Which rating system is better – qSOFA or SIRS?

Abstract

Introduction The definitions of sepsis and septic shock were redefined in 2016. This study compares the performance of qSOFA with that of SIRS criteria for the diagnosis of sepsis and prediction of 30-day mortality. Aim The aim of this article is to assess the severity of the infection of patients using SIRS and qSOFA scales and to compare their specificity and predictive value. Materials and Methods A prospective, non-interventional single-center clinical trial was conducted at St. Marina University Hospital in Varna. The sample included 87 patients with sepsis and septic shock. The criteria for inclusion in the study were laboratory constellation for systemic exposure; over 18 years of age; with or without co-morbidities; no malignancies. Pregnancy, neoplasia and the age of under 18 were the criteria for exclusion. Logistic regression was used to test the predictability of both scales. ROC curve analysis determined the sensitivity and specificity of SIRS and qSOFA. Results Our analysis showed that both SIRS and qSOFA are significant predictors of mortality of septic patients. The SIRS scale had a 2.050-fold probability of predicting the death of the patient (p = 0.004, 95% CI 1.255 - 3.349), whereas the qSOFA score was 2.581 times more likely to predict mortality in patients with sepsis and septic shock (p = 0.0001, 95% CI 1.557 - 4.279). Cut-off values for SIRS higher than 2.5 points showed 91% sensitivity and  60% specificity - (AUC 0.80, 95% CI - 0.712 - 0.907), whereas qSOFA scores greater than 1.5 points indicated sensitivity of 82.2% and  specificity of 70.3% (AUC 0.85, 95% CI 0 0.770 - 0.934). Conclusion SIRS and qSOFA criteria for early detection of sepsis are useful clinical tools for mortality reduction and predictability.