Contributions of individual qSOFA elements to assessment of severity and for prediction of mortality

Ann Med. 2024 Dec;56(1):2397090. doi: 10.1080/07853890.2024.2397090. Epub 2024 Sep 2.

Abstract

Background: The quick sequential [sepsis-related] organ failure assessment (qSOFA) acts as a prompt to consider possible sepsis. The contributions of individual qSOFA elements to assessment of severity and for prediction of mortality remain unknown.

Methods: A total of 3974 patients with community-acquired pneumonia were recruited to an observational prospective cohort study. The area under the receiver operating characteristic curve (AUROC), odds ratio, relative risk and Youden's index were employed to assess discrimination.

Results: Respiratory rate ≥22/min demonstrated the most superior diagnostic value, indicated by largest odds ratio, relative risk and AUROC, and maximum Youden's index for mortality. However, the indices for altered mentation and systolic blood pressure (SBP) ≤100 mm Hg decreased notably in turn. The predictive validities of respiratory rate ≥22/min, altered mentation and SBP ≤100 mm Hg were good, adequate and poor for mortality, indicated by AUROC (0.837, 0.734 and 0.671, respectively). Respiratory rate ≥22/min showed the strongest associations with SOFA scores, pneumonia severity index, hospital length of stay and costs. However, SBP ≤100 mm Hg was most weakly correlated with the indices.

Conclusions: Respiratory rate ≥22/min made the greatest contribution to parsimonious qSOFA to assess severity and predict mortality. However, the contributions of altered mentation and SBP ≤100 mm Hg decreased strikingly in turn. It is the first known prospective evidence of the contributions of individual qSOFA elements to assessment of severity and for prediction of mortality, which might have implications for more accurate clinical triage decisions.

Keywords: community-acquired pneumonia; contribution; mortality; qSOFA; sepsis; severity; triage.

Plain language summary

Respiratory rate ≥22/min demonstrated the most superior diagnostic value.Respiratory rate ≥22/min showed the strongest association with severity.Respiratory rate ≥22/min, altered mentation and SBP ≤100 mm Hg predicted mortality well, adequately and poorly, respectively.

Publication types

  • Observational Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Blood Pressure
  • Community-Acquired Infections / diagnosis
  • Community-Acquired Infections / mortality
  • Female
  • Humans
  • Male
  • Middle Aged
  • Organ Dysfunction Scores*
  • Pneumonia / diagnosis
  • Pneumonia / mortality
  • Predictive Value of Tests
  • Prognosis
  • Prospective Studies
  • ROC Curve*
  • Respiratory Rate
  • Sepsis / diagnosis
  • Sepsis / mortality
  • Severity of Illness Index

Grants and funding

This work was supported by the Medical Science and Technology Foundation of Guangdong Province [Grant No. A2010553], the Planned Science and Technology Project of Shenzhen Municipality [Grant No. 201102078], and the Non-Profit Scientific Research Project of Futian District [Grant No. FTWS201120]. The funding sources had no role in the design and conduct of these studies; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.