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

Despite the numerous studies critiquing the Quick Sequential Organ Failure Assessment (qSOFA) score for sepsis prognosis in the emergency department (ED), there are limited known risk factors that can be missed by qSOFA.

This is a multicenter retrospective cohort study using ED data from Dr Sulaiman AL-Habib Medical Group Hospitals in Riyadh, Saudi Arabia. We assessed all suspected septic patients who came through the EDs from 1st May 2022 to 30th April 2023 with the qSOFA < 2. Among these patients, we identify those who develop critical outcomes (the requirement for vasopressors/inotropes or mortality) within 72 hours of triage. Additionally, we analyzed the potential risk factors of critical outcomes using a multivariable logistic regression model.

We identified 1011 patients who presented with suspected sepsis and qSOFA < 2. Among them, 70 patients developed critical outcomes within 72 hours. In the multivariable logistic regression model, the potential risk factors for critical outcomes were age ≥65 years (adjusted OR, 3.87 [1.25, 14.9]), lactate ≥ 2.5 mmol/L with adjusted OR 2.04 [1.16, 3.54], and shock index >1 with adjusted OR 3.27 [1.13, 10.3]. There are no specific comorbidities that were independently associated with the critical outcomes.

The study identified potential risk factors for sepsis outcomes that qSOFA overlooks. Integration of risk factors (lactate, shock index, age) with qSOFA could enhance early sepsis recognition and improve patient outcomes. We recommend further studies to validate these risk factors.