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Original Research |

SIRS, qSOFA and organ dysfunction: insights from a prospective database of emergency department patients with infection

Julian M. Williams, MBBS; Jaimi H. Greenslade, PhD; Juliet V. McKenzie, MBBS; Kevin Chu, MS; Anthony FT. Brown, MBChB; Jeffrey Lipman, MD (research)
Author and Funding Information

Conflict of Interest: Prof. Lipman served as a board member for Bayer ESICM Advisory Board; consulted for and received grant support from AstraZeneca; and lectured for AstraZeneca and Bayer. Anthony Brown served as a consultant to Boehringer Ingelheim and Bayer. All other authors declare no conflict of interest.

Funding was obtained from the Queensland Emergency Medicine Research Foundation.

1Department of Emergency Medicine, Royal Brisbane and Women’s Hospital

2School of Medicine, University of Queensland

Corresponding author: Julian Williams, Department of Emergency Medicine, Royal Brisbane and Women’s Hospital, Herston 4029 Queensland, Australia.


Copyright 2016, . All Rights Reserved.


Chest. 2016. doi:10.1016/j.chest.2016.10.057
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Abstract

Objective  A proposed revision of sepsis definitions has abandoned SIRS, defined organ dysfunction as an increase in total SOFA score of ≥2, and conceived “qSOFA” as a bedside indicator of organ dysfunction. We aimed to (1) determine the prognostic impact of SIRS, (2) compare diagnostic accuracy of SIRS and qSOFA for organ dysfunction, and (3) compare standard (Sepsis-2) and revised (Sepsis-3) definitions for organ dysfunction in emergency department patients with infection.

Methods  Consecutive ED patients admitted with presumed infection were prospectively enrolled over three years. Observational data were collected sufficient to calculate SIRS, qSOFA, SOFA, comorbidity and mortality.

Results  8871 patients were enrolled, 4176 (47.1%) with SIRS. SIRS was associated with increased risk of organ dysfunction (RR 3.5), and mortality in patients without organ dysfunction (OR 3.2). SIRS and qSOFA showed similar discrimination for organ dysfunction (AUROC 0.72 vs 0.73). qSOFA was specific but poorly sensitive for organ dysfunction (96.1%, 29.7% respectively). Mortality for patients with organ dysfunction was similar for Sepsis-2 and Sepsis-3 (12.5%, 11.4%) although 29% of patients with Sepsis-3 organ dysfunction did not meet Sepsis-2 criteria. Increasing number of Sepsis-2 organ dysfunctions was associated with greater mortality.

Conclusions  SIRS was associated with organ dysfunction and mortality, and abandoning the concept appears premature. Although qSOFA≥2 showed high specificity, poor sensitivity may limit utility as a bedside screen. Although mortality for organ dysfunction was comparable between Sepsis-2 and Sepsis-3, more prognostic and clinical information is conveyed using Sepsis-2 regarding number of organ dysfunctions. ​The SOFA score may require recalibration.


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