BACKGROUND: Several studies were published to validate quick-SOFA (qSOFA), namely in comparison with Systemic Inflammatory Response Syndrome (SIRS) criteria. We performed a systematic review and a meta-analysis with the aim of comparing qSOFA and SIRS in patients outside the ICU.
METHOD: We searched the MEDLINE, CINAHL, and Web of Science database, from February 23rd, 2016 until June 30th, 2017, to identify full-text English language studies published after the Sepsis-3 publication that compared qSOFA and SIRS as well as sensitivity or specificity to diagnose sepsis, the hospital and ICU length of stay (LOS) and hospital mortality. Data extraction from the selected studies followed the recommendations of the MOOSE group and the PRISMA statement.
RESULTS: From 4,022 citations, ten studies met the inclusion criteria. Pooling all the studies, a total of 229,480 patients were evaluated. The meta-analysis of sensitivity for the diagnosis of sepsis comparing qSOFA and SIRS was in favor of SIRS (1.32 [0.40-2.24], p<0.0001, I2=100%). One study described the specificity for the diagnosis of infection comparing SIRS (84.4% [76.2-90.6]) to qSOFA (97.3% [92.1-99.4]) and demonstrated a better specificity of qSOFA. The meta-analysis of AUROC of six studies comparing qSOFA and SIRS was in favor of qSOFA (0.03 [0.01-0.05], p=0.002, I2=48%) as a predictor of in-hospital mortality.
CONCLUSION: The SIRS was significantly superior than qSOFA for sepsis diagnosis and qSOFA was slightly better than SIRS in predicting hospital mortality. The association of both criteria could provide a better model to initiate or escalate therapy in sepsis patients.
SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42017067645.
- SIRS criteria
- prediction of mortality
- sepsis diagnosis