qSOFA and Body Temperature: A Simple Strategy for Evaluate Cirrhotic Patients with Sepsis in Emergency Unit?

Abstract

Background: Cirrhotic patients have a high risk of developing sepsis: an early diagnosis is essential for their management. The quick Sequential Organ Failure Assessment (qSOFA) is an accepted tool to identify patients with suspected infection at risk of negative evolu-tion.This study aims to evaluate whether qSOFA can predict the risk of intra-hospital mortality in cirrhotic patients with suspected infection presenting in the Emergency Department; moreover this study aims to evaluated if a new score, T-qSOFA (that altered if qSOFA was ≥ 2 or body temperature >38°C), increases the accuracy of qSOFA. Methods: qSOFA and T-qSOFA were calculated in 108 cirrhotic pa- tients with suspected infection enrolled during 24 months. Results: qSOFA was ≥ 2 in 9 patients whereas T-qSOFA was al tered in 27.20 patients died (4 with qSOFA ≥2 and 7 with tempera ture >38°C). qSOFA had a high specificity to identifying patients with better prognosis but its sensitivity is low. “T-qSOFA” increases sensitivity and positive predictive value and became an independent predictor of mortality in the multivariate analysis. Conclusion: qSOFA has good prognostic accuracy in patients with cirrhosis and suspected infection; T-qSOFA is an excellent, reproducible and quickly obtainable instrument to discriminate the risk of adverse prognosis in cirrhosis.