Prognostic Accuracy of the Quick Sequential Organ Failure Assessment for Mortality in Patients With Suspected Infection: A Systematic Review and Meta-analysis,Annals of Internal Medicine

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Prognostic Accuracy of the Quick Sequential Organ Failure Assessment for Mortality in Patients With Suspected Infection: A Systematic Review and Meta-analysis
Annals of Internal Medicine ( IF 19.6 ) Pub Date : 2018-02-06 , DOI: 10.7326/m17-2820
Shannon M. Fernando ₁ , Alexandre Tran ₁ , Monica Taljaard ₂ , Wei Cheng ₃ , Bram Rochwerg ₄ , Andrew J.E. Seely ₂ , Jeffrey J. Perry ₂

Affiliation

Background:

The quick Sequential Organ Failure Assessment (qSOFA) has been proposed for prediction of mortality in patients with suspected infection.

Purpose:

To summarize and compare the prognostic accuracy of qSOFA and the systemic inflammatory response syndrome (SIRS) criteria for prediction of mortality in adult patients with suspected infection.

Data Sources:

Four databases from inception through November 2017.

Study Selection:

English-language studies using qSOFA for prediction of mortality (in-hospital, 28-day, or 30-day) in adult patients with suspected infection in the intensive care unit (ICU), emergency department (ED), or hospital wards.

Data Extraction:

Two investigators independently extracted data and assessed study quality using standard criteria.

Data Synthesis:

Thirty-eight studies were included (n = 385 333). qSOFA was associated with a pooled sensitivity of 60.8% (95% CI, 51.4% to 69.4%) and a pooled specificity of 72.0% (CI, 63.4% to 79.2%) for mortality. The SIRS criteria were associated with a pooled sensitivity of 88.1% (CI, 82.3% to 92.1%) and a pooled specificity of 25.8% (CI, 17.1% to 36.9%). The pooled sensitivity of qSOFA was higher in the ICU population (87.2% [CI, 75.8% to 93.7%]) than the non-ICU population (51.2% [CI, 43.6% to 58.7%]). The pooled specificity of qSOFA was higher in the non-ICU population (79.6% [CI, 73.3% to 84.7%]) than the ICU population (33.3% [CI, 23.8% to 44.4%]).

Limitation:

Potential risk of bias in included studies due to qSOFA interpretation and patient selection.

Conclusion:

qSOFA had poor sensitivity and moderate specificity for short-term mortality. The SIRS criteria had sensitivity superior to that of qSOFA, supporting their use for screening of patients and as a prompt for treatment initiation.

Primary Funding Source:

Canadian Association of Emergency Physicians. (PROSPERO: CRD42017075964)

中文翻译：

疑似感染患者死亡率的快速顺序器官衰竭评估的预后准确性：系统评价和荟萃分析

背景：

已经提出了快速顺序器官衰竭评估（qSOFA）来预测可疑感染患者的死亡率。

目的：

总结和比较qSOFA和系统性炎症反应综合征（SIRS）的标准对预测可疑感染成人患者的死亡率的预后准确性。

数据源：

从成立到2017年11月的四个数据库。

研究选择：

使用qSOFA进行英语研究，以预测重症监护病房（ICU），急诊科（ED）或医院病房中疑似感染的成年患者的死亡率（住院，28天或30天）。

数据提取：

两名研究者独立提取数据并使用标准标准评估研究质量。

数据综合：

包括38项研究（n = 385 333）。qSOFA与死亡率的合并敏感性为60.8％（95％CI，51.4％至69.4％）和合并特异性为72.0％（CI，63.4％至79.2％）。SIRS标准的综合敏感性为88.1％（CI，82.3％至92.1％）和特异性为25.8％（CI，17.1％至36.9％）。ICU人群（87.2％[CI，75.8％至93.7％]）的qSOFA合并敏感性高于非ICU人群（51.2％[CI，43.6％至58.7％]）。非ICU人群（79.6％[CI，73.3％至84.7％]）中qSOFA的合并特异性高于ICU人群（33.3％[CI，23.8％至44.4％]）。

局限性：

由于qSOFA的解释和患者选择，所纳入研究存在潜在的偏倚风险。

结论：

qSOFA对短期死亡率的敏感性较低，特异性中等。SIRS标准的敏感性优于qSOFA，支持将其用于筛查患者并提示开始治疗。

主要资金来源：

加拿大急诊医师协会。（PROSPERO：CRD42017075964）

更新日期：2018-02-06

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