes.
• There is a need to identify additional risk factors that qSOFA may overlook.

Purpose of the Study:

• To identify risk factors for critical outcomes in patients with suspected sepsis and a qSOFA score less than 2.
• To evaluate the predictive value of age, lactate levels, and shock index for critical sepsis outcomes.
• To explore potential improvements in early sepsis recognition by integrating additional risk factors with qSOFA.

Main Methods:

• A multicenter retrospective cohort study was conducted using ED data from Saudi Arabia.
• 1011 patients with suspected sepsis and qSOFA < 2 were assessed.
• Multivariable logistic regression analysis was used to identify risk factors for critical outcomes within 72 hours.

Main Results:

• 70 out of 1011 patients developed critical outcomes (vasopressors/inotropes or mortality).
• Independent risk factors for critical outcomes included age ≥65 years (aOR 3.87), lactate ≥ 2.5 mmol/L (aOR 2.04), and shock index >1 (aOR 3.27).
• No specific comorbidities were independently associated with critical outcomes.

Conclusions:

• The study identified age, lactate, and shock index as significant risk factors for critical sepsis outcomes missed by qSOFA.
• Integrating these factors with qSOFA may enhance early sepsis detection and improve patient management.
• Further research is recommended to validate these findings in diverse populations.