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Original Investigation
Caring for the Critically Ill Patient
January 17, 2017

Prognostic Accuracy of Sepsis-3 Criteria for In-Hospital Mortality Among Patients With Suspected Infection Presenting to the Emergency Department

Author Affiliations
  • 1Sorbonne Universités, UPMC Paris Univ-06, Paris, France
  • 2Emergency Department, Hôpital Pitie-Salpêtrière, Assistance Publique–Hôpitaux de Paris (APHP), Paris, France
  • 3Plateforme de recherche clinique de l'est parisien (URCEST-CRCEST), Hôpital St Antoine, APHP, Paris, France
  • 4Emergency Department, Cliniques Universitaires St Luc, Bruxelles, Belgium
  • 5Emergency Department, Princess Grace Hospital, Monte-Carlo, Monaco
  • 6Emergency Department, Centre hospitalo-universitaire, Dijon, France
  • 7Emergency Department, Hôpital Pasteur, Nice, France
  • 8Emergency Department, Hôpital Européen Georges Pompidou, Paris, France
  • 9Emergency Department, Hôpital Lariboisière, APHP, Paris, France
  • 10Emergency Department, Hospital Clinic, Barcelona, Spain
  • 11Emergency Department, Centre hospitalo-universitaire, Angers, France
  • 12Emergency Department, Hôpital Tenon, APHP, Paris, France
  • 13Emergency Department, Centre hospitalo-universitaire, Nîmes, France
  • 14Emergency Department, CHUV, Lausanne, Switzerland
  • 15Emergency Department, Barts Health NHS trust, London, United Kingdom
  • 16Emergency Department, Hôpital Ambroise-Paré, Boulogne, France, and Paris Diderot University, INSERM UMRS 1144, Paris, France
JAMA. 2017;317(3):301-308. doi:10.1001/jama.2016.20329
Key Points

Question  Does the quick Sequential Organ Failure Assessment (qSOFA) score more accurately predict in-hospital mortality than the systemic inflammatory response syndrome (SIRS) or severe sepsis criteria among emergency department patients with suspected infection?

Findings  In this multicenter prospective cohort study involving 879 patients with suspected infection treated at the emergency department, the qSOFA was better at predicting in-hospital mortality with an area under the receiver operating curve (AUROC) of 0.80 than were SIRS (AUROC, 0.65) and severe sepsis (AUROC, 0.65).

Meaning  Among patients presenting to the emergency department setting with suspected infection, the use of qSOFA resulted in greater prognostic accuracy for in-hospital mortality than either SIRS or severe sepsis.

Abstract

Importance  An international task force recently redefined the concept of sepsis. This task force recommended the use of the quick Sequential Organ Failure Assessment (qSOFA) score instead of systemic inflammatory response syndrome (SIRS) criteria to identify patients at high risk of mortality. However, these new criteria have not been prospectively validated in some settings, and their added value in the emergency department remains unknown.

Objective  To prospectively validate qSOFA as a mortality predictor and compare the performances of the new sepsis criteria to the previous ones.

Design, Settings, and Participants  International prospective cohort study, conducted in France, Spain, Belgium, and Switzerland between May and June 2016. In the 30 participating emergency departments, for a 4-week period, consecutive patients who visited the emergency departments with suspected infection were included. All variables from previous and new definitions of sepsis were collected. Patients were followed up until hospital discharge or death.

Exposures  Measurement of qSOFA, SOFA, and SIRS.

Main Outcomes and Measures  In-hospital mortality.

Results  Of 1088 patients screened, 879 were included in the analysis. Median age was 67 years (interquartile range, 47-81 years), 414 (47%) were women, and 379 (43%) had respiratory tract infection. Overall in-hospital mortality was 8%: 3% for patients with a qSOFA score lower than 2 vs 24% for those with qSOFA score of 2 or higher (absolute difference, 21%; 95% CI, 15%-26%). The qSOFA performed better than both SIRS and severe sepsis in predicting in-hospital mortality, with an area under the receiver operating curve (AUROC) of 0.80 (95% CI, 0.74-0.85) vs 0.65 (95% CI, 0.59-0.70) for both SIRS and severe sepsis (P < .001; incremental AUROC, 0.15; 95% CI, 0.09-0.22). The hazard ratio of qSOFA score for death was 6.2 (95% CI, 3.8-10.3) vs 3.5 (95% CI, 2.2-5.5) for severe sepsis.

Conclusions and Relevance  Among patients presenting to the emergency department with suspected infection, the use of qSOFA resulted in greater prognostic accuracy for in-hospital mortality than did either SIRS or severe sepsis. These findings provide support for the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) criteria in the emergency department setting.

Trial Registration  clinicaltrials.gov Identifier: NCT02738164

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